Madam Secretary

$30 incentive convinces more Indian women to deliver babies at the hospital

$30 incentive convinces more Indian women to deliver babies at the hospital

Last month, Secretary Clinton commended the Bill and Melinda Gates Foundation for its $1.5 billion contribution toward women’s and children’s health, saying, “Focusing on women is not only the right thing to do, but it is also the smart thing to do, because investing in the health of women also improves the health of their families and communities.”

I expect Clinton would thus be intrigued by a program in India that aims to reduce maternal morality by providing $30 cash incentives to poor women to give birth in hospitals, and not on the dirt floors of thatched-roof homes.

Why would any woman need to essentially be paid to give birth at a hospital, where the chances of death are much lower? Turns out, getting to a hospital is not so easy, for a variety of reasons. Last week’s Washington Post article about the program mentions one rural woman for whom it would cost $4 to take a taxi to the hospital — a long of money in a poor farming community where the $30 incentive is about three weeks of a family’s pay. 

The hurdles aren’t just economic, but also related to education, class divisions, and patriarchy. The articles says lack of education means a lot of people don’t fully appreciate that medical care in a hospital setting can mean the difference between a happy, healthy mom — and a dead one.

Also, in a society with sharp caste and class divisions, many poor, illiterate mothers-to-be don’t have the assertiveness to set foot in the hospital, according to the article. Perhaps if you’re from a marginalized, look-down-upon caste or social class, going to a relatively modern and clean hospital can be intimidating. One woman told the Post, “Before this [program], we didn’t have a hint of what to do.… The hospital was very confusing. We weren’t sure who to talk to or what we needed.”  Another woman in the article said she was scared to go to the hospital.

The article also mentioned the patriarchal culture, stating that in rural India, many poor husbands don’t let their pregnant wives to go to the hospital.

But money talks — including in Indian languages. In Bihar and Uttar Pradesh, two of India’s poorest states, the percentage of women delivering in medical facilities more than doubled from less than 20 percent in 2005 to almost 50 percent in 2008. Physicians say that’s due to the incentive program.

India still has a long way to go on maternal mortality — its rate of maternal mortality is around 10 times China’s rate. Women’s education and economic development are the long-term fix to the problem, but until then, it’s the lure of $30.