Objective. To investigate whether a national-scale initiative that provides cash transfers to women that deliver in government health facilities in India, the Janani Suraksha Yojana (JSY), reduces maternal depression.

Setting. Uttar Pradesh, India’s largest state, with 200 million people.

Participants. 1,695 women that gave birth in the previous two years in a government health facility.

Design A quasi-experimental study comparing maternal depression among women that received JSY cash (exposed) with those that were offered JSY cash but did not receive it due to administrative problems (unexposed). Women that were not offered JSY cash were excluded. The study compared outcomes across exposed and unexposed women on the basis that administrative factors influencing the receipt of the JSY cash were unlikely to be correlated with characteristics of the woman.

Main outcome measures. Our primary measure of mental health was the continuous score from the 10-question Kessler Psychological Distress Scale, or K10. To identify clinical levels of depressive symptoms, the K10 score was grouped into three categories: none or mild (10 to 15); moderate (16 to 29); and severe (30 or greater).

Results. The characteristics of women who received the JSY were similar to those who did not receive the cash. Adjusted estimates indicate that the JSY was associated with an 8.5% reduction in the continuous K10 score (p=0.013). The JSY was associated with a 63% reduction in severe depression (p=0.07) and a 33% reduction in moderate depression (p=0.031).

Conclusion. Our results suggest that the JSY had a clinically meaningful effect in reducing the burden of maternal depression, possibly by lessening the financial strain of delivery care. Our results provide further evidence that cash transfers may have public health benefits in addition to improving uptake of targeted health services.

(Coauthors: S. K. Pereira, V. Dutt, S. Tougher, K. Haldar, P. Kumar)