Effect of Chiranjeevi Yojana on institutional deliveries and neonatal and maternal outcomes in Gujarat, India: a difference-in-differences analysis.
OBJECTIVE
To evaluate the effect of the Chiranjeevi Yojana programme, a public-private partnership to improve maternal and neonatal health in Gujarat, India.


METHODS
A household survey (n = 5597 households) was conducted in Gujarat to collect retrospective data on births within the preceding 5 years. In an observational study using a difference-in-differences design, the relationship between the Chiranjeevi Yojana programme and the probability of delivery in health-care institutions, the probability of obstetric complications and mean household expenditure for deliveries was subsequently examined. In multivariate regressions, individual and household characteristics as well as district and year fixed effects were controlled for. Data from the most recent District Level Household and Facility Survey (DLHS-3) wave conducted in Gujarat (n = 6484 households) were used in parallel analyses.


RESULTS
Between 2005 and 2010, the Chiranjeevi Yojana programme was not associated with a statistically significant change in the probability of institutional delivery (2.42 percentage points; 95% confidence interval, CI: -5.90 to 10.74) or of birth-related complications (6.16 percentage points; 95% CI: -2.63 to 14.95). Estimates using DLHS-3 data were similar. Analyses of household expenditures indicated that mean household expenditure for private-sector deliveries had either not fallen or had fallen very little under the Chiranjeevi Yojana programme.


CONCLUSIONS
The Chiranjeevi Yojana programme appears to have had no significant impact on institutional delivery rates or maternal health outcomes. The absence of estimated reductions in household spending for private-sector deliveries deserves further study.
Sanford School of Public Policy, Duke University, 302 Towerview Drive, Durham NC 27708, United States of America (USA).
Manoj
M
Mohanan
RAND Corporation, Arlington, USA .
Sebastian
S
Bauhoff
The World Bank, Washington, USA .
Gerard
G
La Forgia
Stanford Medical School, Stanford, California, USA .
Kimberly Singer
KS
Babiarz
Sambodhi Research and Communications Pvt Ltd, New Delhi, India .
Kultar
K
Singh
School of Medicine and Freeman Spogli Institute for International Studies, Stanford University, Stanford, California, USA .
Grant
G
Miller
D000293:Adolescent; D000328:Adult; D036861:Delivery, Obstetric / Q000191:economics* / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility / Q000191:economics; D006801:Humans; D007194:India; D008427:Maternal Health Services / Q000191:economics*; D011203:Poverty; D011247:Pregnancy; D011248:Pregnancy Complications; D011256:Pregnancy Outcome / Q000191:economics; D055818:Public-Private Sector Partnerships / Q000191:economics* / Q000706:statistics & numerical data; D012044:Regression Analysis; D012189:Retrospective Studies; D055815:Young Adult