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In developmental programming, more so over the last two decades, there has been an increased interest in and use of cash transfer programs to improve nutrition and health outcomes. There is considerable global evidence on the impact of the cash transfer programs-conditional or unconditional-on food security, dietary diversity, utilization of healthcare services, child cognitive development, and on morbidity, anemia, and anthropometry for both mothers and children (Raghunathan et. al, 2017). This evidence is largely from African, Latin American and American contexts.In India, conditional cash transfer schemes (CCTs) have been extensively implemented, more so in the context of maternal and child health, and girls' empowerment. One of the earliest schemes was the Muthulakshmi Reddy Maternity Benefit (MRMB) scheme and the Girl Child Protection Scheme implemented in the state of Tamil Nadu in the 1990s (Department of Health and Family Welfare, Government of Tamil Nadu). This was followed by the Janani Suraksha Yojna (JSY), a national scheme introduced in 2005, designed to promote institutional deliveries (Ministry of Health and Family Welfare, Government of India). In 2017, the Government of India launched the Pradhan Mantri Matru Vandana Yojana (PMMVY), which is implemented as per the provisions of the National Food Security Act (NFSA) 2013. The scheme provides financial support to pregnant and lactating mother to improve the health and nutrition for the mother and child, as well as compensate for wage loss, if any (Ministry of Women and Child Development, Government of India).While CCTs have been implemented in India for over two decades, evidence on their impact and effectiveness is limited. India specific evidence is largely in the context of the JSY, where evidence indicates an increase in medically supervised births (Joshi and Sivaram, 2014;Lim S et. al, 2009;Randive et.al) and increase in access to Antenatal care (ANC) (Lim S et. al, 2009). Challenges with poor coverage of the scheme, and poor service quality were noted. After the JSY, the PMMVY is India's flagship maternity benefit program. Evidence on PMMVY is limited to evaluations done during the program pilot phase and studies done at state and district levels. There are few studies that review the scheme at a national level.To understand the impact of the PMMVY on maternal and child nutrition and its effectiveness in improving service uptake, we examined the shift in key health and nutrition indicators in India, over time, comparing groups exposed and those not exposed to the scheme, using secondary data from the National Family Health Surveys (NFHS) and the Health Management Information System (HMIS data).This paper first provides a brief about the scheme, followed by a summary of the available evidence of the effectiveness of the scheme. We then present our methods and analysis, and the results of the impact of PMMVY.Launched on January 1, 2017, the PMMVY seeks to provide a cash incentive for partial compensation for the wage loss, so that women can rest before and after delivery of the first child and can consume nutritious food. In effect, the scheme seeks to improve maternal and child health and nutrition. Through conditions associated with the cash transfer, the scheme also seeks to improve health seeking behavior among Pregnant Women and Lactating Mothers (PW the results however were not statistically significant. There were no significant impacts on stunting or anemia. Children eligible for the program were 9% more likely to be fully immunized compared to those in the control group. Significant improvement in Polio-3 vaccination, but no statistically significant effects for individual vaccinations when accounting for multiple inferences were noted (Haaren and Kloner, 2021).A systematic review by Kumar et al (2024), showed that PMMVY created a positive impact in increasing utilization of key maternal and child health services such as antenatal care visits, institutional deliveries, and timely childhood immunization and vaccinations. It also noted that the evidence on the impact of PMMVY on maternal health outcomes was somewhat mixed and statistically inconclusive, with some studies reporting positive effects while others find no significant improvement.A review of literature on PMMVY by Behera (2023) noted that PMMVY encouraged better utilization of health and nutrition services among PW and denotes the treatment status (whether the child was born before (0) or after (1) the rollout of PMMVY). The equation denotes the pair matching of treated and untreated units (households) based on the lowest propensity score difference. Graph 1 (annexure 2) illustrates the common support and the matched pairs.Using the 22,984 matched pairs of treated and untreated households, we assessed the impact of the PMMVY scheme on the process, mother-level, and child-level indicators relevant to mothers and children in the matched households. We estimated the program's impact using (i) a logistic regression model of binary indicators and (ii) an ordinary least squares (OLS) model for continuous indicators.For binary indicators (for example, registered pregnancy, institutional we used a logistic regression in equation ( 2) = 1 □□ 1 □□ 2 □□ □□ □□ ) = □□ □□ 1 □□ 1 □□ 2 □□ 2 □□ □□ □□ ) □□ □□ 1 □□ 1 □□ 2 □□ 2 □□ □□ □□ ) equation the probability of = 1) between and □□(□□ = 1 □□ 1 □□ 2 □□ □□ □□ ) is the probability of the variable = 1, □□ is the and □□ 1 □□ □□ are the of variables □□ 1 □□ □□ and □□ is the of the continuous indicators (for example, mother and child's hemoglobin month when pregnancy we used an model as in equation ( below,□□ □□ = □□ □□ 1 □□ □□ □□ □□ □□ is the of interest for the mother or child □□ is the and □□ 1 is the for PMMVY = 2017, and 1 = 2017). □□ is the vector of control covariates and □□ □□ is the impact on was estimated using 4 with model more control demographic and household We can for model to the control covariates this The standard errors are for the pair of treated and untreated undertook to assess the potential impact of the by and these to estimate the to which influence our We this for all The results are in We find that the child-level variables are when for bias while some outcomes this bias as a potential of this the nationwide rollout of PMMVY, a pilot program called the Yojana was implemented in districts. The scheme was introduced in and was implemented before the national rollout of PMMVY. All the model control for pilot the data, we used an time series model to estimate the effect of the PMMVY on process indicatorsantenatal care received, institutional deliveries and child multiple data points before and after the to estimate the program's We extracted monthly data from all districts in India between 2008 to This large to estimate the and effects of the PMMVY program on health and nutrition indicators along with its impact on process model a regression by and and is in equation ( □□ = □□ □□ 1 □□ □□ 2 □□ □□ □□ □□ □□ □□ □□ □□ □□ is the of interest for for □□ □□ is the in the time and □□ □□ a dummy variable = for and 1 for The model are as □□ for the □□ at the of and □□ is all the indicators of we a and used a model if the an to the of the variable with over time This can to model as the of of is We used a to in the using the for the and partial The estimated the the is between 1 and there is no the is to or then there is positive or indicators that we used (i) an or (ii) an The difference between the two is the of the time A time series is if its statistical and are over a series is it have a or be subject to that over We use the to the of the of key of using the HMIS data is that it not information by birth results are and as the impact of PMMVY on three of indicators -(i) process indicators, (ii) mother-level indicators, and (iii) child-level NFHS, we found that of firstborn children were more likely to be registered the rollout of PMMVY compared to children born before PMMVY. There was a increase in the probability of pregnancy registered after the of PMMVY. 1 1) the effects of PMMVY. from an increased probability of we also found that were registered after the of were registered about to registered about done there was a statistically significant increase in pregnancy registration, we found a increase in the probability of mothers having received at least antenatal care (ANC) found effects of PMMVY on using and the HMIS the of PMMVY, there was an increase in the of women having received 4 or more 2) and 2) 4 immediate increase in total the of PMMVY in 2017 was noted 1, however, there was a in total over the years 4 Using the HMIS data, we found no significant in the of registered within the 1 or the of pregnant women treated for anemia or hemoglobin NFHS data, we found a increase in the probability of institutional delivery data, we estimated the impact of PMMVY on three delivery indicators -(i) the of institutional deliveries public and (ii) the of within and (ii) the of by birth these three indicators, we not find any statistically significant after the of PMMVY. we a in or increase over time by the after the was not statistically significant. In while we not find a statistically significant in institutional delivery indicators the of PMMVY, we an increase in the for these denoted by the in we found some improvements in the process indicators, we not find any statistically significant improvement in (i) the mothers' weight or (ii) the mothers' hemoglobin the of PMMVY. The same be about the mothers' anemia status. There was an increase in the probability of mothers or with the probability of the status of mothers for the treatment group the NFHS data, we found that child-level indicators the child's birth weight, (ii) hemoglobin and (iii) anemia status were for the treatment group The children's birth weight for the treatment group was by about this is a the results are hemoglobin levels of children in the treatment group were units as compared to the control group. This has for early childhood The treatment group was less likely to be with an increase in the probability of a child by the HMIS data, we at two indicators -(i) the of that were at birth, and (ii) the of who We not a statistically significant in the indicators we found a for 2) reported in the in In there was an increase in the of and a decrease in those however, these were not statistically at the effect of the of PMMVY on child Using NFHS, we the vaccines into two -(i) vaccines that were of the from before and (ii) vaccines introduced To the effects of PMMVY on child immunization using HMIS data, we at vaccines for which there was data from 2008 to In the data for the vaccines introduced 2017 in the has been for the from (for which the data was both datasets, we found a increase in child immunization Using the NFHS data, we found a statistical increase in child immunization for and Using the HMIS data, we not a statistically significant in the of and and PMMVY scheme was launched to wage compensation for pregnant women, rest and better nutrition during pregnancy and The conditional cash transfer scheme the of cash to specific conditions of service the PMMVY to improve access to services and health and nutrition outcomes for women and results that the scheme has had some impact on process access to health services. We an increase in registration and early registration of we also an increase in women and in consumption of IFA deliveries showed an not statistically significant. The same for child an in immunization access was noted, with statistically significant effects for the however, been no impact of PMMVY on mothers' weight and anemia status. The results noted an increase in the probability of mothers or The same was for child weight at birth and birth and hemoglobin levels among children, results are with published literature on the PMMVY. literature was limited largely to the pilot districts, or studies and this paper with at a national level the available Data from NFHS which an increase in maternal and child anemia levels the is an to in these results. and interpretation of NFHS 5 data that influence the increased anemia levels among women and the of such as the of poor households to nutrition for women and children, mother's affecting local of on and and the impact of the among PMMVY to improvement in maternal and child health and nutritional outcomes, there is a to the maternal and child There is a for a on dietary diversity, with the of available nutritious The to improve maternal is food security, with an increased on would be in the The nutrition program also be used as an to by better implementation of the scheme. The implementation challenges of the PMMVY also to be timely of the with Information and agency among women, to to use the cash is is a for research that causal such as variable or equation to better for and use a large to these while conditional cash transfer schemes such as the PMMVY have the potential to improve service uptake, maternal and child health, and they to be with local programs and behavior and effective and scheme ; HMIS 1 In both the we a large reduction in the because of the Government of India's decision to from vaccines to the in
Jagannath et al. (Wed,) studied this question.