Childbirth program fails to deliver in India

Researcher Manoj Mohanan says previous research, which had suggested the Chiranjeevi Yojana program was very successful, had methodological limitations. (Credit: Abhisek Sarda/Flickr)

Despite over $25 million in funding since 2005, a program has been unsuccessful in its efforts to encourage women in rural India to give birth in private hospitals.

The Chiranjeevi Yojana program in Gujarat, a state in northwestern India, received the Wall Street Journal Asian Innovation Award in 2006 and has been hailed by some as a model for wide adoption throughout India. The program aims to reduce infant and maternal deaths.

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The program was launched in 2006 to help address the shortage of obstetricians at public hospitals accessible to low-income women in rural areas. It aimed to provide free childbirth care at participating private-sector hospitals to women who are below the poverty line.

The hospitals are paid 1600 Indian rupees per delivery, approximately $30 to $40. The hospitals may offer additional services to patients and charge separate fees for them. By 2012, approximately 800 private-sector hospitals were participating and the program had helped pay for more than 800,000 deliveries.

Manoj Mohanan, assistant professor of public policy, global health and economics at Duke University, led the research team. They surveyed 5,597 households in Gujarat to collect data on births that had occurred between 2005 and 2010.

They found no statistically significant change in the probability of delivery in health care institutions, the probability of obstetric complications, or the probability that physicians or nurses were present during childbirth.

“We were surprised to find, as well, that even among those who delivered at health care facilities there were no significant reductions in households’ out-of-pocket expenditures for deliveries.”

The findings appear in the Bulletin of the World Health Organization.

While the study did not determine why patients’ delivery costs did not decline or why the program is ineffective, several explanations are possible, Mohanan says.

Media reports in India suggest that despite the promise of free care, hospitals were billing women for extra, chargeable services. Providers also complained that the reimbursement amounts were not adequate to cover costs of providing the service.

In addition, mothers may perceive the quality of care at participating private hospitals to be poor, so even when the care is provided for free, demand does not rise. Transportation costs from rural villages also could be a factor, he says.

Mohanan says previous research, which had suggested the program was very successful, had methodological limitations. It did not address the role of self-selection of institutional delivery by pregnant women and did not account for unrelated increases in institutional deliveries that probably occurred as a result of rapid economic growth in the region.

The International Initiative for Impact Evaluation in New Delhi and the UK Department for International Development and the World Bank supported this study.

Source: Duke University