Breakthroughs for Healthy Birth: What “Health Diaries” Tell Us About Financial and Medical Preparation for Giving Birth Among Women in West Bengal and Jharkhand

India accounts for the highest number of maternal and child deaths globally. To reduce maternal and child mortality, the government introduced a cash transfer scheme in 2005 to encourage women of low socioeconomic status to give birth in health facilities, as childbirth costs have often been cited as barriers to facility-based care. 

This research brief presents results from a series of “Health Diaries” - or frequent surveyor-administered surveys - conducted with 45 women in West Bengal and Jharkhand, India to uncover how low-income women prepare for and experience childbirth and its associated costs. Key findings include:

1. Low-income households are incurring possibly catastrophic expenses for prenatal care and childbirth, despite available government programs meant to mitigate these costs.
2. Households are actively saving for prenatal and/or childbirth expenses, even if they plan to give birth at home.
3. Most of the women in Jharkhand interviewed for this research gave and continue to give birth at home, despite government support to encourage institutional birth.
4. Households are quickly forced to mortgage large assets when they have exhausted at-home savings and loans they can receive from their groups.
5. Financial products designed to assist women in preparing for and covering childbirth costs will have to be designed in such a way that they respond to the urgency in which women feel they have to respond to these costs.