title: More evidence on the impact of India's conditional cash transfer program, Janani Suraksha Yojana: quasi-experimental evaluation of the effects on childhood immunization and other reproductive and child health outcomes.
abstract: BACKGROUND
  In 2005, India established a conditional cash transfer program called Janani Suraksha Yojana (JSY), to increase institutional delivery and encourage the use of reproductive and child health-related services.
  
  
  OBJECTIVE
  To assess the effect of maternal receipt of financial assistance from JSY on childhood immunizations, post-partum care, breastfeeding practices, and care-seeking behaviors.
  
  
  METHODS
  We use data from the latest district-level household survey (2007-2008) to conduct a propensity score matching analysis with logistic regression. We conduct the analyses at the national level as well as separately across groups of states classified as high-focus and non-high-focus. We carry out several sensitivity analyses including a subgroup analysis stratified by possession of an immunization card.
  
  
  RESULTS
  Receipt of financial assistance from JSY led to an increase in immunization rates ranging from 3.1 (95%CI 2.2-4.0) percentage points for one dose of polio vaccine to 9.1 (95%CI 7.5-10.7) percentage points in the proportion of fully vaccinated children. Our findings also indicate JSY led to increased post-partum check-up rates and healthy early breastfeeding practices around the time of childbirth. No effect of JSY was found on exclusive breastfeeding practices and care-seeking behaviors. Effect sizes were consistently larger in states identified as being a key focus for the program. In an analysis stratified by possession of an immunization card, there was little to no effect of JSY among those with vaccination cards, while the effect size was much larger than the base case results for those missing vaccination cards, across nearly all immunization outcomes.
  
  
  CONCLUSIONS
  Early results suggest the JSY program led to a significant increase in childhood immunization rates and some healthy reproductive health behaviors, but the structuring of financial incentives to pregnant women and health workers warrants further review. Causal interpretation of our results relies on the assumption that propensity scores balance unobservable characteristics.
authors.affiliation: Global Burden of Disease Group and Center for Health Policy, Melbourne School of Population and Global Health, Melbourne, Australia; Center for Health Decision Sciences, Harvard School of Public Health, Boston, Massachusetts, United States of America.
authors.forename: Natalie
authors.initials: N
authors.lastname: Carvalho
authors.affiliation: Deep Children Hospital and Research Centre, Gandhidham, Gujarat, India.
authors.forename: Naveen
authors.initials: N
authors.lastname: Thacker
authors.affiliation: Department of Community Medicine, Mahatma Gandhi Institute of Medical Sciences, Sewagram, Maharashtra, India.
authors.forename: Subodh S
authors.initials: SS
authors.lastname: Gupta
authors.affiliation: Center for Health Decision Sciences, Harvard School of Public Health, Boston, Massachusetts, United States of America; Department of Global Health and Population, Harvard School of Public Health, Boston, Massachusetts, United States of America.
authors.forename: Joshua A
authors.initials: JA
authors.lastname: Salomon
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002669:Child Welfare / Q000191:economics* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007114:Immunization / Q000191:economics* / Q000706:statistics & numerical data; D007194:India; D007223:Infant; D016015:Logistic Models; D008427:Maternal Health Services / Q000191:economics* / Q000706:statistics & numerical data; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D012098:Reproduction; D055815:Young Adult