Conditional Cash Transfer to Promote Institutional Deliveries in India: Toward a Sustainable Ethical Model to Achieve MDG 5A

The Millennium Development Goal (MDG) 5 A states that the maternal mortality ratio has to be reduced to three-quarters between 1990 and 2015. The target for India is a maternal mortality ratio of 109/100,000 live births. The Janani Suraksha Yojna (JSY) (Maternal Protection Scheme) is a centrally sponsored conditional cash transfer scheme to promote institutional deliveries and thus ensure safe delivery and reduce maternal mortality. The JSY scheme and its various evaluations were reviewed. The Tannahill's ethical framework was applied to the JSY and analyzed. Evaluations have shown that the JSY has significantly increased institutional deliveries. The public health system is not fully geared up for delivering good quality maternal health services. Thus encouraging women to go to them violates the principle of doing good. There are several barriers for availing the scheme. Procuring the certificates to meet eligibility can be difficult. The women do not have power over the cash incentive. There are large inequities in access to the JSY scheme based on socioeconomic status, caste and education. The accountability mechanisms for the scheme are weak at the grassroots level. Without an overall improvement in health system and awareness among women, the JSY cannot be said to empower the women in a sustainable way. In order, that the increases in institutional deliveries due to JSY are more than just a Hawthorne effect, which is a change in behavior just due to the fact that the population is being closely observed and intervened, there is a need to bridge the ethical gaps in the program to make it an empowering, sustainable, accountable and just one.