Increasing institutional delivery and access to emergency obstetric care services in rural Uttar Pradesh.

DLHS-3 (2006-07) data reveal that in rural Uttar Pradesh (UP) only about one-fourth of women delivered their last child in an institution. In 2005 the Janani Suraksha Yojana (JSY) was launched as an intervention to address the barriers to institutional delivery through the introduction of community-based women volunteers called Accredited Social Health Activists (ASHAs). Women in rural areas in low performing states are given cash assistance for an institutional delivery and for a home delivery conducted by a skilled birth attendant (SBA). ASHAs are given a performance linked fee; they are paid for each woman they motivate for ANC and institutional delivery. ASHAs receive an initial training of three weeks in various aspects of maternal and child care. While initial evaluations of the JSY show improved rates of institutional delivery and that ASHAs provide valuable support during pregnancy and childbirth the scheme needs closer examination to assess how its performance could be enhanced so as to meet the Millennium Development Goals (MDGs) 4 and 5.