Conditional cash incentives, community health workers, and continuum of maternal and child healthcare: evidence from India

Abstract

Continuum of care in maternal and child health (MCH) services is a key strategy for improving MCH outcomes. This study examines the effect of conditional cash incentives and community health worker support on the uptake of the continuum of MCH care, defined as the sequential utilization of antenatal, skilled delivery, and postnatal services. Using nationally representative cross-sectional datasets and a difference-in-difference framework, we find that both interventions significantly improved the continuum of MCH care. The intent-to-treat estimates showed a 5-percentage-point increase in the proportion of women completing the full continuum of care. Heterogeneity analysis revealed more substantial effects among educated women, those in urban areas, and those in higher wealth quintiles. Insights from qualitative interviews with mothers and community health workers suggested that awareness of antenatal care and institutional delivery increased; however, postnatal care was typically sought only in response to complications, and the uptake of all recommended MCH services as a full continuum was often hindered by intersecting demand- and supply-side barriers. Notably, participants emphasized that sustained community health worker engagement had a more significant impact on ensuring care continuity than cash incentives alone. These findings highlight the need for policy strategies that enhance community health worker-led support mechanisms, combined with financial incentives, to promote the comprehensive and sustained use of maternal health services among disadvantaged population groups.