According to the World Health Organization (WHO), 45,000 women died from preventable pregnancy-related complications in India in 2015. Rural women and adolescent girls are the most at risk. Severe shortages of qualified and trained midwives in rural areas is one of the primary reasons behind these deaths. In response, state governments are implementing programmes to encourage women to deliver at medical centres.
However, limited evidence exists on the effectiveness of such interventions. This brief draws on the findings from impact evaluations of two state government programmes, the Chiranjeevi Yojana (CY) in Gujarat and the Thayi Bhagya Yojana (TBY) in Karnataka, aimed at improving maternal health, especially among women living below the poverty line. These programmes were set up in the early 2000s in response to high maternal mortality from these factors.
The programmes did not increase the overall rates of institutional delivery, nor did they improve maternal and child health.
TBY, however, contributed to a noteworthy decline in caesarean rates.
CY did not reduce out-of-pocket expenses for pregnant women. This is not surprising, given that the Indian District Level Household Survey 2007–2008 estimates the cost for institutional delivery at INR1,935, compared with the INR1, 600 provided under CY. TBY contributed to a small reduction of less than INR200 (USD5 in 2010) in hospital expenditure per pregnant woman.
Most health providers in Karnataka TBY mentioned not having a clear understanding of the programme or how the incentives worked.
However, those with contracts rewarding adherence to WHO guidelines reported fewer instances of post-partum haemorrhage, compared with those who were rewarded for the outcome of reducing post-partum haemorrhage.