In 2005, with the goal of reducing the numbers of maternal and neonatal deaths, the
Government of India launched Janani Suraksha Yojana (JSY), a conditional cash transfer
scheme, to incentivise women to give birth in a health facility. We independently
assessed the effect of JSY on intervention coverage and health outcomes.
We used data from the nationwide district-level household surveys done in 2002-04
and 2007-09 to assess receipt of financial assistance from JSY as a function of socioeconomic
and demographic characteristics; and used three analytical approaches (matching, with-versus-without
comparison, and differences in differences) to assess the effect of JSY on antenatal
care, in-facility births, and perinatal, neonatal, and maternal deaths.
Implementation of JSY in 2007-08 was highly variable by state-from less than 5% to
44% of women giving birth receiving cash payments from JSY. The poorest and least
educated women did not always have the highest odds of receiving JSY payments. JSY
had a significant effect on increasing antenatal care and in-facility births. In the
matching analysis, JSY payment was associated with a reduction of 3.7 (95% CI 2.2-5.2)
perinatal deaths per 1000 pregnancies and 2.3 (0.9-3.7) neonatal deaths per 1000 livebirths.
In the with-versus-without comparison, the reductions were 4.1 (2.5-5.7) perinatal
deaths per 1000 pregnancies and 2.4 (0.7-4.1) neonatal deaths per 1000 livebirths.
The findings of this assessment are encouraging, but they also emphasise the need
for improved targeting of the poorest women and attention to quality of obstetric
care in health facilities. Continued independent monitoring and evaluations are important
to measure the effect of JSY as financial and political commitment to the programme
intensifies.
Bill & Melinda Gates Foundation.
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