Grant: Project Grant

India accounts for more than one-fifth of global maternal and neonatal mortality and there are substantial inequalities across states and regions, urban and rural areas, and across various dimensions of socioeconomic status. Promoting access to quality sexual, reproductive, and maternal health services is an important mechanism for accelerating progress toward Sustainable Development Goal targets for reductions in maternal and newborn death. Out-of- pocket costs represent a substantial barrier to access to maternal and reproductive health services, particularly among poorer households, in India. In 2008, the Government of India launched the Rashtriya Swasthya Bima Yojana (RSBY) health insurance scheme to improve access to health services for families below the poverty line, and later expanded to cover unorganized workers. The program provides eligible families with cashless healthcare for inpatient health services, capped at INR 30,000 (USD 500) annually. This includes certain sexual and reproductive health services, such as insertion of an intrauterine device; a maternal care package including antenatal care, diagnostics, and delivery; and neonatal care for newborns admitted with complications. In this study, we will use information collected from three district-representative household surveys to evaluate the impact of expanded access to RSBY on social inequalities in the use of recommended sexual, reproductive, and maternal health services, maternal health, and neonatal health. The findings from this study will help to inform interventions for reducing overall levels and inequalities in maternal and neonatal mortality. More generally, these results will have the potential to influence the design of universal health coverage systems through a better understanding of how to improve equitable access to quality health services and reduce social inequalities in maternal and newborn health.