India's Janani Suraksha Yojana, a conditional cash transfer programme to increase births in health facilities: an impact evaluation.
BACKGROUND
In 2005, with the goal of reducing the numbers of maternal and neonatal deaths, the Government of India launched Janani Suraksha Yojana (JSY), a conditional cash transfer scheme, to incentivise women to give birth in a health facility. We independently assessed the effect of JSY on intervention coverage and health outcomes.


METHODS
We used data from the nationwide district-level household surveys done in 2002-04 and 2007-09 to assess receipt of financial assistance from JSY as a function of socioeconomic and demographic characteristics; and used three analytical approaches (matching, with-versus-without comparison, and differences in differences) to assess the effect of JSY on antenatal care, in-facility births, and perinatal, neonatal, and maternal deaths.


RESULTS
Implementation of JSY in 2007-08 was highly variable by state-from less than 5% to 44% of women giving birth receiving cash payments from JSY. The poorest and least educated women did not always have the highest odds of receiving JSY payments. JSY had a significant effect on increasing antenatal care and in-facility births. In the matching analysis, JSY payment was associated with a reduction of 3.7 (95% CI 2.2-5.2) perinatal deaths per 1000 pregnancies and 2.3 (0.9-3.7) neonatal deaths per 1000 livebirths. In the with-versus-without comparison, the reductions were 4.1 (2.5-5.7) perinatal deaths per 1000 pregnancies and 2.4 (0.7-4.1) neonatal deaths per 1000 livebirths.


CONCLUSIONS
The findings of this assessment are encouraging, but they also emphasise the need for improved targeting of the poorest women and attention to quality of obstetric care in health facilities. Continued independent monitoring and evaluations are important to measure the effect of JSY as financial and political commitment to the programme intensifies.


BACKGROUND
Bill & Melinda Gates Foundation.
Lim
Stephen S
SS
Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA 98121, USA.
Dandona
Lalit
L
Hoisington
Joseph A
JA
James
Spencer L
SL
Hogan
Margaret C
MC
Gakidou
Emmanuela
E
D000293:Adolescent; D000328:Adult; D016550:Birthing Centers / Q000191:economics* / Q000706:statistics & numerical data*; D003906:Developing Countries; D005260:Female; D005380:Financing, Government / Q000191:economics*; D006078:Government Programs; D006297:Health Services Accessibility / Q000191:economics; D006306:Health Surveys; D006771:Hospitals, Maternity / Q000191:economics* / Q000706:statistics & numerical data*; D006801:Humans; D007194:India; D007226:Infant Mortality; D007231:Infant, Newborn; D008428:Maternal Mortality; D008483:Medical Assistance / Q000191:economics*; D015233:Models, Statistical; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011247:Pregnancy; D012044:Regression Analysis; D055815:Young Adult