title: Out-of-pocket expenditure on prenatal and natal care post Janani Suraksha Yojana: a case from Rajasthan, India.
abstract: BACKGROUND
  Though Janani Suraksha Yojana (JSY) under National Rural Health Mission (NRHM) is successful in increasing antenatal and natal care services, little is known on the cost coverage of out-of-pocket expenditure (OOPE) on maternal care services post-NRHM period.
  
  
  METHODS
  Using data from a community-based study of 424 recently delivered women in Rajasthan, this paper examined the variation in OOPE in accessing maternal health services and the extent to which JSY incentives covered the burden of cost incurred. Descriptive statistics and logistic regression analyses are used to understand the differential and determinants of OOPE.
  
  
  RESULTS
  The mean OOPE for antenatal care was US$26 at public health centres and US$64 at private health centres. The OOPE (antenatal and natal) per delivery was US$32 if delivery was conducted at home, US$78 at public facility and US$154 at private facility. The OOPE varied by the type of delivery, delivery with complications and place of ANC. The OOPE in public health centre was US$44 and US$145 for normal and complicated delivery, respectively. The share of JSY was 44 % of the total cost per delivery, 77 % in case of normal delivery and 23 % for complicated delivery. Results from the log linear model suggest that economic status, educational level and pregnancy complications are significant predictors of OOPE.
  
  
  CONCLUSIONS
  Our results suggest that JSY has increased the coverage of institutional delivery and reduced financial stress to household and families but not sufficient for complicated delivery. Provisioning of providing sonography/other test and treating complicated cases in public health centres need to be strengthened.
authors.affiliation: Department of Population Policies and Programs, International Institute for Population Sciences, Govandi Station Road, Deonar, Mumbai, 400088, Maharashtra, India. diptigovil@gmail.com.
authors.forename: Dipti
authors.initials: D
authors.lastname: Govil
authors.affiliation: The IIHMR University, 1, Prabhu Dayal Marg, Near Sanganer Airport, Jaipur, 302029, Rajasthan, India.
authors.forename: Neetu
authors.initials: N
authors.lastname: Purohit
authors.affiliation: The IIHMR University, 1, Prabhu Dayal Marg, Near Sanganer Airport, Jaipur, 302029, Rajasthan, India.
authors.forename: Shiv Dutt
authors.initials: SD
authors.lastname: Gupta
authors.affiliation: Department of Fertility Studies, International Institute for Population Sciences, Govandi Station Road, Deonar, Mumbai, 400088, Maharashtra, India.
authors.forename: Sanjay Kumar
authors.initials: SK
authors.lastname: Mohanty
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D036861:Delivery, Obstetric / Q000009:adverse effects* / Q000191:economics; D004522:Educational Status; D005260:Female; D019538:Health Care Surveys; D005102:Health Expenditures; D006269:Health Facilities, Proprietary; D054625:Healthcare Disparities; D006700:Home Childbirth / Q000009:adverse effects / Q000191:economics; D006779:Hospitals, Public; D006801:Humans; D007194:India; D007744:Obstetric Labor Complications / Q000191:economics / Q000517:prevention & control* / Q000628:therapy; D010342:Patient Acceptance of Health Care; D018743:Perinatal Care / Q000191:economics; D011247:Pregnancy; D011295:Prenatal Care / Q000191:economics; D012423:Rural Health / Q000191:economics; D012923:Social Class; D013222:State Medicine; D055815:Young Adult
keywords: Antenatal care; Cash assistance scheme; Delivery care; India; OOPE