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A qualitative study of factors impacting accessing of institutional delivery care in the context of India's cash incentive program

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  • Vellakkal, Sukumar
  • Reddy, Hanimi
  • Gupta, Adyya
  • Chandran, Anil
  • Fledderjohann, Jasmine
  • Stuckler, David

Abstract

Not all eligible women use the available services under India's Janani Suraksha Yojana (JSY), which provides cash incentives to encourage pregnant women to use institutional care for childbirth; limited evidence exists on demand-side factors associated with low program uptake. This study explores the views of women and ASHAs (community health workers) on the use of the JSY and institutional delivery care facilities. In-depth qualitative interviews, carried out in September-November 2013, were completed in the local language by trained interviewers with 112 participants consisting of JSY users/non-users and ASHAs in Jharkhand, Madhya Pradesh and Uttar Pradesh. The interaction of impeding and enabling factors on the use of institutional care for delivery was explored. We found that ASHAs' support services (e.g., arrangement of transport, escort to and support at healthcare facilities) and awareness generation of the benefits of institutional healthcare emerged as major enabling factors. The JSY cash incentive played a lesser role as an enabling factor because of higher opportunity costs in the use of healthcare facilities versus home for childbirth. Trust in the skills of traditional birth-attendants and the notion of childbirth as a ‘natural event’ that requires no healthcare were the most prevalent impeding factors. The belief that a healthcare facility would be needed only in cases of birth complications was also highly prevalent. This often resulted in waiting until the last moments of childbirth to seek institutional healthcare, leading to delay/non-availability of transportation services and inability to reach a delivery facility in time. ASHAs opined that interpersonal communication for awareness generation has a greater influence on use of institutional healthcare, and complementary cash incentives further encourage use. Improving health workers' support services focused on marginalized populations along with better public healthcare facilities are likely to promote the uptake of institutional delivery care in resource-poor settings.

Suggested Citation

  • Vellakkal, Sukumar & Reddy, Hanimi & Gupta, Adyya & Chandran, Anil & Fledderjohann, Jasmine & Stuckler, David, 2017. "A qualitative study of factors impacting accessing of institutional delivery care in the context of India's cash incentive program," Social Science & Medicine, Elsevier, vol. 178(C), pages 55-65.
    • Handle: RePEc:eee:socmed:v:178:y:2017:i:c:p:55-65
    DOI: 10.1016/j.socscimed.2017.01.059
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    References listed on IDEAS

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    1. Randive, Bharat & San Sebastian, Miguel & De Costa, Ayesha & Lindholm, Lars, 2014. "Inequalities in institutional delivery uptake and maternal mortality reduction in the context of cash incentive program, Janani Suraksha Yojana: Results from nine states in India," Social Science & Medicine, Elsevier, vol. 123(C), pages 1-6.
    2. Tinoco-Ojanguren, Rolando & Glantz, Namino M. & Martinez-Hernandez, Imelda & Ovando-Meza, Ismael, 2008. "Risk screening, emergency care, and lay concepts of complications during pregnancy in Chiapas, Mexico," Social Science & Medicine, Elsevier, vol. 66(5), pages 1057-1069, March.
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    1. Prabal K. De & Laxman Timilsina, 2020. "Cash‐based maternal health interventions can improve childhood vaccination—Evidence from India," Health Economics, John Wiley & Sons, Ltd., vol. 29(10), pages 1202-1219, October.
    2. Vandita Dar & Madhvi Sethi & Saina Baby, 2023. "Direct Cash Transfers in Emerging Economies: The Case of India," Business Perspectives and Research, , vol. 11(2), pages 287-308, May.
    3. Ravi Durga Prasad & Somya Arora & Pradeep S. Salve & Srinivas Goli & K. S. James & Saseendran Pallikadavath & Udaya S. Mishra & Irudaya S. Rajan, 2022. "Why there is underutilization of four and more antenatal care services despite the colossal rise in institutional deliveries in Bihar, India," Journal of Social and Economic Development, Springer;Institute for Social and Economic Change, vol. 24(2), pages 355-378, December.
    4. Anita Makins & Jochen Ehmer & Alexandra Piprek & Francisco Mbofana & Amanda Ross & Michael André Hobbins, 2019. "Demand-side financing in the form of baby packages in Northern Mozambique: Results from an observational study," PLOS ONE, Public Library of Science, vol. 14(5), pages 1-12, May.
    5. Jayanta Kumar Bora & Rajesh Raushan & Wolfgang Lutz, 2019. "The persistent influence of caste on under-five mortality: Factors that explain the caste-based gap in high focus Indian states," PLOS ONE, Public Library of Science, vol. 14(8), pages 1-20, August.
    6. Tulasi Malini Maharatha & Sumirtha Gandhi & Umakant Dash, 2021. "Has the Demand and Supply-side Components of Janani Suraksha Yojana Augmented the Uptake of Maternal Health Care Services among Poor Women in India ? : An Application of Hybrid Matching Technique," BASE University Working Papers 08/2021, BASE University, Bengaluru, India.
    7. Rajesh Kamath & Helmut Brand & Nisha Nayak & Vani Lakshmi & Reena Verma & Prajwal Salins, 2023. "District-Level Patterns of Health Insurance Coverage and Out-of-Pocket Expenditure on Caesarean Section Deliveries in Public Health Facilities in India," Sustainability, MDPI, vol. 15(5), pages 1-17, March.

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