Association for Public Policy Analysis & Management

Complications during pregnancy often lead to maternal and infant mortality. Having access to pre natal and post natal health services is known to be an effective measure to both prepare for complications during delivery and to reduce risk of mortality. Even though there has been tremendous progress in the scientific community on diagnosing and preventing such complications, in developing countries, lack of access to health services plays a large role in amplifying these risks. This restricted access/usage may primarily be due to (1) low affordability of reproductive and child health services, (2) cultural constraints that prevent women from accessing these health services, (3) geographical constraints that prevent women from physically accessing health services.

In this paper, we provide evidence of the effectiveness of health insurance as a tool for improving child health by reducing barriers to health service access for women during their pregnancies. We combine information on the implementation of a national health insurance program, targeted to below poverty line families, with data from the Indian Demographic Health Survey of 2015-16 to estimate the impact of having access to this health insurance on various reproductive and child health outcomes. We find that a child born to a mother with access to health insurance during her pregnancy has a 15 percentage points (p.p.) lower mortality risk than a comparable child born to a mother with no insurance access. This mortality risk decreases monotonically with greater exposure to the program. We argue that these changes are driven by greater utilization of reproductive health care for women in treatment regions. We show that both Pre natal and post-natal healthcare utilization for women increases in treatment districts, while women in these regions are less likely to give birth at home. Additionally, the results indicate that during these health visits mothers living in these areas are more likely to have been attended to by trained medical professionals. All these factors, we propose, explain the differential changes in child mortality across treated and untreated districts.