Income expectations and child health: Evidence from a maternity support programme in India

• This study evaluated a programme that provides income support to pregnant women in rural India.
• The programme had positive effects on child and maternal health, even though it was not working efficiently in Bihar.
• This is because it increased the intervals between the first and second pregnancies, which is known to be beneficial to child health.
• There is a need for interventions that combine programmes on maternal and child health pratices with financial literacy.
• Such programmes should emphasise the importance of intervals between births, as well as helping households save for the period of pregnancy and child birth.

Our study evaluated the Indira Gandhi Matritya Sahayog Yojana (IGMSY) programme in Bihar. This provides income support to rural women for a critical 9 month period, spanning the last trimester of pregnancy and the first 6 months of the child’s life. It is applicable only to the first two live births. Funds for IGMSY are conditional on health behaviours, including full child vaccination.

We found that the programme was not functioning efficiently in Bihar. Only 5% of women received funds intended for their first child before the onset of their second pregnancy, and funds were disbursed without the conditions being verified. Despite this, the health of the first child in families which received IGMSY funding was better than in families which did not. This was largely due to the greater interval between the first and second child in families receiving support from the programme. We found that families were postponing their second pregnancy in expectation of greater income through the programme, which would allow them to cover the costs of pregnancy and early childhood.

Fertility decisions, such as birth spacing, are important means of influencing child health. However, India’s flagship programme for Maternal and Child Health, the Integrated Child Development Service (ICDS) does not currently pay sufficient attention to counselling on the subject of birth intervals.

Our results also suggest that households are unwilling to borrow against expected future income for expenditures that improve maternal and child health. This highlights the dependence of consumption on current income. Financial literacy programmes should therefore be combined with child and maternal health programmes.