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

• Published in: Social science & medicine (1982) 2014-08, Vol.114, p.89-96
• Main Author: Coffey, Diane
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Biological and medical sciences; Birth; Childbirth; Clinical outcomes; Conditional cash transfer; Costs and Cost Analysis - statistics & numerical data; Delivery, Obstetric - economics; Delivery, Obstetric - psychology; Delivery, Obstetric - statistics & numerical data; Delivery. Postpartum. Lactation; Epidemiology; Female; General aspects; Gynecology. Andrology. Obstetrics; Health care expenditures; Health policy; Health Problems; Home Childbirth - economics; Hospitals; Hospitals, Rural - economics; Humans; India; Infant health; Maternal health; Medical sciences; Miscellaneous; Mothers; Obstetrics; Outcome Assessment (Health Care); Pregnancy; Program Evaluation; Public health. Hygiene; Public health. Hygiene-occupational medicine; Qualitative analysis; Qualitative Research; Quality of care; Quality of Health Care; Rents; Rural Areas; Rural health care; Stress, Psychological; Uttar Pradesh; Uttar Pradesh, India; Values; Young Adult
• ISSN: 0277-9536; 1873-5347
• DOI: 10.1016/j.socscimed.2014.05.035

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. •Qualitative study of India's conditional cash transfer for birth in health facilities drawing on field work in Uttar Pradesh.•Addresses why the program has not improved health despite increasing hospital births.•Finds that health workers capture economic rents of the program and provide poor quality care.•Finds that the net monetary value of participation is low and psychological costs are high.•Suggests that the program should be restructured to incentivize health outcomes.