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Tuesday, April 24, 2012
Abay Poster Exhibition and Hall (Millennium Hall)
Background: India launched a national conditional cash transfer program, Janani Suraksha Yojana (JSY), aimed at reducing maternal mortality by promoting institutional delivery in 2005. It provides a cash incentive to women who give birth in public health facilities. This paper studies the extent of program uptake, reasons for participation/ non participation, factors associated with non uptake of the program, program processes, and the role played by a program volunteer, ASHA, among mothers in Ujjain district in Madhya Pradesh, India. Methods: A cross-sectional study was conducted from January to May 2011 among women giving birth in 30 villages. A semi-structured questionnaire was administered to 418 women who delivered in 2009. Socio-demographic and pregnancy related characteristics, role of the ASHA during delivery, program processes, and reasons for place of delivery were collected. Multinomial regression analysis was used to identify predictors for the outcome variables; program facility, private facility, or a home delivery. Results: The majority of deliveries (318/418; 76%) took place within the JSY program; 81% of all mothers below poverty line delivered in the program. Ninety percent of the women had prior knowledge of the program. 24% of women reported the cash incentive as motivation for delivering in a JSY facility. All women reported receiving the cash incentive. The ASHA’s influence on the mother’s decision on where to deliver appeared limited. Women who were uneducated, multiparious or lacked prior knowledge of the JSY program were significantly more likely to deliver at home. Conclusion: In this study, a large proportion of women delivered under the program. . The program processes functioned well with most mothers reporting timely receipt of the cash transfer. Nevertheless, there is still a subset of mothers delivering at home, who do not or cannot access emergency obstetric care under the program and remain at risk of maternal death.
Learning Objectives: 1. Who are the women participating or not participating in a national cash transfer program aimed at reducing maternal mortality through increasing institutional delivery? 2. Assess the utilization and functionality of a maternal health program in regards to program uptake, reasons for participation or non participation, factors associated with non uptake of the program, how well the program processes function, and the role of critical community health workers. 3. Develop an effective intervention that will target the appropriate (disadvantaged women) group and achieve the desired impact i.e. reduce maternal mortality.