Changes in the Proportion of Facility-Based Deliveries and Related Maternal Health Services Among the Poor in Rural Jhang, Pakistan: Results From a Demand-Side Financing Intervention

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Background: Demand-side financing projects are now being implemented in many developing countries, yet evidence showing that they reach the poor is scanty.

Methods:  A maternal health voucher scheme provided voucher-paid services in Jhang, a predominantly rural district of Pakistan, during 2010. A pre-test/post-test quasi-experimental design was used to assess the changes in the proportion of facility-based deliveries and related maternal health services among the poor. Household interviews were conducted with randomly selected women in the intervention and control union councils, before and after the intervention.

Results: Bivariate analysis showed significant increases in the institutional delivery rate among women in the fourth or fifth wealth quintiles in the intervention union councils but no significant changes in this indicator among women in the same wealth quintiles in the control union councils. Multivariate analysis showed that the increase in institutional delivery among poor women relative to non-poor women was significantly greater in the intervention compared to the control union councils.

Conclusions: Demand-side financing projects using vouchers can be an effective way of reducing inequities in institutional delivery.