International Journal of Community Medicine and Public Health | August 2018 | Vol 5 | Issue 8 Page 3311 International Journal of Community Medicine and Public Health Mukherjee M et al. Int J Community Med Public Health. 2018 Aug;5(8):3311-3314 http://www.ijcmph.com pISSN 2394-6032 | eISSN 2394-6040 Original Research Article Non-use of Janani Avam Bal Suraksha Yojana in a district of Bihar: ensuring safe deliveries needs strategy modification Madhumita Mukherjee 1 *, Rashmi Singh 1 , Amrita Mukherjee 2 , Madhulekha Bhattacharya 3 INTRODUCTION Janani Suraksha Yojana (JSY)), in India, a 100% centrally sponsored scheme is the largest Conditional Cash Transfer (CCT) program in the world in terms of the number of beneficiaries - covering about 9·5 million (36%) of 26 million women giving birth in India, with a budget allocation in the 2009-2010 financial year of 15.4 billion rupees ($342 million). 1 Established in 2005 as a key component of the National Rural Health Mission (NRHM), JSY is a safe motherhood intervention being implemented with the objective of reducing maternal and neo-natal mortality by promoting institutional delivery among the poor pregnant women. Reduction in the number of unsafe home deliveries is the expected outcome of the programme. 2 However in spite of cash incentive and other facilities home deliveries continue to occur. The same exists in states such as Bihar, Chhattisgarh, Jharkhand, Uttar Pradesh, Assam, West Bengal, Himachal Pradesh, Manipur, Meghalaya, ABSTRACT Background: India‟s Janany Surakhsha Yojana (JSY) is the largest conditional cash transfer (CCT) program in the world in terms of the number of beneficiaries - covering about 9·5 million (36%) of 26 million women giving birth in India. Eleven States/UTs including Bihar, are still below the National estimate for institutional delivery of 78.9% (NFHS 4). In this study we attempted to find out the status of institutional and home deliveries in district Arwal of Bihar and reasons why in spite of cash incentives a proportion of mothers are opting for home delivery. Methods: A cross sectional descriptive design was used to interview 407 women, who had given birth to a child in previous one year. Focuss group discussions was held with community and health staff to corroborate the interview data. Results: Fifty nine percent of mothers were found to have preferred home delivery over institutional one. Reasons which came to light were home deliveries are cheaper (24.1%), unawareness about JSY (22%), unavailability of transport to reach hospital (22%) and better care being taken at home delivery (20.1%) variables. Older age, having a BPL card, and literacy of husband were found as favoring institutional delivery whereas dissatisfaction during a previous abortion or a livebirth in hospital were both associated with non-use. Conclusions: Better client awareness, strengthening of public health infrastructure, availability of skilled birth attendants at health subcentres (HSCs) and emergency transport in time can reduce number of home deliveries and lead to success of JBSY programme and subsequent reduction in maternal morbidity and mortality. Keywords: Home delivery, Incentives, Quality of care, Transport 1 Department of PSM, Patna Medical College, Patna, Bihar, India 2 Department of Epidemiology, UAB School of Public health, Alabama, Birmingham, USA 3 Department of CHA, National Institute of Health and Family Welfare, New Delhi, India Received: 03 June 2018 Revised: 06 July 2018 Accepted: 07 July 2018 *Correspondence: Dr. Madhumita Mukherjee, E-mail: mmadhumita2611@gmail.com Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. DOI: http://dx.doi.org/10.18203/2394-6040.ijcmph20182969