Can Conditional Cash Transfers Improve Maternal and Child Health? Evidence from India's Maternity Benefit Program
*Names in bold indicate Presenter
The IGMSY is a conditional maternity benefit program that provides a cash benefit of INR 4000 ($58) to pregnant mothers for their first two live births. Beneficiaries receive the cash benefit in three installments conditional on meeting a set of criteria: at least three antenatal checkups, breastfeeding the child for six months and complete immunization of the child. By encouraging these positive behaviors, the conditional maternity benefit program aims to improve maternal and child health outcomes in India. The program was initially implemented in 52 of India’s 640 districts in 2011 and later scaled up to all districts in 2017. The government developed a composite score using data from a national household survey in 2007 to select the 52 IGMSY districts. A mix of high, medium and low performing districts were selected with at least one district from each of India’s 36 states and union territories.
This study estimates the effect of conditional maternity benefits on health-seeking behaviors by using the phased rollout of IGMSY and recently released data from the National Family Health Survey (NFHS-4), a nationally representative cross-sectional household survey of women aged 15-49 years. The data includes birth histories of all respondents as well as geospatial information about the location of households. I use the geospatial data from NFHS to compare households living along the borders of the 52 districts that were eligible to participate in the program (IGMSY districts) with households living across the border in neighboring districts that were not eligible to participate. By using a boundary design, along with district-border fixed-effects, I am able to estimate the impact of the program on antenatal check-ups, immunization and duration of breastfeeding. I find that the program increases antenatal check-ups in high and medium performing districts but does not have a significant effect in low performing districts.
I corroborate my quantitative results with qualitative findings from in-depth interviews with program administrators and beneficiaries. I conducted these interviews in 16 villages across four IGMSY districts (a high, a medium and two low performing districts) in the summer of 2018. Respondents in low performing districts reported long delays in benefit payments (often more than a year after the birth of the child) due to limited administrative capacity.