Cash‐based maternal health interventions can improve childhood vaccination—Evidence from India

Abstract

Childhood vaccination has lagged in countries like India, despite its demonstrated positive effects on health outcomes like infant mortality. At the same time, many conditional cash transfer programs have been effective in improving health outcomes. We estimate the effect of the world's largest maternal health program, Janani Suraksha Yojana (JSY, maternal protection scheme), on childhood vaccination in India. We exploit exogenous variations in the expansion of the policy around the country and the fact that some key vaccines are given at or near birth to identify the effects of cash‐based maternal health policy on infant immunization. We find that JSY increased the probability of Bacillus Calmette–Guérin (BCG) and diphtheria, pertussis, and tetanus toxoid (DPT) vaccination among newborns and infants. However, we find almost no significant effects on the measles vaccine, which is administered several months after birth.

Lessons learned? Intended and unintended effects of India's second‐generation maternal cash transfer scheme

“…Our study contributes to a rapidly growing literature on the effectiveness of CCTs in the context of child and maternal health (Bastagli et al, 2019;Glassman et al, 2013;Grépin et al, 2019;Ranganathan & Lagarde, 2012). Most closely related to our work are the numerous studies of India's JSY program (De & Timilsina, 2020;Glick, 2017;Lim et al, 2010;Powell-Jackson et al, 2015) and Ghosh and Kochar (2018), who evaluate IGMSY with primary data collected in two districts of Bihar, India's most destitute state. Our principal contributions to this literature are, first, that we evaluate the IGMSY program on a national scale.…”

“…Similarly, our estimates might be biased if fertility was increased in order to select into the program, and not as a result of receiving the program. While De and Timilsina (2020) argue that the uncertainty of government programs in India renders this quite unlikely, they propose to test for fertility selection by testing for program effects on fertility. Applying this test to our data yields a small negative, insignificant effect, which confirms that the IGM-SY program has not significantly increased birthrates in treatment districts (Table A9).…”

“…Moreover, the program has had several unintended effects, including a fertility increase (Nandi & Laxminarayan, 2016;Powell-Jackson et al, 2015), which has previously been documented for maternal CCTs in other countries (Powell-Jackson & Hanson, 2012;Stecklov et al, 2007), as well as substitution away from private health care providers (Powell-Jackson et al, 2015). On the other hand, it is broadly acknowledged that JSY has also had a number of positive side effects regarding breastfeeding (Powell-Jackson et al, 2015), infant immunization (De & Timilsina, 2020) and contact with the public health system later in the child's life course (Glick, 2017). The program features held responsible for JSY's failure to improve maternal and child health and its unintended effects on fertility are its narrow focus on institutional delivery, the short time interval around delivery covered by the program, cash incentives for all live births including higher parities, and a lack of qualitatively adequate health infrastructure supply (Lahariya, 2014;Powell-Jackson et al, 2015).…”

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“…Despite these efforts, the coverage of DPT3 and Measles had remained sub-optimal and inequitable. This could be due to dearth of trained personnel managing the programme at the national and state levels [36,37].…”

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“…They rely on a difference‐in‐difference design as well as a triple‐difference design to conduct their analysis. Also, De and Timilsina (2020) study the impact of JSY on childhood vaccination and find positive effects. To the best of our knowledge, none of the studies conducted so far have attempted to estimate the effects of JSY on child learning outcomes.…”