title: The Differential Impact of User-Fee Exemption Compared to Conditional Cash Transfers on Safe Deliveries in Nepal.
abstract: To assess the differential impact of a copayment exemption compared to a cash incentive on increasing skilled birth attendance (i.e., birth attended by a skilled health worker) in Nepal.
  
  
  
  This study used data on 8,785 children born between July 2005 and December 2008, obtained from the nationally representative Demographic and Health Surveys, 2006 and 2011.
  
  
  
  Twenty-five districts received both the policy interventions, and the remaining 50 control districts received only the cash incentive. We employed a difference-in-differences model to compare children born in districts with both interventions to those in districts with conditional cash transfers only. Average marginal effects of the difference-in-difference coefficient on skilled birth attendance measures are estimated.
  
  
  
  Skilled birth attendance in districts with both interventions was no higher on average than in districts with only the cash incentive. In areas with adequate road networks, however, significantly higher skilled birth attendance was observed in districts with both interventions compared to those with only the cash incentive.
  
  
  
  The added incentive of the user-fee exemption did not significantly increase skilled birth attendance relative to the presence of the cash incentive. User-fee exemptions may not be effective in areas with inadequate road infrastructure.
authors.affiliation: Department of Global Health & Population, Harvard T.H. Chan School of Public Health, Boston, MA.
authors.forename: Elina
authors.initials: E
authors.lastname: Pradhan
authors.affiliation: Department of Public Health Sciences & Epidemiology, University of Hawaii at Manoa, Honolulu, HI.|François-Xavier Bagnoud Center for Health and Human Rights, Harvard T.H. Chan School of Public Health, Boston, MA.|Center for Global Development, Washington, DC.
authors.forename: Victoria Y
authors.initials: VY
authors.lastname: Fan
mesh_terms: D000293:Adolescent; D000328:Adult; D017047:Cost Sharing / Q000191:economics; D036861:Delivery, Obstetric; D005260:Female; D005382:Financing, Personal; D019538:Health Care Surveys; D006291:Health Policy; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008427:Maternal Health Services / Q000191:economics; D008875:Middle Aged; D009390:Nepal; D010342:Patient Acceptance of Health Care; D011247:Pregnancy; D036301:Qualitative Research; D055815:Young Adult
keywords: Conditional cash transfers; financial incentives; maternal health; skilled birth attendance; user fees