Reproductive health expenditure and quality of service

This paper uses a unique natural experiment to investigate the sensitivity of American college women’s contraceptive choice and sexual behavior to the price of prescription birth control. In 2005, Congress unexpectedly increased the effective price of birth control pills (“the Pill”) at college health centers more than three-fold, from $5 to $10 a month to between $30 to $50 a month. Using two different data sets, we employ multiple empirical strategies—including interrupted time-series, quasi-difference-in-differences, and fixed effects—for identification, and we find consistent results across data sets and methodologies. Our benchmark estimates show that this policy change reduced use of the Pill by at least 1.5 percentage points, or 3 to 4 percent, among all college women. For college women who lacked health insurance or carried large credit card balances, the decline was two to three times as large. We also find modest but significant decreases in frequency of intercourse and the number of sex partners, suggesting that some women may be substituting away from sexual behavior in general. Finally, supplementing our data with a unique survey on how and where birth control prescriptions are filled, we use a back-of-the-envelope calculation to bound the price elasticity of Pill usage between -0.09 and -0.04.

This study measures the incidence and intensity of ‘catastrophic’ and impoverishment effect of maternal health care expenditure of households and its socio-economic correlates in urban and rural areas separately. Using data from 60th round of National Sample Survey, we find that urban household spent almost twice that of rural households on maternal health care. A little more than one third households suffered catastrophic payments in both urban and rural areas. On the other hand, the head count was greater among illiterate women living in urban areas compared to those living in rural areas. After adjusting out-of-pocket maternal health care expenditure, the poverty in urban and rural areas increased by almost equal percentage points. Increasing education level, higher consumption expenditure quintile and, higher caste of women was associated with increasing odds of impoverishment due to maternal health care expenditure. To reduce maternal health care expenditure induced poverty, the demand-side maternal health care financing programs and policies in future should take into consideration all the costs incurred during prenatal, delivery and postnatal periods and focus not only on those women who suffered catastrophic expenditure and plunged into poverty but also those who forgo maternal health care due to their inability to pay.

Since the launch of the reproductive and child health policy regime in 1998-99, there has been a massive rise in government expenditure on family welfare programmes in Bihar and national level. This paper makes a systematic effort to assess the performance of the family welfare programmes vis-à-vis trends in expenditure. The trends in key performance indicators for Bihar reveal that progress has been slow and limited in the post-RCH policy regime. Contraceptive prevalence coverage has accelerated, and the increased in the Child immunization and institutional delivery. Consequently, the pace of reduction in the couple protection rate, total fertility rate and infant mortality rate has slowed. It is evidently clear that in the absence of suitable mechanism to operationalise of RCH programme, the exponential increase in expenditure alone cannot lead to commensurate a positive impact on key performance and outcome indicators. There is need suitable mechanism to operationalise RCH programme.

Objective of the paper was to assess OPE incurred by beneficiaries in accessing maternal health services and the extent to which Janani Suraksha Yojana (JSY) incentives could share the burden of total cost incurred. A community based study was conducted in an Indian State on 424 women, who delivered in last one year. Data was also collected from state government’s record on yearly expenditure under JSY. Study was funded by UNFPA, Bangkok.

The OPE per delivery was USD 28.8 if conducted at home; USD 72.5 at public facility and USD 155.4 at private facility. OPE varied by type of delivery, delivery with or without complications and place of ANC. The cost was USD 44.0 and 149.7 for normal and complicated delivery, respectively.

Direct and indirect expenditure incurred by government per delivery was USD 34.5 and 11.5 respectively. After deducting government expenditure from OPE, new OPE per delivery came out to be USD 9.5 for normal delivery (without complication) and USD 115.2 for complicated delivery. The government shared 55% of the total cost (OPE) per delivery. In case of the normal delivery the share increased to 83% whereas in case of complicated delivery it reduced to 29%.