JSY maternal care quality

Conditional cash transfers and quality of maternal and newborn care: Women’s experience of the Janani Suraksha Yojana in Rajasthan KG Santhya, Shireen J Jejeebhoy, Rajib Acharya, AJ Francis Zavier Population Council, New Delhi Supported by the John D. and Catherine T. MacArthur Foundation National Conference on Bringing Evidence into Public Health Policy Bangalore, December 10-11, 2010

JSY: what we know and what we don’t ,[object Object],[object Object],[object Object]

Objective ,[object Object],[object Object],[object Object]

Study location ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],1 Selection of blocks based on female literacy and % of SC/ST population 2 Selection of villages/urban wards proportional to size

Study tools, participants and response rates ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Selected background characteristics of surveyed women Characteristics Combined Urban Rural Mean age 23.6 24.6 23.3 Median years of schooling completed 2.0 7.0 NC % Hindu 77.8 72.9 79.3 % Muslim 20.6 24.8 19.4 % belonging to SC/ST 33.0 21.4 36.5 Mean SLI 22.8 31.1 20.2 Mean age at marriage 16.2 18.3 15.5 Mean number of pregnancies 3.0 2.5 3.1 Mean number of children ever born 2.6 2.1 2.7

Reach of JSY: How many are reached and is it reaching the most vulnerable?

How many are reached? ,[object Object],[object Object],[object Object],[object Object],[object Object],% who had received cash 1 Of women who had delivered in model sub-centres, PHCs, CHCs, DH & accredited private hospitals 2 Of those aged 19 and above, belonging to BPL households and having first or second deliveries 3 Of the non-eligible deliveries, including those who delivered at home aged below 19, not belonging to BPL households and having 3+ parity, at sub-centres, non-accredited pvt hospitals and in transit

[object Object],[object Object],[object Object],[object Object],Is it reaching the most vulnerable?

Effects of JSY: Has it contributed to improve the quality of maternal and newborn care ?

Effects of JSY: Analysis approach ,[object Object],[object Object],[object Object],[object Object],1 after controlling for maternal age, education, household economic status. religion, caste, parity, place of residence, contact with ASHA

Measuring the effects of JSY: Indicators of quality of antenatal service ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object],[object Object],Quality of antenatal services Index of comprehensive care received Index of information on pregnancy-related care received % Measure of client-provider interaction

Measuring the effects of JSY: Indicators of quality of delivery service ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],Received basic check-ups prior to delivery Quality of delivery services Measure of provider availability and behaviour %

[object Object],[object Object],Quality of delivery services Discharged after 24 hours Allowed the escort to remain with the woman % *** ***

Measuring the effects of JSY: Indicators of quality of postpartum services ,[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],Quality of postpartum services Comprehensive information received Comprehensive check-up received %

Measuring the effects of JSY: Indicators of quality of newborn care practices ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object],Quality of newborn care services Comprehensive immediate care of the newborn % Followed appropriate feeding practices Immunization

Net effect of JSY: Results of difference-in-difference estimation Indicators Effect Index of information on pregnancy-related care received ++** Index of comprehensive antenatal services received ++* Measure of client-provider interaction No Received basic check-ups prior to delivery No Measure of provider availability and behaviour No Discharged after 24 hours ++* Allowed the escort to remain with R during delivery ++* Comprehensive check-ups during the postpartum period No Index of comprehensive information received No Comprehensive immediate care of the newborn ++*** Followed appropriate feeding practices ++** Full immunization No

Effects of JSY: women’s perceptions ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Conclusions ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

JSY maternal care quality

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JSY maternal care quality