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Costs and consequences of a cash transfer for hospital births in a rural district of Uttar Pradesh, India

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  • Coffey, Diane

Abstract

The Janani Suraksha Yojana, India's “safe motherhood program,” is a conditional cash transfer to encourage women to give birth in health facilities. Despite the program's apparent success in increasing facility-based births, quantitative evaluations have not found corresponding improvements in health outcomes. This study analyses original qualitative data collected between January, 2012 and November, 2013 in a rural district in Uttar Pradesh to address the question of why the program has not improved health outcomes. It finds that health service providers are focused on capturing economic rents associated with the program, and provide an extremely poor quality care. Further, the program does not ultimately provide beneficiaries a large net monetary transfer at the time of birth. Based on a detailed accounting of the monetary costs of hospital and home deliveries, this study finds that the value of the transfer to beneficiaries is small due to costs associated with hospital births. Finally, this study also documents important emotional and psychological costs to women of delivering in the hospital. These findings suggest the need for a substantial rethinking of the program, paying careful attention to incentivizing health outcomes.

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  • Coffey, Diane, 2014. "Costs and consequences of a cash transfer for hospital births in a rural district of Uttar Pradesh, India," Social Science & Medicine, Elsevier, vol. 114(C), pages 89-96.
    • Handle: RePEc:eee:socmed:v:114:y:2014:i:c:p:89-96
    DOI: 10.1016/j.socscimed.2014.05.035
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    Cited by:

    1. Hunter, Benjamin M., 2018. "Brokerage in commercialised healthcare systems: A conceptual framework and empirical evidence from Uttar Pradesh," Social Science & Medicine, Elsevier, vol. 202(C), pages 128-135.
    2. Diane Coffey & Payal Hathi, 2016. "Underweight and Pregnant: Designing Universal Maternity Entitlements to Improve Health," Indian Journal of Human Development, , vol. 10(2), pages 176-190, August.
    3. Diane Coffey, 2019. "The association between neonatal death and facility birth in regions of India," Demographic Research, Max Planck Institute for Demographic Research, Rostock, Germany, vol. 40(16), pages 417-430.
    4. Srinivas Goli & Moradhvaj & Anu Rammohan & Shruti & Jalandhar Pradhan, 2016. "High Spending on Maternity Care in India: What Are the Factors Explaining It?," PLOS ONE, Public Library of Science, vol. 11(6), pages 1-17, June.
    5. Coffey, Diane & Spears, Dean, 2019. "Neonatal Death in India: Birth Order in a Context of Maternal Undernutrition," IZA Discussion Papers 12288, Institute of Labor Economics (IZA).
    6. Dhiman Das, 2017. "Public expenditure and healthcare utilization: the case of reproductive health care in India," International Journal of Health Economics and Management, Springer, vol. 17(4), pages 473-494, December.

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