Do You Need to Pay for Quality Care? Exploring Associations Between Bribes and Out-of-Pocket Expenditures on Quality of Labor and Delivery Care in High-Volume Public Health Facilities in Uttar Pradesh, India

Amanda Landrian , University of California, Los Angeles
Beth Phillips, University of California, San Francisco
Shreya Singhal, Community Empowerment Lab
Shambhavi Mishra, Community Empowerment Lab
Fnu Kajal, Government of India, Ministry of Health, Uttar Pradesh
May Sudhinaraset, University of California, Los Angeles

This paper examines the prevalence of bribe requests, total out-of-pocket expenditures (OOPEs), and associations between bribe requests and total OOPEs on the experience of quality of care and maternal complications during childbirth among 2,018 women who delivered in public facilities in Uttar Pradesh, India using cross-sectional survey data. Nearly half (43%) of women were asked to pay a bribe and 73% incurred OOPEs. Bribe requests were significantly associated with lower odds of receiving all health checks upon arrival to the facility (aOR=0.49; 95% CL: 0.24-0.98) and during labor and delivery (aOR=0.44; 95% CL: 0.25-0.76), lower odds of receiving health checks after delivery (aOR=0.44; 95% CL: 0.31-0.62), and higher odds of experiencing maternal complications (aOR=1.45; 95% CL: 1.13-1.87). Although it is mandated that maternity care be provided for free in public facilities in India, these findings suggest that OOPEs are high, and bribes/tips contribute significantly. Interventions centered on improving person-centered care, particularly guidelines around bribes, are needed.

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 Presented in Session 242. Challenges in Operationalizing Population and Reproductive Health Policies and Programs