Sidney Kristi, Tolhurst Rachel, Jehan Kate, Diwan Vishal, De Costa Ayesha
Karolinska Institutet, Public Health Sciences, Tomtebodavägen 18, Stockholm, 171 77, Sweden.
Liverpool School of Tropical Medicine, Liverpool, L3 5QA, Merseyside, UK.
BMC Pregnancy Childbirth. 2016 Mar 4;16:47. doi: 10.1186/s12884-016-0834-y.
In 2005-06, only 39 % of Indian women delivered in a health facility. Given that deliveries at home increase the risk of maternal mortality, it was in this context in 2005, that the Indian Government implemented the Janani Suraksha Yojana program that incentivizes poor women to give birth in a health facility by providing them with a cash transfer upon discharge. JSY helped raise institutional delivery to 74 % in the eight years since its implementation. Despite the success of the JSY in raising institutional delivery proportions, the large number of beneficiaries (105 million), and the cost of the program, there have been few qualitative studies exploring why women participate (or not) in the program. The objective of this paper was to explore this.
In March 2013, we conducted 24 individual in-depth interviews with women who delivered within the previous 12 months in two districts of Madhya Pradesh, India. Qualitative framework analysis was used to analyze the data.
Our findings suggest that women's increased participation in the program reflect a shift in the social norm. Drivers of the shift include social pressure from the Accredited Social Health Activist (ASHA) to deliver in a health facility, and a growing individual perception of the importance for 'safe' and 'easy' delivery which was most likely an expression of the new social norm. While the incentive was an important influence on many women's choices, others did not perceive it as an important consideration in their decision to deliver in a health facility. Many women reported procedural difficulties to receive the benefit. Retaining the cash incentive was also an issue due to out-of-pocket expenditures incurred at the facility. Non-participation was often unintentional and caused by personal circumstances, poor geographic access or driven by a perception of poor quality of care provided in program facilities.
In summary, while the cash incentive was important for some women in facilitating an institutional birth, the shift in social norm (possibly in part facilitated by the program) and therefore their own perceptions has played a major role in them giving birth in facilities.
在2005 - 2006年期间，仅有39%的印度女性在医疗机构分娩。鉴于在家分娩会增加孕产妇死亡风险，正是在这种背景下，2005年印度政府实施了“贾纳尼·苏拉卡莎·尤贾纳”计划，该计划通过在贫困妇女出院时提供现金转移支付，激励她们在医疗机构分娩。自实施以来的八年里，“贾纳尼·苏拉卡莎·尤贾纳”计划促使机构分娩率提高到了74%。尽管该计划在提高机构分娩比例方面取得了成功，受益人数众多（1.05亿），且成本高昂，但很少有定性研究探讨女性参与（或不参与）该计划的原因。本文的目的就是对此进行探究。
2013年3月，我们对印度中央邦两个地区在过去12个月内分娩的女性进行了24次个人深度访谈。采用定性框架分析法对数据进行分析。
我们的研究结果表明，女性对该计划参与度的提高反映了社会规范的转变。这种转变的驱动因素包括经认证的社会健康活动家（ASHA）要求在医疗机构分娩的社会压力，以及个人对“安全”和“轻松”分娩重要性的认识不断增强，这很可能是新社会规范的一种体现。虽然激励措施对许多女性的选择有重要影响，但其他女性在决定是否在医疗机构分娩时，并不认为这是一个重要的考虑因素。许多女性报告在领取福利时遇到程序困难。由于在医疗机构产生的自付费用，保留现金激励也成了一个问题。不参与往往是无意的，是由个人情况、地理位置不便或认为计划实施机构提供的护理质量差所导致的。
总之，虽然现金激励对一些女性选择在医疗机构分娩很重要，但社会规范的转变（该计划可能在一定程度上促成了这种转变）以及她们自身的观念在她们选择在医疗机构分娩中起到了主要作用。
