The long road to health: Healthcare utilization impacts of a road pavement policy in rural India

• Published in: Journal of development economics 2021-06, Vol.151, p.102667, Article 102667
• Main Author: Aggarwal, Shilpa
• Format: Article
• Language: English
• Subjects: Ante-natal care; Fetal mortality; Healthcare; Infant mortality; Institutional births; PMGSY; Roads; Vaccination
• ISSN: 0304-3878; 1872-6089
• DOI: 10.1016/j.jdeveco.2021.102667

Despite demand-stimulation efforts, coverage rates of many essential health services remain low in developing countries, suggesting that there may be binding supply constraints, such as poor access to healthcare facilities. This paper utilizes quasi-random variation in road-pavement intensity to study the impact of improved access on adoption of reproductive health services. I find that road construction led to more institutional antenatal visits and deliveries, which translated into better medical care and vaccination coverage, with larger gains for girls. Better ante-natal care resulted in fewer miscarriages, although much of this decline is due to delayed, rather than averted mortality as infant mortality went up. Overall mortality, including in-utero, stillbirths, and during infancy, is unimpacted. Most gains in natal and ante-natal care accrue from repeat visits by existing patients, and some from new entrants into the formal health sector. Evidence suggests that beneficiaries travel farther to see better providers. •I study the impact of rural roads on utilization of reproductive health services.•Roads improved rates of institutional deliveries and institutional antenatal care.•Pregnant women received better medical care; child vaccination rates improved.•Fetal mortality declined, but was offset by an equivalent rise in infant mortality.•Households switched from private to public healthcare providers.