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American Public Health Association
133rd Annual Meeting & Exposition
December 10-14, 2005
Philadelphia, PA
APHA 2005
4332.0: Tuesday, December 13, 2005 - 4:30 PM

Abstract #101821

Evaluating program effects on institutional delivery in Peru

Michael J. McQuestion, PhD, MPH, Department of Population and Family Health Sciences, Johns Hopkins Bloomberg School of Public Health, E4142 Hygiene, 615 N. Wolfe Street, Baltimore, MD 21210, 410-502-6037, mmcquest@jhsph.edu and Anibal Velasquez, MD, Universidad de San Carlos, Av. del Sur 368 Dep 304 , Lima, PERU, Urb. Chacarilla del Estanque, Surco, Lima, Peru.

We evaluate the joint effects of two targeted Peruvian health programs on a mother's choice of whether to deliver in a public emergency obstetric care (EmOC) facility. The national maternal and child health insurance, or SMI Program, provided delivery care coverage to Peru's poorest households beginning in 1998. During 1996-2002, Proyecto 2000 sought to improve the quality of EmOC and increase utilization of public EmOC facilities in the districts reporting the highest maternal and neonatal mortality levels. Our data come from the Proyecto 2000 endline evaluation, which sampled 5335 mothers living in the catchment areas of 29 treatment and 29 matched control EmOC facilities. Using propensity scoring and two quality of care indices, we find significantly higher quality of care in Proyecto 2000 treatment facilities. Using variance components logistic models, we find a mother enrolled in the SMI Program was more likely to have delivered her last child in a public EmOC, controlling for household constraints. Residence in a Proyecto 2000 treatment area did not significantly affect the choice. A cross-level interaction term was insignificant, indicating the two program effects were independent. We conclude that a direct subsidy for maternal care was a more powerful incentive for Peruvian mothers to use EmOC facilities than the quality of care on offer.

Learning Objectives:

Keywords: Evaluation, Maternal Care

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.

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The 133rd Annual Meeting & Exposition (December 10-14, 2005) of APHA