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More Evidence on the Impact of India's Conditional Cash Transfer Program, Janani Suraksha Yojana: Quasi-Experimental Evaluation of the Effects on Childhood Immunization and Other Reproductive and Child Health Outcomes

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  • Natalie Carvalho
  • Naveen Thacker
  • Subodh S Gupta
  • Joshua A Salomon

Abstract

Background: In 2005, India established a conditional cash transfer program called Janani Suraksha Yojana (JSY), to increase institutional delivery and encourage the use of reproductive and child health-related services. Objective: To assess the effect of maternal receipt of financial assistance from JSY on childhood immunizations, post-partum care, breastfeeding practices, and care-seeking behaviors. Methods: We use data from the latest district-level household survey (2007–2008) to conduct a propensity score matching analysis with logistic regression. We conduct the analyses at the national level as well as separately across groups of states classified as high-focus and non-high-focus. We carry out several sensitivity analyses including a subgroup analysis stratified by possession of an immunization card. Results: Receipt of financial assistance from JSY led to an increase in immunization rates ranging from 3.1 (95%CI 2.2–4.0) percentage points for one dose of polio vaccine to 9.1 (95%CI 7.5–10.7) percentage points in the proportion of fully vaccinated children. Our findings also indicate JSY led to increased post-partum check-up rates and healthy early breastfeeding practices around the time of childbirth. No effect of JSY was found on exclusive breastfeeding practices and care-seeking behaviors. Effect sizes were consistently larger in states identified as being a key focus for the program. In an analysis stratified by possession of an immunization card, there was little to no effect of JSY among those with vaccination cards, while the effect size was much larger than the base case results for those missing vaccination cards, across nearly all immunization outcomes. Conclusions: Early results suggest the JSY program led to a significant increase in childhood immunization rates and some healthy reproductive health behaviors, but the structuring of financial incentives to pregnant women and health workers warrants further review. Causal interpretation of our results relies on the assumption that propensity scores balance unobservable characteristics.

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  • Natalie Carvalho & Naveen Thacker & Subodh S Gupta & Joshua A Salomon, 2014. "More Evidence on the Impact of India's Conditional Cash Transfer Program, Janani Suraksha Yojana: Quasi-Experimental Evaluation of the Effects on Childhood Immunization and Other Reproductive and Chil," PLOS ONE, Public Library of Science, vol. 9(10), pages 1-13, October.
    • Handle: RePEc:plo:pone00:0109311
    DOI: 10.1371/journal.pone.0109311
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    1. Powell-Jackson, Timothy & Mazumdar, Sumit & Mills, Anne, 2015. "Financial incentives in health: New evidence from India's Janani Suraksha Yojana," Journal of Health Economics, Elsevier, vol. 43(C), pages 154-169.
    2. Ho, Daniel E. & Imai, Kosuke & King, Gary & Stuart, Elizabeth A., 2007. "Matching as Nonparametric Preprocessing for Reducing Model Dependence in Parametric Causal Inference," Political Analysis, Cambridge University Press, vol. 15(3), pages 199-236, July.
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    1. Cooper, Jan E. & Benmarhnia, Tarik & Koski, Alissa & King, Nicholas B., 2020. "Cash transfer programs have differential effects on health: A review of the literature from low and middle-income countries," Social Science & Medicine, Elsevier, vol. 247(C).
    2. Yannick Markhof & Isabela Franciscon & Nicolò Bird & Pedro Arruda, 2021. "Social assistance programmes in South Asia: an evaluation of socio-economic impacts," Research Report 62, International Policy Centre for Inclusive Growth.
    3. Elizabeth Tilley & Isabel Günther, 2016. "The Impact of Conditional Cash Transfer on Toilet Use in eThekwini, South Africa," Sustainability, MDPI, vol. 8(10), pages 1-16, October.
    4. Mili Mehrotra & Karthik V. Natarajan, 2020. "Value of Combining Patient and Provider Incentives in Humanitarian Health Care Service Programs," Production and Operations Management, Production and Operations Management Society, vol. 29(3), pages 571-594, March.
    5. Sudha Narayanan & Nicolas Gerber, 2015. "Social safety nets for food and nutritional security in India," Indira Gandhi Institute of Development Research, Mumbai Working Papers 2015-031, Indira Gandhi Institute of Development Research, Mumbai, India.
    6. Giang, Long Thanh & Nguyen, Cuong Viet, 2017. "How would cash transfers improve child welfare in Viet Nam?," Children and Youth Services Review, Elsevier, vol. 82(C), pages 87-98.
    7. Susmita Baulia, 2020. "Cash incentives to mothers or to community health workers - what contributes better to the health of the mother and the newborn? Evidence from India," Discussion Papers 133, Aboa Centre for Economics.
    8. Sudha Narayanan Narayanan & Nicolas Gerber, 2016. "Safety Nets for Food and Nutritional Security in India," FOODSECURE Working papers 37, LEI Wageningen UR.
    9. Evan Borkum & Dana Rotz & Anu Rangarajan & Swetha Sridharan & Sukhmani Sethi & Mercy Manoranjini & Lakshmi Ramakrishnan & Lalit Dandona & Rakhi Dandona & Priyanka S. Kochar & G. Anil Kumar & Priyanka , "undated". "Midline Findings from the Evaluation of the Ananya Program in Bihar," Mathematica Policy Research Reports 74ef56ababd9412b82ef906fc, Mathematica Policy Research.
    10. Rahman, Mohammad Mahbubur & Pallikadavath, Saseendran, 2018. "How much do conditional cash transfers increase the utilization of maternal and child health care services? New evidence from Janani Suraksha Yojana in India," Economics & Human Biology, Elsevier, vol. 31(C), pages 164-183.
    11. Kekre, Aishwarya & Mahajan, Kanika, 2023. "Maternity support and child health: Unintended gendered effects," Journal of Comparative Economics, Elsevier, vol. 51(3), pages 880-898.
    12. Benjamin M Hunter & Sean Harrison & Anayda Portela & Debra Bick, 2017. "The effects of cash transfers and vouchers on the use and quality of maternity care services: A systematic review," PLOS ONE, Public Library of Science, vol. 12(3), pages 1-37, March.
    13. 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.
    14. Christopher Strader & Joanna Ashby & Dominique Vervoort & Aref Ebrahimi & Shoghi Agbortoko & Melissa Lee & Naomi Reiner & Molly Zeme & Mark G Shrime, 2020. "How much is enough? Exploring the dose-response relationship between cash transfers and surgical utilization in a resource-poor setting," PLOS ONE, Public Library of Science, vol. 15(5), pages 1-12, May.
    15. Matthew Walsh & Santiago Poy & Ianina Tuñón, 2020. "The Impact of Health Conditionalities in Conditional Cash Transfer Programmes: the case of the AUH in Argentina," Revista Desarrollo y Sociedad, Universidad de los Andes,Facultad de Economía, CEDE, vol. 85(4), June.
    16. Kusuma, Dian & Thabrany, Hasbullah & Hidayat, Budi & McConnell, Margaret & Berman, Peter & Cohen, Jessica, 2017. "New Evidence on the Impact of Large-scale Conditional Cash Transfers on Child Vaccination Rates: The Case of a Clustered-Randomized Trial in Indonesia," World Development, Elsevier, vol. 98(C), pages 497-505.
    17. Aizawa, T.;, 2019. "Reviewing the Existing Evidence of the Conditional Cash Transfer in India through the Partial Identification Approach," Health, Econometrics and Data Group (HEDG) Working Papers 19/24, HEDG, c/o Department of Economics, University of York.

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