Implementing IGMSY: Evidence from Jharkhand

Peeyush Kumar, Anushka Mitra, Aparna MB, Mrithyunjayan Nilayamgode

Department of Economics, Delhi School of Economics

Abstract

This paper attempts to examine the effect of the conditional cash transfer scheme IGMSY, on maternalhealth and labour outcomes, for pregnant and lactating women in Simdega, Jharkhand. The study alsoanalyzes the role played by demographic factors in the take-up of this scheme. Using data collected frominterviews conducted with 221 women, it was found that factors like education, literacy and occupationseem to have significantly determined the pattern of the take-up of the scheme. Institutional delivery stoodout starkly as a concentrated trend among beneficiaries, though it is not mentioned as a conditionality in theimplementation guidelines of the scheme. Delay in receipt of the benefit amount remains the biggest lacunaof this scheme. Though the amount is certainly useful, the delay chokes the very purpose of the scheme,which is to encourage women to use this money as partial wage compensation for the working hours lostdue to pregnancy. Uncertain of the time of disbursement of the cash, the women are forced to work anyway.

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Contents

1 Introduction 51.1 Introduction to IGMSY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51.2 Introduction to the site of research . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61.3 Research Question . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

2 Literature Review 7

3 Methodology 8

4 Results 94.1 Demographics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94.2 Pregnancy-specific Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

4.2.1 Conditionality Variables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124.2.2 Outcomes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144.2.3 Sources of Biased Uptake . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

4.3 Scheme Infrastructure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

5 Conclusions 18

6 Acknowledgements 20

7 References 20

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Table of Abbreviations

Acronym Full formANC Ante Natal CareANM Auxillary Nurse and MidwifeAWC Anganwadi CentreAWW Anganwadi WorkerBRGF Backward Regions Grant FundDLHS District Level Household SurveyHH HouseholdIFA Iron Folic AcidIGMSY Indira Gandhi Matritva Sahyog YojanaIYCF Infant and Young Child FeedingJSY Janani Suraksha YojanaYB Yet to Benefit from the schemeNFSA National Food Security ActPDS Public Distribution SystemMCP Mother and Child ProtectionMoHFW Ministry of Health and Family WelfareMWCD Ministry of Women and Child DevelopmentSC Scheduled CasteSECC Socio Economic and Caste CensusST Scheduled TribeTHR Take Home RationTT TetanusUID Unique Identification

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1. Introduction

There are uses to adversity, and theydon’t reveal themselves until tested.Whether it’s serious illness, financialhardship, or the simple constraint of par-ents who speak limited English, difficultycan tap unexpected strengths.-Sonia Sotomayor

Nestled amidst the calm skies and the dense for-est cover of Jharkhand lies the pristine plateau ofSimdega. It is a place of warm welcome, despitethe teeming Maoist insurgency. The people thereare shy, but should not be mistaken to be weak. Thelives of the women, in particular, speak volumesabout the toil they have to undergo in order to sur-vive in this harsh terrain, when collecting firewoodmay take up to eight hours, and when you have towalk up to two hours in order to relieve yourselfin the absence of toilets in homes. These obsta-cles become especially important when the womenbear children, and this leads to poor maternal andchild health outcomes. It is against this backdropthat we analyse the welfare impacts of the IndiraGandhi Matritva Sahyog Yojana (IGMSY), whichis a conditional cash transfer for pregnant women.Clad in their light sarees that defy the scorchingheat of Jharkhand, the women of Simdega spoke tous about their lives and gave us a glimpse into theirmotherhood, which is usually a mingled chapter ofjoy and anguish. At the end of the day, there weremany stories to take home, some narrating whis-pers of domestic harassment behind their latcheddoors, others pointing fingers at instances of bla-tant diversion of funds and denial of their rightfulbenefits.One of our interviewees, Sushila Devi, comes tomind in this context. She sat clutching her infant,cradling him gently and refusing to meet our eyes.When she started speaking, her voice came outtremulously and something unsaid hung betweenus like a raincloud. It was a long while later thatshe showed us the burn marks on her hand, left bycigarette butts. Then came the downpour of herstory, of her silent submission to torture by her hus-band and in-laws, all because she couldn’t work

since she had to take care of her young childrenaged 18 and 2 months respectively. As the storyprogressed, we got the biggest shock of all. Shewas one of those ‘yet to benefit’ from the scheme,meaning that though she had filled up the forms,the money had not been received yet. She sto-ically told us how her in-laws keep torturing herbecause of this delay, saying that it is, somehow,her fault. “Saas kehti hain ki tu ghar kuch nahilaati hai, baki sab ko kaise mil gaya?”, she said.Adding to her miseries is the fact that her husbandis a chain smoker and an alcoholic. She also saidthat she wants to get a tubectomy done, because sheis scared of the prospect of what she might face ifshe has one more little child to steal her workinghours.A scheme aimed at improving maternity outcomesbecomes a ground for domestic violence. Theadministrative delay gnaws at her and causes hernightmares. The sad irony might make us want toquestion the sanctity of the scheme, but are thingsas ghastly as they seem?

1.1. Introduction to IGMSYThe Indira Gandhi Matritva Sahayog Yojana

(IGMSY) was launched by the Ministry of Womenand Child Development (MCWD) in 2010 in anattempt to tackle the problem of falling maternitywelfare and excessive effort undertaken by womenduring the course of their pregnancy. It was estab-lished to complement the Janani Suraksha Yojana(JSY; the conditional cash transfer scheme aimedat promoting institutional deliveries). IGMSY aimsto improve the health and nutrition status of preg-nant and lactating women through the promotionof appropriate care, ensuring utilization of healthservices during pregnancy and encouraging womento follow optimal Infant and Young Child Feed-ing (IYCF) practices. It provides a conditionalcash transfer that serves to partially compensate forwage loss during pregnancy.The target beneficiaries are pregnant and lactatingwomen of 19 years of age and above, for their firsttwo live births. The age criterion is chosen to ac-cord with the legal marriage age of 18 years inIndia, so as to encourage marriage and childbirth

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at the right age. The scheme is valid only for thefirst two births so as to ensure that the health of thewoman is not compromised due to repeated preg-nancies, and thereby, bring in an element of familyplanning.The scheme was initially introduced in fifty twodistricts all across India. For selecting these dis-tricts, data from the third District Level House-hold Survey (DLHS-3), conducted in 2007-08, wasused. All districts in India were evaluated on sixcounts: literacy rate among the female popula-tion (age 7+), proportion of mothers registered inthe first trimester when they were pregnant withlast live birth/stillbirth, proportion of mothers whohad at least 3 antenatal care (ANC) visits dur-ing the last pregnancy, proportion of institutionalbirths, proportion of children (12-23 months) fullyimmunized (BCG, 3 doses each of DPT, Polioand Measles), and proportion of children breastfedwithin one hour of birth. A comprehensive indexwas then developed and districts were divided intothree categories on the basis of performance: good,medium and poor. Then 11, 26 and 11 districts re-spectively were picked from these three categories,in addition to 4 that were from Union Territories.IGMSY has been implemented through the Inte-grated Child Development Services (ICDS) plat-form, and its success was largely deemed to dependon the successful convergence of the ICDS and theNational Rural Health Mission (NRHM). We wereable to gather a fair picture of the functioning ofthe former during the course of our fieldwork.The implementation guidelines for IGMSY as is-sued by the MWCD on 4 April 2011 specified thatthe cash transfer was to be implemented in threeinstalments of Rs. 1500 (in the second trimesterof pregnancy), Rs. 1500 (three months after deliv-ery), and Rs. 1000 (six months after delivery), onapplication, after fulfilment of the conditions spec-ified in Table 1. After the introduction of the Na-tional Food Security Act, a revised guideline wasissued on 27 September 2013 that increased the to-tal amount to be disbursed from Rs 4000 to Rs 6000in two instalments of Rs 3000 each, one in the thirdtrimester of pregnancy and the other six months af-

ter delivery. The conditionalities were kept moreor less unchanged. Nevertheless, we found that inspite of the revised notification, the scheme has notyet been implemented in its new form at the re-search site.

Instalment 1 Instalment 2 Instalment 3

• Pregnancy registeredwithin 4 months

• Child birth registered • Child exclusively breast-fed for 6 months

• At least 1 ANC visit • Polio & BCG vaccination • Child introduced to com-plementary foods after 6months

• Received IFA tablets • Polio & DPT-1 vaccina-tion

• Polio & DPT-3 vaccina-tion

• At least 1 TT shot • Polio & DPT-2 vaccina-tion

• Child weighed at leastfour times

• At least 1 counselling ses-sion at AWC

• Child weighed at leasttwice

• At least 4 IYCF sessions

• At least 2 IYCF sessionsat AWC

Table 1: Conditions for disbursal of instalments

On the basis of whether they have received thebenefits from the scheme, we partition our sam-ple into three groups: those who have already re-ceived at least part of the money (beneficiaries,B), those who have applied for benefits under thescheme, but have not received anything yet (thoseyet-to-benefit, YB), and those who have not ap-plied for the scheme at all (non-beneficiaries, NB).A woman might become a non-beneficiary due tolack of awareness or interest, lack of a bank ac-count, or her ineligibilty for the scheme.

1.2. Introduction to the site of research

Located in the south-western part of Jharkhand,Simdega is one of the 24 districts of Jharkhand,which was carved out from the adjacent district ofGumla in 2001. It has 10 blocks and is the thirdleast populous district of Jharkhand with 31.75%of total land area under forest coverage. Its ge-ographical location and dense forests, along withother factors, have made Simdega a strategicallyimportant part of the Red Corridor, the region east-ern India infamous for its teeming Maoist insur-gency. In 2006, the Ministry of Panchayati Rajnamed Simdega as one of the country’s 250 mostbackward districts (out of a total of 664). It is oneof the 21 districts in Jharkhand currently receiv-ing funds from the Backward Regions Grant Fund

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(BRGF) Programme. According to the 2011 cen-sus, Simdega has a population of 599,813. The to-tal literacy rate is 67.59% with male literacy rateat 75.84% and female literacy rate at 59.38%. Thepopulation is mainly dominated by tribals, with anotable presence of Christian missionaries. Themain source of income is agricultural farming andforest produce.IGMSY has been implemented in two districts ofJharkhand, Simdega and East Singhbhoom. We se-lected Simdega for our research primarily becauseof the contacts we had there. We restricted our at-tention to two blocks, namely Simdega Sadar andPakartanr, chosen on the basis of accessibility byroad and safety parameters (which include the ex-tent of Maoist insurgency). Both fall under thepurview of the same Child Development ProgramOfficer (CDPO). We were able to find a reason-ably good control district, Gumla, on the basis ofthe 6 DLHS parameters. However, we were un-able to visit Gumla due to threats of Maoist insur-gency. We are aware of the indeterminacy of ef-fects (whether differences in outcomes are due tothe scheme or otherwise) this leads to, and this re-mains as a shortfall of our study. Also, since theinitial choice of blocks was not random, the samplemight not be representative of the district at large.

1.3. Research QuestionOur study aims to analyse the welfare impacts of

IGMSY in Simdega, by looking at the differencesin outcomes of beneficiaries and non-beneficiariesof the scheme within the district. We also examineif there is evidence for differential take-up of thescheme, based on demographic parameters.

The rest of the paper is structured as follows.In section 2, we review the existing literature onthe implementation effectiveness of this schemeand other similar schemes and expound howour study is different. Section 3 talks about ourmethodology, defining our sampling strategyand method of analysis. Section 4 assimilatesour results on differential take-up on the basisof demographics, pregnancy-specific variables(conditionalities and outcomes of the scheme, and

sources of biased take-up), and the current stateof the supporting infrastructure of the scheme,combined with a few anecdotes from our fieldexperiences. Section 5 concludes.

2. Literature Review

The idea for our study came from an article in anational daily on a study by Falcao et al. [8]. Thisis a broad-based qualitative study assessing the im-plementation of IGMSY in Bihar, Chhattisgarh,Jharkhand and Madhya Pradesh. Their variablesof interest include women’s access to health care,nutrition, rest and breastfeeding for the child. Thewhole study is put to light as an indicator of the pre-paredness of these states to implement the mater-nity entitlements defined as per the National FoodSecurity Act (the raise of cash transfer amountfrom Rs. 4000 to Rs. 6000). The study makesextensive use of secondary data (mainly Census2011) to assess the summary statistics of the cho-sen districts and attempts to relate these to the out-comes of the scheme (mainly its reach). Our studyhas tried to dig deeper, using a larger sample and amore quantitative approach, with a focus on a fewblocks of one district where the scheme has beenimplemented, to see the difference in the welfare ofbeneficiaries and non-beneficiaries there, and dis-cover the extant pitfalls of the scheme.Since the scheme is closely tied to other schemeslike ICDS and JSY, papers highlighting the statusof these and their connection to IGMSY are alsorelevant to this study. Jehan et al. [2] report in-creased use of maternal health services since theinitiation of schemes like JSY. The study points outcertain areas for improvement in this scheme, suchas the need for more efficient operational manage-ment, clear guidelines, financial transparency, andproven impact on quality of care and maternal mor-tality and morbidity. Sahayog India [4] highlightspoor access to maternal health services and theneed for state-supported maternity protection mea-sures. When women workers in the unorganizedsector undergo pregnancy and childbirth, they areforced to take time away from work. In the ab-sence of timely delivery of maternity benefits, the

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study indicates that they often continue with phys-ically strenuous wage labour till the eighth monthand shorten their post-partum rest. In the absenceof crches, they are forced to stay at home if theywish to breastfeed the children, which adversely af-fects household income. As a result, mothers havea tendency to stop breastfeeding earlier than advis-able.Most of the literature on IGMSY seems to suggestthat the implementation of the scheme has beensloppy at best. Lingam and Yelamanchili [1] high-light that the strength of IGMSY lies in its attemptto provide maternity protection to women while itsweakness lies in its exclusionary criteria. Dhar [3]points out that an ill equipped ICDS health sys-tem is a major reason for the poor uptake of thisscheme. Another key problem has been the lack ofawareness and information regarding the schemeamongst both women as well as ICDS workers. Se-jal Dand and Nikita Agarwal [10] quote IGMSY as“one of the poorest performing schemes which en-tails an urgent requirement to frame a new one”.

3. Methodology

We were able to obtain a block-wise list ofAWCs from the CDPO office. From amongstthese AWCs, we randomly selected 21: 3 inPakartand (Jamtoli ,Basantpur, Grondabeda) and18 in Simdega (Saldega I,Saldega II, Ghochotoli,Lohratoli, Brahmin Basti, Mahuatoli, Baspahar,Birnibeda, Khuntitoli, Arani, Bindhaintoli, KhijriKhas, Kullukera, Rigdi Khas, Choytatoli, Tongri-toli, Purnapani and Tamra Khas). These werespread over 12 Panchayats and spanned an areawithin a radius of approximately of around 25 kilo-metres from Simdega town. We contacted eachAWW one or two days before we went to theirAWC, and informed them that we were doing a sur-vey of women who had been pregnant since 2011.We asked them to gather all such women. We didnot mention that we were particularly interested inIGMSY beneficiaries, as this would have incen-tivised the AWW to tell us only about those womenwho had received the money, whilst attempting tosweep the non-beneficiaries under the carpet. We

proceeded to meet expectant mothers and womenwho had children upto 4 years of age either at theAWC itself or at their homes. We would try toreach the village early in the morning so that wecould meet the women before they left for work.Many a time, we were able to coordinate our visitto an AWC with the immunisation or THR distri-bution day. In that case, we met the women at theICDS centre itself. Sometimes, however, we wereunable to meet some women, if, for instance, theyhad gone away to their parental home. However,since such instances were scant and there does notseem to be any systematic reason for this absence,we do not expect this to create any bias in our re-sults.To avoid exclusion, we asked both the AWW aswell as the respondents about women who werenot registered at the AWC. We found that almostall women in each village were registered and in-volved with the AWC. The most plausible reasonfor this roughly complete coverage of ICDS is thatsince this is a platform for a multitude of schemesand benefits, women have a high incentive to getthemselves registered with the AWC.Each woman was interviewed on the basis of atwo-part questionnaire. The first part comprisedof details about their household, such as householdsize, wealth, access to other government schemesthrough the possession of ID cards such as the ra-tion card and the Aadhar card, and accessibility tobanks or post offices through which IGMSY bene-fits are to be disbursed. The second part focussedon issues relating to their pregnancy (such as healthproblems faced, level of physical activity and restundertaken both before and after delivery), childhealth outcomes (including immunisation, breast-feeding and other IYCF practices) as well as aware-ness about IGMSY.We were successful in interviewing a total of 221women over a period of 21 days. Since the ICDSworkers are an integral part of the scheme, we in-terviewed them in order to understand their degreeof awareness about the scheme and their motivationtowards their work, which could have an impact onthe uptake of the scheme. Figure 1 illustrates the

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breakup of these women into beneficiaries, thoseyet to benefit, and non-beneficiaries.We have used two-tailed t-tests for difference inmeans to check for differences in the average de-mographic characteristics and average outcomesof beneficiaries and non-beneficiaries. All testshave been run by partitioning the sample intotwo groups, using two different specifications; onewhere we include all those who have received thecash amount in one group (B), and another wherewe include all those who have had some form ofaccess to the scheme in one group (B+YB). Thequantitative analysis has been carried out after ex-cluding all ineligible women from the sample.

39%

15%

34%

12%

Beneficiaries

Yet to Benefit

Non-beneficiaries

Ineligible

Figure 1: Distribution by beneficiary status

4. Results

4.1. DemographicsFemale literacy was one of the six indicators

on the basis of which the pilot districts were cho-sen for the implementation of IGMSY. We expectliteracy rates to be a key variable since it is nat-ural to think that high literacy will aid in taskslike opening a bank account. A significant differ-ence in literacy rates among beneficiaries and non-beneficiaries under both specifications reinforcesthis belief. The literate women were most inquis-itive to look into our questionnaires, and asked usquestions about the purpose of the survey. So muchso that, once while asking questions about dietary

habits, one respondent read the question in advancewhile we were still struggling to phrase it in Hindi,and answered, in English, “I like apples! A sim-ilar test for the significance of husbands’ literacyindicates that there is no difference under eitherspecification. However, we did come across aninstance when a woman came to know about thescheme from her husband, even before the AWWtold her. She enquired about the scheme on herhusband’s insistence, and successfully took homethe cash amount, doing the needful.

Education, though not one of the original six

Variable NB YB B p-value(B vsYB+NB)

p-value(B + YBvs NB)

Age 24.42 23.13 25.43 0.0275 0.6212Literacy 66.20% 75.75% 85.36% 0.0100 0.0103Spouse Literacy 86.67% 83.87% 90.47% 0.3803 0.765910th pass 31.91% 56.00% 54.29% 0.0959 0.0101Housewife 32.39% 45.45% 54.88% 0.0123 0.0082Laborer 63.38% 45.45% 37.80% 0.0069 0.0018Nuclear family 36.62% 51.52% 50.00% 0.2413 0.0665Religion 50.70% 60.60% 60.49% 0.3679 0.1917SC/ST 56.25% 53.33% 57.74% 0.7574 0.9814Livestock 126.9 78.90 46.91 0.0010 0.0004HH Assets 14.33 6.879 12.59 0.8838 0.4392Total Assets 141.3 85.79 59.50 0.0015 0.0003Bank A/c 57.75% 84.84% 95.12% 0.0000 0.0000Distance to bank(km)

8.485 13.26 5.262 0.0546 0.7136

Wood Collected 73.24% 66.67% 52.43% 0.0085 0.0218Wood CollectionTime (hrs)

4.278 4.727 4.328 0.8986 0.7711

Presence of La-trine

19.72% 6.06% 14.63% 0.8878 0.1639

Table 2: Differential uptake on the basis of demographics

indicators, is expected to be an important indica-tor of improvement in the standard of living. Thereis a significantly higher proportion of matriculatesamong beneficiaries than among non-beneficiarieswithin the literate section of the population, whichmay indicate that they are more aware of the mone-tary benefits of the scheme and of health outcomesin general, and about what may be good for them.Jebline Bage, one of the YBs of the scheme, is a12th pass-out and is eager to join college. Her hus-band is most supportive and she plans to enrol assoon as her 6-month-old child grows a bit older.There are other elder females in the household whowould take care of her son. Rajani Lugun is oneof the beneficiaries of the scheme, who has done aB.Ed. She talks knowledgeably to the other womenabout our questions when they have some difficultyfollowing them. She also asked us why the NFSAupdate has not been implemented for the scheme

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23

13

32

22 12

8

6 4

9

5 0

5

2 3

13

1 0 0

12 1

15

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

NB YB B

Unclear

32 to 35

29 to 31

26 to 28

22 to 25

18 to 21

16 to 17

Figure 2: Differential Takeup by Age

47 25

70

24 8

12

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

NB YB B

Illiterate

Literate

Figure 3: Differential Takeup by Literacy

52 26 57

8

5

6

11 2

19

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

NB YB B

Unclear

Illiterate

Literate

Figure 4: Differential Takeup by Husband’s Literacy

in Jharkhand. Her conditionality record has checksall over. These are a couple of the pleasant excep-tions that stand out.

Occupation is an important indicator that drawsattention to two of the most important parametersof interest - the working hours of and the rest un-dertaken by a pregnant woman. A larger proportionof women were engaged in physical labour duringpregnancy among non-beneficiaries than beneficia-ries, whereas there were more housewives amongthe beneficiaries. It would seem that the availabil-ity of the scheme does not very effectively translateinto eligibility or the instance of actual transfer be-ing received for the group of women engaged inthe most strenuous class of work. This potentiallyunfortunate result may follow from the inability ofthose engaged in physical labor to find the time tomake effective use of healthcare facilities, whichis a prerequisite to obtain any disbursement underthis scheme.

The proportion of nuclear households is largeramong beneficiaries, which supports the argumentthat women in larger households might have to doa greater amount of work, and hence may be morelikely to not fulfil the conditionalities of the schemeand thereby be excluded from receiving IGMSYbenefit. It is also interesting to note that the differ-ence is significant only when yet-to-benefit womenare included as beneficiaries (specification 2), andnot when they are included as non-beneficiaries(specification 1). This suggests that a decline inhousehold size may facilitate a movement towardsenrolling in the scheme.Simdega has an approximately equal proportionof Hindus and Christians, and is dominated by atribal population, including SCs such as Bhogta,Bhuiyan, Dhobi, Ghasi, and Harijan, and STs suchas Munda, Oraon, Khadia, Bhinjia, Lohar, andGond. No significant difference is observed in theproportion of beneficiaries amongst Christians andHindus, and amongst the SC/ST population andother caste groups, which is an encouraging result.

We look at ownership of household assetsby assigning weights equal to a thousandth of themarket price of a second-hand unit of that asset

10

24 8

12

7

2

8

25

9 24

8

9 21

7 4

14

0 1 3

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

NB YB B

Graduate

Intermediate but not graduate

Matriculation but not Intermediate

5th plus but below 10th class

literate or educated but not till 5th class

Illiterate

Figure 5: Differential Takeup by Education

23 15

45 2

2

6

45

15 31

1 1 0

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

NB YB B

Unclear

HH and Physical labour

HH and Service

HH

Figure 6: Differential Takeup by Occupation

Wood Collection

26

17 41

40 13 36

4 2 4 1 1 1

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

NB YB B

12+

8-12

4-8

0-4

Figure 7: Differential Takeup by Household Size

35 13 32

36 20 49

0 0 1

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

NB YB B

Other

Hindu

Christian

Figure 8: Differential Takeup by Religion

36 16 41

28 14 30

7 3 11

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

NB YB B

Unclear

Not SC/ST

SC/ST

Figure 9: Differential Takeup by Caste

19 11

39

52 22

43

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

NB YB B

Wood Collected

No wood collection

Figure 10: Differential Takeup by Fuelwood Market Accessi-bility

11

in Simdega. We find no significant difference inaverage asset ownership among beneficiaries andnon-beneficiaries in either specification. This mayarise from the fact that the consumption basket inthe area is pretty restricted due to dearth of manygoods. The assets that households aspire to ownare also limited due to the unavailability or poorquality of electricity connections in the area. Adifferent story, however, takes shape regarding theownership of livestock. Weights to cattle were as-signed using the current market prices in Simdega.There is a significant difference in mean livestockassets between beneficiaries and non-beneficiaries.The “poorer” sections of society, i.e. the ones withmore limited livestock assets, tend to be the onesto make better use of the scheme, though it is notclear whether this is due to targeting or greaterneed. This observation does seem somewhat pos-itive. Connecting this to our earlier observationthat women engaged in strenuous labour seem to beable to avail the benefits of the scheme to a lesserextent, we make note of the fact that this ‘strenu-ous labour’ included cases of seasonal agriculturefor the most part. Since livestock is closely relatedto agriculture, this correlation can explain why the“richer” women seem to be engaged in more stren-uous forms of labour. It needs to be noted thatthe housewives from our sample are significantly“poorer”, on average, than the laborers.IGMSY benefits are deposited in a savings accountopened in the name of the woman. To assess fi-nancial accessibility, we look at the distance be-tween the beneficiary’s home and the nearest bank.Under the first specification, the average distanceto the nearest bank is statistically different for thetwo groups, while under the second, we do notfind any significant difference. This seems to sug-gest that a nearby bank only serves to differenti-ate between those yet to benefit from the schemeand those who have already done so, which is tosay that it helps in the realization and utilization ofthe benefit amount, rather than improve take-up ofthe scheme. These findings are consistent with ourown experiences in the field. Many women wholived far away from their bank branches said that

they had never gone to the bank once the accountwas opened, and it was their husbands who wouldgo to check if the money from the scheme had ar-rived or not.The primary source of fuel in Simdega is fire-wood, and collecting it is a major form of phys-ical labour. There is a highly significant differ-ence in the proportion of those who collected fire-wood amongst beneficiaries and non-beneficiaries.This might indicate that beneficiaries have greateraccess to the firewood markets. The mean hoursspent per visit to collect firewood, however, arenot significantly different for beneficiaries and non-beneficiaries who choose to collect firewood. Wehave had instances where pregnant women havehad to spend 12 hours on collecting firewood, of-ten travelling by foot, right up to the ninth monthof pregnancy. Anita Devi of Brahmin Basti, amother of four children, had to collect firewoodfrom 10 km away twice a week till the last monthof pregnancy, since her husband is an alcoholicand doesnt contribute to household chores. In herwords, “Bahut taklif hota tha. Par kya karein, petke khaatir, bachho ke khatir karna padta hai. Sabzikharidne ka paisa nahi hai, lakdi kahan se kharidedidi?”Recently there has been quite a bit of focus on sani-tation facilities with different government schemesfacilitating access to toilets, etc. But sadly, the vil-lages we visited were quite neglected in this regard.Out of 221 households, only 35 (15%) had toiletsat home, which mainly included simple holes in theground. 85% of the households did not have anyaccess to sanitation facilities and had to defecate inthe open. This creates a major problem for womenwho sometimes have to walk as far as 3 km to finda suitable spot. Needless to say, this is a burden onpregnant women.

4.2. Pregnancy-specific Results4.2.1. Conditionality Variables

Iron Folic Acid intake is one of the conditionsthat have to be fulfilled by the expectant mother tobenefit from the scheme. The condition requiresthe woman to collect 100 IFA tablets, or an equiv-alent dose of IFA syrup, and consume them over

12

a period of 3 months. While the scheme does notask for verification of intake, we decided to lookat the actual intake of the supplements in our sur-vey, and found that around 47% of the women hadtaken IFA tablets for three or more months, witharound 86% having taken them for some period oftime. Many women complained of the tablets in-ducing nausea, and hence did not consume themat all. Some of the expectant mothers were nottaking the IFA supplements because of a rumourgoing around that the IFA tablets make the childgain weight while in womb, and hence results inproblems during delivery. Nevertheless, the AWCdistributes IFA on a regular basis and most womenhave access to it. Awareness about IFA is high andsome women even purchase the tablets from medi-cal stores and continue having it during the courseof the pregnancy. It was found that IFA consump-tion was significant under the first specification andnot in the second, which, combined with the meanuptake in each group, suggests the presence of amore or less universal coverage of IFA, consistentwith our claim.Yet another of the conditions of IGMSY is to get atleast one TT shot during pregnancy (out of an opti-mal two shots). We found that all but three womenhad been administered at least one TT shot. Inter-estingly, all three women are beneficiaries of thescheme. Administering TT shots has been takenup intensively by the AWC. There is no significantdifference in the number of TT shots between ben-eficiaries and non beneficiaries under either speci-fication, as expected. This, combined with the ear-lier observation of near 100% coverage of at leastone TT shot tells us that IGMSY has neither incen-tivized women to start taking TT, nor has it moti-vated them to get two shots instead of one. Thisreduces getting TT shots to being a health prac-tice that is anyway followed by the women, moredue to the merit of the ICDS system, regardless ofIGMSY.The benefits of breastfeeding extend well beyond

basic nutrition, and breast milk is considered to beabsolutely essential for infants. IGMSY promotessix months of exclusive breastfeeding by making

Variable NB YB B p-value(B vsYB+NB)

p-value(B + YBvs NB)

IFA 83.81% 75.61% 93.15% 0.0212 0.5226TT (two shots) 90.24% 82.22% 90% 0.5718 0.5058Breastfed imme-diately

83.92% 89.28% 88.70% 0.5979 0.5718

Exclusive Breast-feeding

97.13% 96.15% 94.45% 0.4383 0.4758

Immunization 100% 100% 100%ANC 93.58% 97.50% 98.75% 0.1532 0.0781Three ANC 64.10% 62.50% 83.75% 0.0018 0.0555Weight 80.90% 100% 85.71% 0.9396 0.3027Diet 17.33% 8.88% 15.18% 0.8423 0.3933Reduced activity 17.65% 13.95% 12.20% 0.4090 0.3361Postpartum restHH

2.5 2.231 2.776 0.3339 0.7248

Postpartum restoutside

2.570 3.923 3.429 0.2592 0.0317

Health Pre 0.3049 0.4565 0.3441 0.8695 0.2330Health during 0.2045 0.1714 0.1263 0.1644 0.1817Health post 0.1070 0.1563 0.1064 0.8536 0.6763Institutionalization 62.10% 96.55% 92.11% 0.0004 0.0000Birth Order 1.560 1.550 1.287 0.0013 0.0184Gender 54.37% 50.00% 45.75% 0.2976 0.3022Awareness of theWoman

30.99% 84.85% 91.46% 0.0000 0.0000

AWW Awareness 1.516 1.571 1.584 0.6011 0.5201AWW Motivation 1.690 1.478 1.730 0.2205 0.7597Awarenessdummy

53.52% 57.58% 58.54% 0.6129 0.5291

Motivationdummy

47.89% 36.36% 59.76% 0.0356 0.4970

Table 3: Differential pregnancy-specific outcomes

it one of the conditions imposed on aspiring ben-eficiaries. From our survey, it was clear that quitea large number of women knew about the meritsof exclusive breastfeeding, although instances ofgross misinformation were not uncommon. For in-stance, one of the respondents in Saldega told usthat she fed her child only powder milk becauseshe had heard it was better than breast milk. Ona more positive note, many respondents said thatthe importance of exclusive breastfeeding was be-ing emphasised by the health workers. BirmuniDevi from Khijri Khas, who has eight children,the eldest being 19 years old and the youngestaround 5, said that earlier there was no such aware-ness about exclusive breastfeeding, but nowadaysthe AWW, ANM and other health workers pro-mote it quite strongly. With such practices, theinsignificant difference between beneficiaries andnon-beneficiaries for the prevalence of both im-mediate breastfeeding and exclusive breastfeedingwas not unexpected. The delay in most cases wasdue to medical reasons, and only in a small fractionof cases due to lack of awareness.Immunisation against various diseases is of utmostimportance, and has manifestations throughout the

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lifetime of a person. Our team was witness to sev-eral immunisation days at various AWCs, and it ap-pears that immunisation is carried out in these cen-tres as a very thorough exercise. A certain day ofthe month is fixed for the ANM to visit the AWC,and the AWW makes sure that all children who areto be immunised receive their doses. Our results re-flect this positive aspect, as all eligible respondentshad provided the required vaccinations (includingthat for measles) to their children. The only groupwhere immunisation was not 100% was that of in-eligible (NB-I) women.IGMSY requires an expectant mother to undergo atleast one antenatal care visit, and considers three tobe the optimal number of ANC visits. We used datacollected from surveying the respondents, and notfrom the MCP cards, where all beneficiaries haveat least one ANC marked. On the whole, it is clearthat the beneficiaries turned up for ANCs (whetherfor one or three) in larger proportions.Growth monitoring sessions are conducted oncea month at most AWCs on the day of immuni-sation. However, none of the AWCs we visitedmeasured height. IGMSY requires the child to beweighed at least twice in the first 6 months afterbirth. No significant difference in attendance wasfound between beneficiaries and non beneficiariesunder any specification.

4.2.2. OutcomesDietary practice during pregnancy is an impor-

tant indicator of nutrition, and also a crucial in-dicator of child health. We constructed a dummythat takes the value 1 for a diet that has improvedduring pregnancy. The null hypothesis of there be-ing no difference in proportion of diet improve-ment among beneficiaries and non-beneficiaries isnot rejected. A major reason for this could be latereceipts of the transfer, mostly after delivery. Thestories relating to diet were diverse, and in someaspects, strange. Unavailability of milk was one ofthe most common stories across almost all AWCswe visited. Even where available, milk is veryexpensive; in remote villages, milk costs aroundRs 12 per glass. Even women from householdswhich own scores of cows say “gai doodh nahi

deti hai” and have scarcely any milk componentin their diet. There were instances where when-ever milk was available, women gave it up for theirchildren and husband. Our ‘frequency of milk con-sumption’ question often made the women laugh.“Peena ka mann to hai, nahi milta toh kya karein”,they said. Most often, inclusion of milk in their di-ets is one luxury that makes women say that theirdiets had improved during pregnancy.The only fruits that seemed to be available weremango and jamun, and they too are seasonal. Meatand eggs were mostly consumed once or twice aweek. Vegetables and daal were consumed nearlyevery day. Seen in this light, most women seemto have a somewhat balanced diet, the only catchbeing the quantity consumed, especially in largerfamilies. There were stories that stood out too.Soni Devi was one of the women who tearfully toldus how her in-laws used to starve her during herpregnancy when she was unable to work. Her childsuffered from low birth weight, she did not havebreast milk, and as a result, the child has to be fedLactogen even now.One of the goals of the scheme was to incentivisepregnant women, by means of a partial wage com-pensation, to work less and take adequate rest.Since many of our respondents were housewives(for whom the concept of working hours was alien)and since several others were agricultural labour-ers (whose workload was seasonal), a simple cal-culation of average working hours before and dur-ing pregnancy would not be very useful, not tomention plagued with problems of imperfect recall.To bypass this, we decided to look at the related,and more easily recalled, question of whether thewomen had moved to less physically intense occu-pations or activities during pregnancy. A dummy isconstructed which takes the value 1 for any preg-nancy during which the woman switched to a lessintensive occupation. It was found that roughlythe same proportion of women from both groupsmake the switch during pregnancy, driven perhapsby their own needs, rather than by the existence ofthe scheme. It could be argued that the beneficia-ries make the switch because of the money they re-

14

ceive, whereas the non-beneficiaries do so becausethey are inherently better-off, but this is unlikelyin light of the very small proportion that actuallymakes the switch. However, this result is not en-tirely unexpected, for the money is often delayed,and as such, can no longer serve as even a partialwage compensation. For 25 year old Kunti Devi,every day is a new challenge. Leaving for firewoodcollection before sunrise and returning at dusk twotimes a week and carrying heavy bucketsful of wa-ter drawn from the well an hour away is hard workredefined. She has received just Rs. 1500 fromthe scheme yet and she is frustrated that the rest ofthe money hasnt been forthcoming, since she leftworking in the fields in the hope of receiving Rs.4000. “Kab aenge paise, aap pata karke batao na”she tells us. As Juliani Topo, one of our respon-dents from Arani, puts it, “paise nahin hai; jeenahai to kaam karna hi padega na?”To evaluate the amount of rest taken, we createan index that represents the number of fortnightsrested before resuming work. We find no sig-nificant difference between beneficiaries and non-beneficiaries in the rest taken before resuminghousehold work. This seems to suggest that thescheme may be of no avail in relieving womenfrom household work immediately post delivery.However, we find a significant difference betweenthe two groups in the rest taken before resumingoutside work, which includes resuming work at theplace where the women may have been employedpost-delivery. It is worthwhile to note that de-spite IGMSY benefits being delivered so late, weare able to find a significant positive impact, evenamong those who are yet to benefit. These numbersare likely to understate the potential effect of thescheme, and we may expect to see an even greaterimpact if the cash transfer is made timely. PoojaDevis story is sombre. Her husband is an alcoholicand rarely works. This adds to her work burden andno cash transfer can make for the effort she takesevery day, she says. Her child was born under-weight and she has taken her best efforts to nour-ish him, of no avail. The way she single handedlystrives to feed her family and take care of the child

moved us.We expect the cash transfer to have a positive ef-fect on mitigating health problems, because it em-powers women to purchase medical services.Theresults, however, show that there is no signif-icant difference between beneficiaries and non-beneficiaries in the number of women who facedhealth problems during pregnancy, at the time ofdelivery, or after delivery.Although institutional deliveries are not an officialprecondition for disbursal of grants under IGMSY,many of the AWWs that we talked to seemed tobelieve that it was, and they forced the women togo to the hospital for their deliveries.The differencebetween beneficiaries and non-beneficiaries on thiscount is staggering and highly significant underboth specifications. Hence, although this miscon-ception seems to have had a very strong positiveexternality, it has also resulted in instances such asthat of Lakshmi Devi from Tongritoli, who was de-nied the benefits simply because she delivered herchild at home. One of the saddest cases we en-countered was in Birnibeda. The AWW stronglyinsisted in taking us to this womans house. Shewas making plates and bowls out of saal leavesfor her sister-in-law’s upcoming wedding, whenwe arrived. The 17-year-old sister-in-law watchedus as the womans three-year-old mute elder childroamed around, playing. He lost his voice twoyears ago, due to malnourishment. The woman’ssecond delivery was excruciatingly painful, result-ing in huge blood loss and the child coming out de-formed and stillborn. Her household members didnot let her go for checkups or to a hospital for de-livery, deeming it unnecessary, though she was al-ways in pain. None of this shows on the placid faceof the woman who has borne enough tragedies for alifetime. This is an example of how stereotypes cutthrough all else, whatever scheme may be in place.

4.2.3. Sources of Biased UptakeThe benefits granted under IGMSY are avail-

able only for the first two live births, and, as a re-sult, all eligible births have birth order one or two.Given that almost every family we talked to had,or planned to have, more than two children, a high

15

average birth order among beneficiaries might indi-cate that the scheme has been gaining in popularity.A low average birth order, on the other hand, mightindicate reluctance to enrol for the second child,perhaps due to the perception of inefficiency in thesystem. We find that the difference in average birthorder (and hence in proportion of 2nd order births)between beneficiaries and non-beneficiaries is neg-ative and highly significant. Interestingly, the aver-age birth order among pregnancies where the bene-fit was not received due to the AWW not informingthem is in fact the lowest. The case of Aarti Devi isqueer. She is a beneficiary with three children. Herfirst child Gabbar was from her first husband whodrowned in a dam. She got married to her brother-in-law with whom she has 2 children. She got thebenefit amount for her second and third pregnancy,though not the first.A look at the breakup of various classes of bene-ficiaries and non-beneficiaries by gender yields avery interesting picture of gender discrimination orbias. After excluding the ineligible pregnancies,the null hypothesis of no difference in the propor-tion of girls in both groups is not rejected. How-ever, when the ineligible pregnancies are included,the distribution seems decidedly one-sided, withsignificantly greater proportions of boys amongbeneficiaries, and of girls among non-beneficiaries.A widely prevalent preference for a male childleads to couples without male children continuingtheir attempts until successful. This results in alarge number of girls in families that have multiplekids. Since these families continue to have kids,they usually end up becoming ineligible, and thuswe get a large proportion of ineligible girl children.This same observation also indicates that the fam-ily planning aspect of the programme, as envisagedby the restriction to children of birth orders one andtwo, is perhaps being overpowered by the existingpreference for male children.In our interviews, we observed that none ofthe women were aware of the conditionalities ofIGMSY; it was only the AWW who knew aboutthem. We find that the proportion of people whohave heard about the existence of IGMSY from

sources such as the AWW or neighbours is sig-nificantly higher for beneficiaries than for non-beneficiaries. This supports the view that lack ofknowledge about the scheme is a major factor con-tributing to differential uptake. However, this doesnot rule out the possibility that the lack of aware-ness stems from a lack of interest, or a kind of ap-athy to such matters.In order to gain a perspective on how the IGMSYbenefit is actually used, we asked the beneficia-ries what they had done with the money theyhad received. Our findings, as indicated by Fig-ure 11, show that a large chunk of the amountis spent on daily or incidental expenses. Whenseen together with the lack of ready cash amongpoor households, this suggests that a timely cashtransfer could substantially improve maternal andchild health. 18 year old Poonam Devi is a non-beneficiary in Basantpur, who did not to take theefforts for document submission since she wouldhave had to go all the way to Simdega, she says.The AWW had offered to submit forms for her, butshe was complacent. “4000 rupaye se kya hogadidi, ghar pe paise rahenge toh kharch ho hi jatehain, pata hi nahi chalega kaise khatm hue” sheinsists. When asked if she would have been moremotivated to take up benefits if the amount hadbeen more, she says maybe.

41

30

21

8

Household expenses

Medical treatment for mother/ child

Savings in bank

Expenditure on child

Figure 11: Utilization of the Benefit Amount

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4.3. Scheme Infrastructure

If the structure of the scheme were to be fol-lowed correctly, the money was to be receivedin instalments over the course of pregnancy, ex-tending to six months post-delivery. It was foundthat practically all the women who received theamount received it post-delivery, whether they gotthe money in instalments or all at once. The trans-fer was delayed, and was received over anywherefrom 2 months to two years post-delivery, in one,two, or three instalments. While probing into thepossible cause for this delay, we elicited the fol-lowing story from a group of AWWs. The moneyis actually disbursed according to how the AWWssubmit the IGMSY forms. Nowadays, because ofdelay in opening bank accounts and unavailabilityof MCP cards in AWCs, the form itself is submit-ted late, which is why the money is late in arriving.The AWWs themselves decided on nine months asthe deadline for submitting forms, without gettingany guidelines about the same from above. Thoughit is doubtful whether this was the sole reason forthe delay or if red tape also hindered operationwithin the time frame, it can surely be said thatthis delay kills the purpose of the scheme to a largeextent. The instalments were meant to ease thewhole experience of pregnancy and childbirth forthe woman, and by becoming a one-shot transferthat may come months after delivery, the transferamount has been rendered a mere means for addi-tional household expenditure to most of the bene-ficiaries. There were even cases where the AWWsinsisted that the women have received the moneywhile the women claim they havent. After all, whowould check an account every day hoping to see acredit of 4000 Rupees that is known to come yearslater, they ask.There were also instances of corruption where theAWW took bribes. One of the respondents hadcome all the way from her home five kilometresaway just to speak to us about this. “Aap log aarahe hain, suna toh hame bhi accha laga, hamaripareshani sunne ke lie koi nahi hai” she said. Inthat AWC, the AWW took Rs. 500 as bribe for ev-ery Rs. 4000 she helped give out. If the money

came in installments, and if the woman refused topay the bribe, the AWW would say she wouldntget her the next instalment. She was one of thepeople who refused to pay. As a result, the AWWwould not inform her about any new scheme. Sheconstantly ignores her questions about her eligibil-ity for the Ladli Yojana and her delay in respond-ing has now resulted in the breach of deadline forapplication. Another respondent told us that theAWW herself keeps only Rs. 200, while the restgoes to those higher up the chain. The strangestpart of it all was that the AWW was right next to therespondents during the interview despite our bestefforts to separate them and neither the women northe AWW flinched from this discussion. For us,it was like staring at the stubborn face of corrup-tion. In other AWCs, the AWWs took bribes of Rs.200- 300 as transportation costs for submitting theforms, and did not reimburse it after the receipt ofthe benefit.The ICDS runs surprisingly well in the district, es-pecially in terms of coverage of immunization. TheANM regularly visits each month, as reported byboth the AWW and the respondents. A major pro-portion of the respondents also send their childrento the AWCs though many say that the teachingquality is poor. Later, most of these children aresent to government or missionary schools whichare aplenty, but are still taken to the AWC for thecooked meal they get till 6 years of age.UIDs are a prerequisite in most banks for openinga bank account, and thereby, to avail the benefitsof IGMSY. It was found that 97% of the samplehad UIDs. In some cases though, delay in receiptof UIDs delayed the opening of bank accounts andprevented the women from availing the benefits ofthe scheme. Opening a bank/post office accountbeing the starting point of the scheme, we checkedif there is a significant difference in proportionsof account-holders among beneficiaries and non-beneficiaries, and found that the null hypothesis ofno difference is strongly rejected in both specifica-tions. We had also asked questions about the at-titude of bank/post office employees. While therewere a couple of cases where the post office of-

17

ficial took bribes, the primary complaint was thatmany visits were required to get the bank accountopened. Another issue that came up was the insis-tence of some banks on having two ID proofs in-stead of one, which denied benefits of the schemeto some, due to the delay in receipt of these IDs.We also noticed that most respondents were un-aware of zero-balance or no-frills accounts. Mostrespondents admitted to having started accountsby depositing money, despite financial difficulties.However, it is unlikely that this financial constraintkept many people from opening accounts; giventhe assurance of receiving money under IGMSY,even if it is delayed, most respondents were will-ing to make an investment to open the accounts.We also discovered that many women had recentlybeen able to open no-frills accounts under the Prad-han Mantri Jan- Dhan Yojana, which may act as apositive externality as it may reduce the number ofwomen who are unable to get IGMSY benefit sim-ply because they do not have an account.We now examine the level of motivation of the An-ganwadi worker to see if this has a significant im-pact on the uptake of the scheme. To measure mo-tivation, we asked the women to rate their AWWas unhelpful (0), indifferent (1) or helpful (2). Theaverage of these responses was taken to assign amotivation score to each worker. A two tailed testin the first specification shows that the proportionof women from villages whose AWW was cited ashighly motivated (cited as helpful by all respon-dents) is significantly higher among beneficiaries(specification 1) but not significantly lower amongnon-beneficiaries (specification 2). From this, wecan infer that a woman in an AWC with a highlymotivated AWW has a greater probability of actu-ally getting the benefit amount. In other words, thissuggests that highly motivated AWWs may be in-strumental in reducing the delay in payments.We also conducted a test to see if the proportionof beneficiaries can vary with the level of aware-ness of the AWW about the scheme, as measuredby the proportion of questions about the condition-alities of the scheme that she was able to answercorrectly. However, the results turn out to be in-

significant. This is indicative of our observationsthat AWWs tend to be aware of the scheme in gen-eral, and the variation in awareness, which primar-ily arise in their understanding (or lack thereof) ofthe minutiae of the scheme, is not large enough toaffect enrolment or delays. However, there are alsocases such as that of 25-year-old Susheela Devi,who could not avail the benefits of the scheme be-cause of a miscommunication from the AWW. Shewas told that the scheme would provide only Rs.1600 for a girl child, while Rs. 4000 was only ifthe woman had a boy child. Being a mother of a 4month old girl, she decided not to go through thepain of the whole process, just for Rs. 1600.

5. Conclusions

IGMSY has been implemented with mixed suc-cess in Simdega. The takeup of the scheme hasbeen bolstered by an already robust ICDS system,but is also marred by the flaws of the system. Thisvery robustness of the system also seems to under-cut the scope of the scheme. The eligibility condi-tions of the scheme, and the social proclivities ofthe target population have also led to a differentialuptake of the scheme.A large number of beneficiaries come from womenin the mid-20s. Recently married, and newly preg-nant, everything they say or do is tinged with theexuberance of their youth. The more educatedthese women are, the better they are able to chan-nel this exuberance into healthy practices, increas-ing the uptake of the scheme. On a related note,the literate section of the population seems to ex-hibit a greater uptake of the scheme. The schememight be well-targeted in terms of ownership oflivestock, with greater proportions of beneficiariesin the poorer sections of society, but does not seemto appeal to the right target audience in terms ofoccupation. Rather than the daily wage labourerswho are truly in need of the scheme, it is the house-wives of Simdega who appear to be opting for it inlarger numbers. The uptake does not seem to de-pend on social characteristics such as religion orcaste, but does depend on household size, with afall in proportion of beneficiaries with increasing

18

family size. The respondents ability to obtain andutilize the benefit amount seems to increase withgreater financial accessibility, but uptake of thescheme does not. Firewood collection, as an effort-intensive activity, seems to differ significantly be-tween beneficiaries and non-beneficiaries, indicat-ing that beneficiaries might be having greater ac-cess to firewood markets.There also appears to be differential uptake of thescheme along gender lines. This bias is likely to beassociated with prevailing boy-child-preferences.A lower average birth order among beneficiariesmight suggest a reluctance to enrol for later births,given that most beneficiaries have more than onechild. Awareness of the potential beneficiaries alsoseems to be key to the uptake of the scheme. Themoney accruing from the scheme is spent primarilyas a supplementary income for household needs,and indicates the cash-strapped nature of the bene-ficiary households.The scheme seems to promote ANC visits, andtaking adequate rest from work outside the house-hold, but this effect cannot be attributed purely tothis scheme, but may also be arising from vari-ous other improvements in the recent past. Giventhe lack of a control group (due to our inabilityto visit the control district of Gumla), it is im-possible to separate out these effects. However,it is interesting to note that, even in this situation,there is no real difference between the beneficia-ries and non-beneficiaries in outcomes such as con-sumption of iron supplements (IFA), uptake of TTshots, and breastfeeding and immunisation prac-tices, in large part because of the strength of theICDS system, and a near-universal implementationof these practices among the general population.The scheme has not helped popularise growth mon-itoring, primarily due to the inability of the ICDSsystem to meet the infrastructural requirements ofthe practice. Further, we do not observe any sig-nificant differential effect on maternal health, diet,or physical activity levels, with any changes be-ing reflected similarly across beneficiary and non-beneficiary groups. Since there does not seem to beany other factor that would work on these aspects

differentially and still result in such low levels ofchange overall, it seems likely that the scheme is,in fact, not having any effect on these parameters inand of itself. One key, unexpected takeaway fromthe scheme seems to be the promotion of institu-tional deliveries as a positive externality, thoughalso as an unintended exclusionary criterion . Thehighly significant difference in the proportion of in-stitutional deliveries among beneficiaries and non-beneficiaries of IGMSY might be accidental in ori-gin, but seems to have significant welfare implica-tions for the target group.Keeping in mind any other positive outcomes thisscheme may have resulted in, the delay in the re-ceipt of the cash amount can be deemed as thebiggest drawback of the scheme. The transfers arestaggered, and the delay ranges from two monthsto nearly two years. The uncertainty such an incon-sistent time schedule generates kills the purpose ofthe scheme by making working during pregnancyan all-the-more-necessary condition for many re-spondents. Even this scheme doesnt seem to befree from the clutches of the long arms of corrup-tion. Bribe-taking has become a rule in some ofthe Anganwadis, where women who refuse to payare often denied further help from the AWW. Thisleakage from the transfer amount significantly low-ers the welfare of the women from this scheme, andworse, makes them lose faith in the entire processof working of the scheme.Most of the women we spoke to told us that theywere aware of the necessity of taking IFA tabletsand ANC visits among other things. They did notknow that these were a part of the conditions ofthe scheme. Since they took it as a kind of generalcounselling given by the AWW, they mostly did notgive much thought about fulfilling these conditionsseriously, though the relatively robust ICDS struc-ture seems to be taking care of this anyway. Of-ten, women were totally unaware of the purpose ofthe scheme. For them, it was just another sarkaarischeme which gets them money on filling forms.In short, the entire scheme seems to be standing onthe shoulders of a strong ICDS structure, at least inthe aspect of imparting good health practices as a

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part of the conditions of the scheme.To conclude, we recount one of our pleasant en-counters with a respondent. Estella Dungdung -her smile was that of a person who has learnt tobe happy even amidst a kind of poverty most ofus don’t even know. Our conversation with hermade us introspect about how happiness comes atunexpected times. We were way lighter of heartand probably wiser. We don’t know what she tookback. We had nothing to offer this exceptionalwoman with a sharp mind, a warm and open smile,and a determination that left us amazed and in-spired. We are left wondering what she might havebeen able to achieve, for herself and her family, ifshe had the right kind of support, when and whereit counted. If only government schemes worked asthey were intended to; as they ought to.

6. Acknowledgements

We would like to express our gratitude towardsour supervisor Dr. Deepti Goel for her valuableguidance throughout the research. We are alsothankful to Dr. Janaki Abraham from the Depart-ment of Sociology, DSE, for the insights she sharedwith us on the things to focus on while looking atthe social fabric of our area of study. We wouldalso like to thank the CDE staff for all the timelycommunications regarding the research.We would like to thank Dr. Jean Dreze for beingour guide throughout the research. Responding ex-uberantly to all our requests for counsel, he gaveus an idea of what the feeling of living in a surveytruly was. Each of his suggestions gave us new av-enues to think about, which modified the course ofour survey as we moved along.We are immensely thankful to Mr. Novel Jojowar,Joint Secretary (retd.), Rural Development Depart-ment, Government of Jharkhand, without whosehelp this study might not have been possible.We express our sincere gratitude towards theCDPO, DDC and NDC of the district of Simdega,Jharkhand. Their hospitality and willingness tohelp made the research experience one of the mostpleasant times of our lives. They did everythingin their capacity to make sure we had access to all

the official data about the scheme that was avail-able, to take care of our transportation on the dayswe had to go to remote and thickly forested placesfor our survey and recommend us to other gov-ernment officials whenever necessary, to make ourwork smoother and more efficient.We would also like to thank all the AnganwadiWorkers who took time off to initiate our conver-sations with the respondents, talk about all the sto-ries centered around the scheme and often, walkwith us in the scorching summer heat, to take us tohouseholds.Last, but most definitely not the least, we wouldlike to thank all the 221 women who talked tous during the survey. They listened to our ques-tions patiently and poured their hearts out abouttheir problems. No report can fully do justice tothe plethora of stories of life experiences that wereopened up before us, though we have made our sin-cerest attempt to capture the essence of them here.

7. References[1] Lingam, L. and Yelamanchili, M., Reproductive Rights and

Exclusionary Wrongs: Maternity Benefits, Economic PoliticalWeekly, 94-104, Oct 22, 2011.

[2] Jehan, K., Sidney, K., Smith, H. and Dcosta, A., Improvingaccess to maternity services: an overview of cash transfer andvoucher schemes in South Asia, Reproductive Health Matters,142-154, 2012.

[3] Dhar, A., Left Out of Benefits, The Hindu, Sept 20, 2012.[4] SahayogIndia, Monitoring the IGMSY from Equity and Ac-

countability Perspective A block-level study in West Bengal,Odisha, Jharkhand and Uttar Pradesh, India, 2011-12

[5] Shandana Khan Mohmand, Policies without Politics: AnalysingNutrition Governance in India, Institute of Development Stud-ies, Brighton, 2012

[6] MWCD, Government of India, Approval of Indira Gandhi Ma-tritva Sahyog Yojana (IGMSY)- a Conditional Maternity Benefit(CMB) Scheme, No.9-5/2010-IGMSY (November 8, 2010).

[7] MWCD, Government of India, Implementation Guidelines ofIGMSY- a Conditional Maternity Benefit (CMB) Scheme, No.9-5/2010-IGMSY (April 4, 2011).

[8] Vanita Leah Falcao, Dipa Sinha, et al., Report on the study ofthe IGMSY, Centre for Equity Studies.

[9] Reetika Khera, Childrens Development - Baby steps in Odisha,Economic Political Weekly, Oct 2015.

[10] Dand, Sejal and Agarwal, Nikita Towards a Universalist Con-ception of Adequate Maternity Entitlements in NFSA 2013 Cen-ter for Equity Studies, December 2014

[11] MoHFW, Government of India, DLHS-3, 2007-08.[12] DLHS-3 Questionnaires,

http://rchiips.org/Questonaire.html.[13] PEEP Survey 2013 questionnaires,

http://web.iitd.ac.in/ reetika/ > Survey Instru-ments.

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