What are the JSY (Janani Suraksha Yojana) cash incentives for institutional deliveries?

JSY Cash Incentives for Institutional Deliveries

The Janani Suraksha Yojana (JSY) provides cash incentives ranging from ₹600 to ₹1,400 for eligible women to promote institutional deliveries in India, with the amount varying based on geographic location (Low Performing States vs. High Performing States) and parity. 1, 2

Cash Incentive Structure

The JSY cash transfer program operates on a conditional basis, providing monetary incentives to economically disadvantaged women who deliver in healthcare institutions rather than at home. 1

Eligibility and Payment Amounts

• JSY-eligible women are those from lower socioeconomic strata who meet program criteria based on poverty status and geographic location 1, 3
• Women in Low Performing States (including Madhya Pradesh, Uttar Pradesh, and Jharkhand) receive higher incentive amounts compared to High Performing States 4
• The program specifically targets rural, illiterate, and primary-literate women from lower socioeconomic backgrounds 2
• Multiparity (having multiple previous births) can act as a deterring factor for program uptake despite eligibility 1

Payment Distribution

• Cash is distributed through ASHA workers (Accredited Social Health Activists) who serve as community health workers facilitating the program 4
• Payment occurs after institutional delivery is completed 1
• 90.2% of women who completed three or more antenatal check-ups received cash, compared to lower rates among those with fewer visits 1

Program Impact on Institutional Delivery Rates

JSY-eligible women who received cash incentives were 1.5 times more likely to deliver in government institutions compared to non-eligible women. 1

Delivery Uptake Statistics

• 78.8% of women who received cash opted for institutional delivery, significantly higher than the 64.5% rate among those who did not receive incentives 1
• Overall institutional deliveries increased by 42.6% following JSY implementation in tertiary care settings 2
• Government institutions were strongly preferred for childbirth among all groups regardless of JSY eligibility status 1
• Without the cash incentive, the likelihood of institutional delivery was reduced by half 1

Barriers Despite Cash Incentives

Several factors continue to impede institutional delivery uptake even with financial incentives:

• Distance to 24×7 delivery facilities beyond 5 km significantly reduces institutional delivery rates (74.8% vs. 81.8% for closer facilities) 1
• Islamic religion is associated with lower institutional delivery rates (62.7% vs. 83.2%) 1
• Higher opportunity costs of using healthcare facilities versus home delivery often outweigh the cash incentive value 4
• Trust in traditional birth attendants and the cultural belief that childbirth is a "natural event" requiring no medical intervention remain prevalent impeding factors 4
• Many women wait until complications arise before seeking institutional care, resulting in transportation delays and inability to reach facilities in time 4

Critical Quality Concerns

Despite increased institutional delivery rates, birth attendants at JSY facilities demonstrate alarmingly low competence at providing emergency obstetric care, with 75% of staff scoring below 35% on competency assessments. 5

Competency Deficits

• The mean emergency obstetric care competence score was only 5.4 out of 20 points among 233 birth attendants surveyed 5
• Only 14% of respondents were competent at initial assessment, 58% at making correct clinical diagnoses, and 20% at providing appropriate first-line care 5
• Competence was marginally higher among those with Skilled Birth Attendant training, general nursing and midwifery qualifications, those at higher facility levels, and those conducting more than 30 deliveries monthly 5

Maternal Morbidity and Mortality Patterns

Following JSY implementation, there were significant increases in high-risk cases presenting at institutions, including eclampsia, pre-eclampsia, polyhydramnios, oligohydramnios, antepartum hemorrhage, postpartum hemorrhage, and malaria. 2

• Eclampsia, pre-eclampsia, and severe anemia remained the leading causes of maternal mortality both before and after JSY implementation 2
• Anemia was the most common morbidity factor observed among women delivering in institutions 2
• The maternal mortality ratio follows a secular trend rather than showing dramatic improvement proportional to increased institutional delivery rates 5

Program Implementation Challenges

Inclusion and Exclusion Errors

• Approximately 36.8% of JSY-ineligible women received cash payments, indicating significant targeting errors 1
• Only 27.3% of eligible mothers actually benefited from the JSY scheme, and just 14.5% received cash benefits, revealing substantial coverage gaps 3

Enabling Factors for Success

ASHA workers' support services—including transport arrangement, facility escort, and on-site support—emerged as the major enabling factor, more influential than the cash incentive itself. 4

• Interpersonal communication for awareness generation has greater influence on institutional healthcare uptake than cash incentives alone 4
• Women who had more than 6 antenatal check-ups were significantly more likely to avail JSY benefits 3
• Belonging to Hindu religion was a significant predictor of program utilization in urban slum populations 3

Geographic and Access Considerations

The program operates within India's tiered facility system for maternal care, which includes primary health centers for normal deliveries, secondary facilities with obstetrician-gynecologists for high-risk cases, and tertiary centers for complex complications. 6

Recommendations for Improvement

Urgent efforts are required to increase birth attendant competence at managing obstetric complications to translate institutional delivery gains into actual maternal mortality reduction. 5

• Strengthen ASHA worker support services focused on marginalized populations, as these services enable program uptake more effectively than cash alone 4
• Improve public healthcare facility quality to build trust and encourage utilization 4
• Target difficult-to-access areas with special measures and encourage more antenatal visits as prerequisites for program impact 3
• Address competency gaps in emergency obstetric care among facility staff through enhanced training and supervision 5
• Recognize that births in JSY facilities cannot currently be considered to have access to competent emergency obstetric care given documented skill deficits 5