Examining the Effect of Maternity Cash Incentives Under Nepal's Aama Program on the Continuum of Maternity Care: A Difference-in-Differences Analysis of NDHS 2011 to 2022.
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| Title: | Examining the Effect of Maternity Cash Incentives Under Nepal's Aama Program on the Continuum of Maternity Care: A Difference-in-Differences Analysis of NDHS 2011 to 2022. |
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| Authors: | Rawat, Poonam1 (AUTHOR), Hussey, Jon M.1 (AUTHOR), Zunaid Ahsan, Karar1 (AUTHOR) zunaid@email.unc.edu |
| Source: | Inquiry (00469580). 4/24/2026, Vol. 63, p1-12. 12p. |
| Subject Terms: | *Health services accessibility, *Endowments, *Research methodology, *Comparative studies, *Educational attainment, Maternal health services, Research funding, Maternal age, Evaluation of human services programs, Socioeconomic factors, Spouses, Residential patterns, Continuum of care, Descriptive statistics, Postnatal care, Rural health services, Prenatal care, Cluster sampling, Parity (Obstetrics), Medical care costs, Regression analysis, Poverty |
| Geographic Terms: | Nepal |
| Abstract: | This study examines whether higher maternity cash incentives under Nepal's Aama Program —intended to reduce household out-of-pocket (OOP) expenditures for delivery care—are associated with completion of the continuum of maternity care across Nepal's three ecological regions: mountainous, hilly, and Terai. A difference-in-differences (DID) analysis was conducted using data from the Nepal Demographic and Health Surveys 2011 and 2022. The treatment group included mountainous and hilly districts (n = 55), which received higher cash incentives for facility deliveries, while the control group comprised Terai districts (n = 20). The primary outcome was a binary 'continuum of care' indicator, coded as 1 if a woman received 4 or more antenatal care (ANC) visits, at least 1 ANC from a skilled provider, and skilled birth attendance (SBA) during delivery, and 0 otherwise. From 2011 to 2022, continuum-of-care coverage increased from 16.2% to 46.3% in treatment districts and from 18.9% to 42.4% in control districts, yielding an unadjusted DID of 6.7 percentage points. The regression DID analysis found that the higher cash incentive in hilly and mountainous regions was associated with a statistically significant 0.7 percentage point increase in the likelihood of completing the continuum of maternity care (P =.014). While statistically significant, the magnitude is modest, indicating incremental improvement rather than a transformational shift in service utilization. Mother's age, mother's education, and husband's education were positively associated with completion, whereas poverty, rural residence, and higher parity were negatively associated (all P <.001). These findings suggest that targeted financial incentives can positively influence maternal health service utilization, but achieving larger improvements will likely require refining the program and addressing non-financial barriers. Limitations include the two-period DID design, reliance on parallel trends, and potential residual confounding. [ABSTRACT FROM AUTHOR] |
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| Database: | Education Research Complete |
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| Abstract: | This study examines whether higher maternity cash incentives under Nepal's Aama Program —intended to reduce household out-of-pocket (OOP) expenditures for delivery care—are associated with completion of the continuum of maternity care across Nepal's three ecological regions: mountainous, hilly, and Terai. A difference-in-differences (DID) analysis was conducted using data from the Nepal Demographic and Health Surveys 2011 and 2022. The treatment group included mountainous and hilly districts (n = 55), which received higher cash incentives for facility deliveries, while the control group comprised Terai districts (n = 20). The primary outcome was a binary 'continuum of care' indicator, coded as 1 if a woman received 4 or more antenatal care (ANC) visits, at least 1 ANC from a skilled provider, and skilled birth attendance (SBA) during delivery, and 0 otherwise. From 2011 to 2022, continuum-of-care coverage increased from 16.2% to 46.3% in treatment districts and from 18.9% to 42.4% in control districts, yielding an unadjusted DID of 6.7 percentage points. The regression DID analysis found that the higher cash incentive in hilly and mountainous regions was associated with a statistically significant 0.7 percentage point increase in the likelihood of completing the continuum of maternity care (P =.014). While statistically significant, the magnitude is modest, indicating incremental improvement rather than a transformational shift in service utilization. Mother's age, mother's education, and husband's education were positively associated with completion, whereas poverty, rural residence, and higher parity were negatively associated (all P <.001). These findings suggest that targeted financial incentives can positively influence maternal health service utilization, but achieving larger improvements will likely require refining the program and addressing non-financial barriers. Limitations include the two-period DID design, reliance on parallel trends, and potential residual confounding. [ABSTRACT FROM AUTHOR] |
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| ISSN: | 00469580 |
| DOI: | 10.1177/00469580261441754 |
