Cash Transfers and Delivery Care: Evidence from the Safe Delivery Incentive Program in Nepal

Abstract

This paper examines the effects of the Safe Delivery Incentive Program in Nepal, a cash transfer program that conditions benefits on women giving birth in a health facility. The cash transfers reduce the cost of facility deliveries, with greater reductions for women residing in districts with a lower Human Development Index (HDI). I evaluate the effects of this program on delivery care by comparing differences over time between low-parity women, who became eligible at program onset, and high-parity women, who became eligible two years later. Using three waves of the Demographic and Health Survey Nepal, I find that eligible low-parity women in high HDI districts are 8.6 percentage points more likely to deliver in a health facility. These women are 7.5 percentage points more likely to deliver with skilled health personnel instead of giving birth at home without the assistance of skilled health personnel. In contrast, eligible low-parity women in low HDI districts are no more likely to deliver in a health facility but are 5 percentage points more likely to deliver with skilled personnel in the home. Low-parity women in low HDI districts are less responsive despite higher program benefits, suggesting that these women are constrained by barriers beyond cost. Heterogeneous effects show a more pronounced response to eligibility for more educated, wealthier, and empowered women. These results indicate that home deliveries are typical due to high barriers to facility usage and reliance on customs. Moreover, I find that high-parity women show no measurable response after becoming eligible two years into the program. I also show spillovers to other forms of health care utilization, with eligible women increasing childhood vaccination usage in high and low HDI districts. Results suggest that the increase in deliveries with skilled personnel has informational value.

Manda Tiwari
Manda Tiwari
PhD candidate in Economics

I am a PhD candidate in Economics at the University of Iowa.