Demand – and Supply – Side Incentivization and Child Health Outcomes: Evidence from India
Conditional Cash Transfer (CCT) programs are increasingly gaining importance as a policy option to achieve desirable health outcomes. Janani Suraksha Yojana (Safe Motherhood program), one of the world’s largest CCT was announced by the Government of India in 2005. Apart from demand-side cash-incentivization, supply-side nudges in the form of deployment of community health workers (ASHAs) were provided to encourage and assist the expectant mothers in seeking prenatal, delivery and postnatal care assistance. The existing evidence on the impact of the program on child survival outcomes, the key aim of the program, is insufficient, mixed and involves identification concerns. Using a retrospective panel on birth histories of children for more than 35000 mothers from the Demographic and Health Survey (DHS) of India, we identify the Intent-To-Treat (ITT) effects of the program on the child survival outcomes by employing a difference-in-differences identification strategy combined with mother fixed effects. Consistent with the structure and timing of cash incentives,we find significant improvements in infant survival outcomes, primarily in the neonatal period. The effect, however, is restricted only in areas where the cash incentives to both the expectant mothers and ASHAs were high. The results highlight complementarities between supply-side nudges and demand-side incentivization.