Replication Researcher: Slawa Rokicki (with Natalie Carvalho).
Original Paper Title: India's Janani Suraksha Yojana, a Conditional Cash Transfer Programme to Increase Births in Health Facilities: an Impact Evaluation
Original Researchers: Stephen S. Lim, Lalit Dandona, Joseph A. Hoisington, Spencer L. James, Margaret C. Hogan and Emmanuela Gakidou
Original Publication: Lancet
Replication Plan: Rokicki’s Replication Plan
Current Status: Completed Replication Study
The Original Study
Janani Suraksha Yojana (JSY), a large-scale conditional cash transfer programme launched by the Indian government in 2005 and aimed at reducing maternal, perinatal and neonatal mortality, provides a financial incentive to encourage pregnant women to give birth in a government or accredited private health facility. Using data originated from the 2002-2004 and 2007-2009 India District-Level Households Survey (DLHS), the authors use three different approaches (matching, with-versus-without comparison, and diﬀerences-in-diﬀerences) to assess the programme’s effectiveness on intervention coverage and health outcomes.
The study finds significant variation in programme uptake across districts. Moreover, uptake was different across women with different levels of education (higher among women having 1–11 years of education than among women with no education or with more than 11 years of education). The three methodological approaches show similar significant improvements in the use of antenatal care and the number of in-facility births. The programme shows a reduction in perinatal and neonatal morbidity when using the matching estimates and the with-versus-without comparison. However, none of the three methodological approaches shows any impact on maternal mortality, and no statistically significant effects are found on any of the health outcomes when the differences in differences approach is used.
Conditional cash transfer programs are becoming increasingly popular in low- and middle-income countries, with a goal of improving access to health and social services and reducing inequities in access and outcomes for the poor and marginalized. Policy makers need to better understand whether these programs are effective through rigorous evaluation of existing programs. India’s conditional cash transfer program, Janani Suraksha Yojana (JSY), is one of the largest programs of its kind in the world. JSY provides financial incentives to pregnant women to encourage them to deliver in health facilities. This replication study, through robustness checks and additional model specifications, reexamines recent work on the effectiveness of JSY on maternal, perinatal, and neonatal health service utilization and outcomes. The research will specifically evaluate the original article’s findings that JSY was associated with a reduction in perinatal and neonatal deaths.