Understanding Women's Perception of Quality and Satisfaction with care: Role of Conditional Cash Transfer Scheme in Promoting Institutional Births

Half million women die annually due to childbirth and India alone accounts for fifth of global maternal mortality burden. Efforts under health sector reform program to prevent death and morbidity introduced Janani Suraksha Yojana (JSY), conditional cash transfer scheme promoting institutional deliveries. Evaluation studies have acknowledged JSY as effective in generating demand, however, none has touched upon women's perspective on quality of care (QoC) and their level of satisfaction. The paper explores issues around women's perceptions of quality and determinants of care for home and facility births in context of JSY. The study uses qualitative method; in-depth interview, focus group discussion with recently delivered mother, who have delivered in primary level facility and at home, randomly selected around catchment areas of functional facility, in Jharkhand, India. Though cash incentive is instrumental for institutional delivery but other determinants are responsible like: assurance of appropriate medical care for complication, feeling of privacy, comfort at facility due to presence of family members in delivery room, promptness in care. Factors that are deterring utilization of health services are prevalence of informal payment at facility, cultural practice, lack of trust on providers. Lack of birth preparedness and readily available transport is also leading to unexpected homebirths. Women have limited expectations of QoC as seeking pain reduction, fast labor is most desirable, she has no ability to judge hygiene or QoC from clinical perspective. JSY is stimulant in increasing institutional delivery but whether cash incentive schemes themselves a significant facilitator of patient satisfaction needs further exploration.