Unintended effects of Janani Suraksha Yojana on maternal care in India.
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ABSTRACT:
SUBMITTER: Sen S
PROVIDER: S-EPMC7334609 | biostudies-literature | 2020 Aug
REPOSITORIES: biostudies-literature
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Project description:BackgroundCaste plays a significant role in Indian society and it influences women to health care access in the community. The implementation of the maternal health benefits scheme in India is biased due to caste identity. In this context, the paper investigates access to Janani Suraksha Yojana (JSY) among social groups to establish that caste still plays a pivotal role in Indian society. Also, this paper aims to quantify the discrimination against Scheduled Castes/Scheduled Tribes (SCs/STs) in accessing JSY.MethodsThis paper uses a national-level data set of both NFHS-3 (2005-06) and NFHS-4 (2015-16). Both descriptive statistics and the Fairlie decomposition econometric model have been used to measure the explained and unexplained differences in access to JSY between SCs/STs and non-SCs/STs groups.ResultsOverall, the total coverage of JSY in India is still, 36.4%. Further, it is found that 72% of access to JSY is explained by endowment variables. The remaining unexplained percentage (28%) indicates that there is caste discrimination (inequity associated social-discrimination) against SCs/STs in access to JSY. The highest difference (54%) between SCs/STs and non-SCs/STs in access to JSY comes from the wealth quintile, with the positive sign indicating that the gap between the two social groups is widening.Discussion and conclusionIt is necessary for the government to implement a better way to counter the caste-based discrimination in access to maternal health benefits scheme. In this regard, ASHA and Anganwadi workers must be trained to reduce the influence of dominant caste groups as well as they must be recruited from the same community to identify the right beneficiaries of JSY and in order to reduce inequity associated with social-discrimination.
| S-EPMC7951864 | biostudies-literature
Project description:BackgroundIn Madhya Pradesh, India, the government invited private obstetric hospitals for partnership to provide intrapartum care to poor women, paid for by the state. This statewide program, the Janani Sahayogi Yojana (JShY or maternal support scheme), ran from 2006 to 2012. The partnership was an uneasy one with many private obstetricians choosing to leave the partnership. This paper explores the motives of private obstetricians in the state for participating in the JShY, their experiences within the partnership, their interactions with the state and motives for withdrawal among those who withdrew from the scheme. This study sheds light on the dynamics of a public-private partnership for obstetric care from the perspective of private sector obstetricians.MethodFifteen in-depth interviews were conducted with private obstetricians and hospital administrators from eight districts of Madhya Pradesh who had participated in the JShY. A Framework approach was used to analyze the data.ResultsPrivate obstetricians reported entering the JShY partnership for altruistic reasons but also as way of expanding their practices and reputations. They perceived that although their facilities provided better quality of care than state facilities, participation was risky because beneficiaries were often unbooked and seen as 'high risk' cases. The need to arrange for blood transfusions for these high risk women was perceived as particularly difficult. Cumbersome paper work and delays in receiving payments from the state also dissuaded participation. Some participants felt that there was inadequate engagement by the state, and better monitoring and supervision would have helped. The state changed the financial reimbursement arrangements due to a high proportion of Cesarean births in the early years of the partnership, as these were perversely incentivized. This change resulted in a large exodus of private obstetricians from the partnership.ConclusionThis study highlights the contribution of cumbersome processes, trust deficits and a lack of dialogue between public and private partners. Input from both public and private sectors into the design of a carefully thought through financial reimbursement package for private partners was highlighted as a necessary component for future success of such schemes.
| S-EPMC6708218 | biostudies-literature
Project description:IntroductionIndia's Pradhan Mantri Jan Arogya Yojana (PM-JAY) is the world's largest health assurance scheme providing health cover of 500,000 INR (about USD 6,800) per family per year. It provides financial support for secondary and tertiary care hospitalization expenses to about 500 million of India's poorest households through various insurance models with care delivered by public and private empanelled providers. This study undertook to describe the provider empanelment of PM-JAY, a key element of its functioning and determinant of its impact.MethodsWe carried out secondary analysis of cross-sectional administrative program data publicly available in PM-JAY portal for 30 Indian states and 06 UTs. We analysed the state wise distribution, type and sector of empanelled hospitals and services offered through PM-JAY scheme across all the states and UTs.ResultsWe found that out of the total facilities empanelled (N = 20,257) under the scheme in 2020, more than half (N = 11,367, 56%) were in the public sector, while 8,157 (40%) facilities were private for profit, and 733 (4%) were private not for profit entities. State wise distribution of hospitals showed that five states (Karnataka (N = 2,996, 14.9%), Gujarat (N = 2,672, 13.3%), Uttar Pradesh (N = 2,627, 13%), Tamil Nadu (N = 2315, 11.5%) and Rajasthan (N = 2,093 facilities, 10.4%) contributed to more than 60% of empanelled PMJAY facilities: We also observed that 40% of facilities were offering between two and five specialties while 14% of empanelled hospitals provided 21-24 specialties.ConclusionA majority of the hospital empanelled under the scheme are in states with previous experience of implementing publicly funded health insurance schemes, with the exception of Uttar Pradesh. Reasons underlying these patterns of empanelment as well as the impact of empanelment on service access, utilisation, population health and financial risk protection warrant further study. While the inclusion and regulation of the private sector is a goal that may be served by empanelment, the role of public sector remains critical, particularly in underserved areas of India.
| S-EPMC8158976 | biostudies-literature
Project description:BackgroundIn 2005, India established a conditional cash transfer program called Janani Suraksha Yojana (JSY), to increase institutional delivery and encourage the use of reproductive and child health-related services.ObjectiveTo assess the effect of maternal receipt of financial assistance from JSY on childhood immunizations, post-partum care, breastfeeding practices, and care-seeking behaviors.MethodsWe use data from the latest district-level household survey (2007-2008) to conduct a propensity score matching analysis with logistic regression. We conduct the analyses at the national level as well as separately across groups of states classified as high-focus and non-high-focus. We carry out several sensitivity analyses including a subgroup analysis stratified by possession of an immunization card.ResultsReceipt of financial assistance from JSY led to an increase in immunization rates ranging from 3.1 (95%CI 2.2-4.0) percentage points for one dose of polio vaccine to 9.1 (95%CI 7.5-10.7) percentage points in the proportion of fully vaccinated children. Our findings also indicate JSY led to increased post-partum check-up rates and healthy early breastfeeding practices around the time of childbirth. No effect of JSY was found on exclusive breastfeeding practices and care-seeking behaviors. Effect sizes were consistently larger in states identified as being a key focus for the program. In an analysis stratified by possession of an immunization card, there was little to no effect of JSY among those with vaccination cards, while the effect size was much larger than the base case results for those missing vaccination cards, across nearly all immunization outcomes.ConclusionsEarly results suggest the JSY program led to a significant increase in childhood immunization rates and some healthy reproductive health behaviors, but the structuring of financial incentives to pregnant women and health workers warrants further review. Causal interpretation of our results relies on the assumption that propensity scores balance unobservable characteristics.
| S-EPMC4193776 | biostudies-literature
Project description:BackgroundIn 2009 the state government of Madhya Pradesh, India launched an emergency obstetric transportation service, Janani Express Yojana (JEY), to support the cash transfer program that promotes institutional delivery. JEY, a large scale public private partnership, lowers geographical access barriers to facility based care. The state contracts and pays private agencies to provide emergency transportation at no cost to the user. The objective was to study (a) the utilization of JEY among women delivering in health facilities, (b) factors associated with usage, (c) the timeliness of the service.MethodsA cross sectional facility based study was conducted in facilities that carried out > ten deliveries a month. Researchers who spent five days in each facility administered a questionnaire to all women who gave birth there to elicit socio-demographic characteristics and transport related details.Results35% of women utilised JEY to reach a facility, however utilization varied between study districts. Uptake was highest among women from rural areas (44%), scheduled tribes (55%), and poorly educated women (40%). Living in rural areas and belonging to scheduled tribes were significant predictors for JEY usage. Almost 1/3 of JEY users (n = 104) experienced a transport related delay.DiscussionThe JEY service model complements the cash transfer program by providing transport to a facility to give birth. A study of the distribution of utilization in population subgroups suggests the intervention was successful in reaching the most vulnerable population, promoting equity in access. While 1/3 of women utilized the service and it saved them money; 30% experienced significant transport related delays in reaching a facility, which is comparable to women using public transportation. Further research is needed to understand why utilization is low, to explore if there is a need for service expansion at the community level and to improve the overall time efficiency of JEY.
| S-EPMC4020755 | biostudies-literature
Project description:BACKGROUND:This study aims to explore the potential association between unintended pregnancy and maternal health complications. Secondarily, we test whether antenatal care (ANC) and community health worker (CHW) visits moderate the observed association between unintended pregnancy and maternal health complications. METHODS:Cross sectional data were collected using a multistage sampling design to identify women who had a live birth in the last 12?months across 25 highest risk districts of Uttar Pradesh (N?=?3659). Participants were surveyed on demographics, unintendedness of last pregnancy, receipt of ANC clinical visits and community outreach during pregnancy, and maternal complications. Regression models described the relations between unintended pregnancy and maternal complications. To determine if receipt of ANC and CHW visits in pregnancy moderated associations between unintended pregnancy and maternal complications, we used the Mantel-Haenzel risk estimation test and stratified logistic models testing interactions of unintended pregnancy and receipt of health services to predict maternal complications. RESULTS:Around one-fifth of the women (16.9%) reported that their previous pregnancy was unintended. Logistic regression analyses revealed that unintended pregnancy was significantly associated with maternal complications- pre-eclampsia (AOR:2.06; 95% CI:1.57-2.72), postpartum hemorrhage (AOR:1.46; 95% CI: 1.01-2.13) and postpartum pre-eclampsia (AOR:2.34; 95% CI:1.47-3.72). Results from the Mantel Haenszel test indicated that both ANC and CHW home visit in pregnancy significantly affect the association between unintended pregnancy and postpartum hemorrhage (p?<?0.001). CONCLUSION:Unintended pregnancy is associated with increased risk for maternal health complications, but provision of ANC clinical visits and CHW home visits in pregnancy may be able to reduce potential effects of unintended pregnancy on maternal health.
| S-EPMC7106893 | biostudies-literature
Project description:BackgroundWomen in South Asia often return to their natal home during pregnancy, for childbirth, and stay through the postpartum period-potentially impacting access to health care and health outcomes in this important period. However, this phenomenon is understudied (and not even named) in the demographic or health literature, nor do we know how it impacts health.ObjectiveThe aim of this study is to measure the magnitude, timing, duration, risk factors and impact on care of this phenomenon, which we name Temporary Childbirth Migration.MethodsUsing data from 9,033 pregnant and postpartum women collected in 2019 in two large states of India (Madhya Pradesh and Bihar) we achieve these aims using descriptive statistics and logistic regression models, combined with qualitative data from community health workers about this practice.ResultsWe find that about one third of women return to their natal home at some point in pregnancy or postpartum, mostly clustered close to the time of delivery. Younger, primiparous, and non-Hindu women were more likely to return to their natal home. Women reported that they went to their natal home because they believed that they would receive better care; this was born out by our analysis in Bihar, but not Madhya Pradesh, for prenatal care.ConclusionsTemporary childbirth migration is common, and, contrary to expectations, did not lead to disruptions in care, but rather led to more access to care.ContributionWe describe a hitherto un-named, underexplored yet common phenomenon that has implications for health care use and potentially health outcomes.
| S-EPMC10852266 | biostudies-literature
Project description:Received wisdom in the field of fungal biology holds that the process of editing a genome by transformation and homologous recombination is inherently mutagenic. However, that belief is based only on circumstantial evidence. We provide the first direct measurement of the effects of transformation on the genome by sequencing the genomes of 29 transformants and 30 untransformed controls to high coverage. Contrary to the received wisdom, our results show that transformation of DNA flanked by long targeting sequences, followed by homologous recombination and selection on a drug marker, is extremely safe. Gene deletion may select for a few mutations that occur after transformation, but even then we found fewer than two point mutations per gene deletion strain. We also tested these strains for changes in gene expression and found only a few genes that were consistently differentially expressed between wild types and strains with a drug resistance marker inserted. As part of this process, we provide the first published genome sequence of the commonly used laboratory strain Cryptococcus neoformans var. grubii strain KN99.
2017-09-26 | GSE104198 | GEO
Project description: Not available
| S-EPMC5953198 | biostudies-literature
Project description:Background:Pregnancy outcomes might be affected by unintended pregnancy such as preeclampsia, preterm birth, cesarean section and low birth weight. The aim of the present study is to assess the association between unintended pregnancy and pregnancy outcomes. Methods:This was a cross-sectional study conducted in 103 hospitals in Tehran, Iran, in July 2015. The data were collected by trained midwives. The interested independent variable was unintended pregnancy and also preeclampsia, weight gain during pregnancy, preterm birth, cesarean section and low birth weight were considered as interested outcomes, and the association of unintended pregnancy and interested outcomes were assessed. Results:Out of 5152 cases, 1021 (19.82%) cases were unintended pregnancy. There was no significant relationship between unintended pregnancy and low birth weight (adjusted OR?0.67, 95% CI 0.403-1.13, P?=?0.138), the risk of preterm birth (adjusted OR?1.15, 95% CI 0.850-1.57, P?=?0.351) and preeclampsia (adjusted OR?1.21, 95% CI 0.846-1.75, P?=?0.289). The results of multiple linear regression model showed that the mean difference between two groups was 0.70 kg, and weight gain mean in unintended pregnant women significantly was lower than unintended pregnant women (mean difference?=?0.70, 95% CI 0.14-1.26 kg, P?=?0.014). Multiple logistic regression showed that after adjusting confounders, there was a significant relationship between unintended pregnancy and cesarean section, and the adjusted odds of cesarean section in unintended pregnant women was 1.32 times of intended pregnant women (95% CI 1.07-1.63, P?=?0.009). Conclusion:We found higher risk of cesarean section and inappropriate weight gain during pregnancy as adverse outcomes of unintended pregnancy in adjusted model.
| S-EPMC6430264 | biostudies-literature