Abstract for: Understanding Causal Pathways to Disparities in Institutional Delivery Rates Among Primiparous and Multiparous Marginalized Wom

Women in India are encouraged to deliver in health facilities through the Janani Suraksha Yojana (JSY) conditional cash-transfer scheme provided to pregnant women and accompanying front-line health workers (Accredited Social Health Activists, ASHAs). Despite additional governmental efforts catalyzed by a statewide technical-support program led by CARE India and funded by the Bill and Melinda Gates Foundation, both institutional delivery rates in public and private facilities among Scheduled Caste and Tribe women in West Champaran district remained 10-15 percentage points lower for multiparous than primiparous women in 2014-19. The objectives of our study are to understand the major causal mechanism that gave rise to the disparities among the IDRs between marginalized women with parity one and two, identify high-impact intervention points in the system, and design a well-balanced intervention strategy to boost institutional deliver rates. Through simulation and model-based analysis, we compare, contrast, and design the most feasible and effective policy. We recommend improving ASHAs’ work performance and ambulance availability to increase institutional delivery rate for women with parity one and two.