Impact of conditional cash transfers under the Janani Suraksha Yojana on neonatal outcomes in India’s EAG states

Abstract

The effectiveness of conditional cash transfer programs in enhancing maternal and neonatal health outcomes cannot be undermined however key neonatal parameters such as skin-to-skin contacts of mother and newborn immediately after birth, early initiation of breastfeeding, zero dose immunization and postnatal checkup within 2 months of birth that could indirectly influence the neonatal outcomes remain under researched. This study aims to examine the effectiveness of Janani Suraksha Yojana (JSY) in providing comprehensive postnatal care by enhancing the uptake of key neonatal parameters in the less developed i.e., Empowered Action Group (EAG) states of India. This study utilized data from the fifth round (2019-21) of the National Family Health Survey (NFHS) in India, focusing on 62,415 women in the EAG states. We employed Propensity Score Matching (PSM) to evaluate the impact of the JSY on four key neonatal outcomes. Large scale cross-sectional sample survey. A total of 62,415 women who had normal deliveries in healthcare facilities were included in the analysis. Of these, 33,623 women received JSY services, indicating that approximately 53.9% of women in the EAG states benefited from JSY. The descriptive analysis revealed that almost all the service uptake variables were better amongst those women who received JSY services. Result from PSM analysis reports as (after controlling for socio-economic covariates) - For breastfeeding within one hour, 39% would do so without JSY (T stat- 1.68), while JSY support could increase this by 7%. Regarding postnatal check-ups within two months, 42% of newborns would receive all check-ups without JSY (T stat-5.30), but JSY could increase this by 12%. Lastly, 64% of newborns would receive all zero-dose vaccinations without JSY (T stat- 6.20), with JSY potentially raising this by 6%. Lastly, no significant results were observed for skin-to-skin contact. We can infer that the impact of JSY extends beyond institutional delivery into the postnatal period in the poorer states of India. The contact and interaction of beneficiaries with health system as evident from utilization of JSY services during antenatal period seems to have lasting impact. Better coordination and counseling may increase the effect size further. Additionally, monitoring and leveraging community networks can ensure consistent support and follow-up care for mothers. Addressing these areas can optimize JSY, ensuring healthier futures for mothers and their children in India.