Utilization of National Health Insurance for Family Planning and Reproductive Health Services by the Urban Poor in Uttar Pradesh, India

A new report and two briefs from the Evidence Project/Population Council outline recommendations for improving awareness and use of national health insurance for family planning and reproductive health services by the urban poor in Uttar Pradesh, India.

In 2008, the Government of India launched the National Health Insurance Scheme, Rashtriya Swasthya Bima Yojana (RSBY), to enable families living below the poverty line to access a range of health services, including family planning (FP) and other reproductive health (RH) services, at designated private hospitals.

Nearly 8 years into the program, there is limited understanding of the awareness and knowledge of RSBY among intended beneficiaries or the reasons women continue to seek FP and RH care at public hospitals rather than private, RSBY empaneled hospitals. To better understand and help expand awareness and utilization of RSBY, the Evidence Project/Population Council conduct­ed a study among the urban poor in Uttar Pradesh, seeking to:

  1. Determine RSBY awareness and barriers to enrollment;
  2. Identify barriers and facilitating factors to use of RSBY for FP/RH services;
  3. Assess the concerns and limitations of administrators and providers at RSBY empaneled private hospitals for providing FP/RH services under RSBY; and
  4. Provide programmatic recommendations to improve the delivery and utilization of RSBY for various FP/RH services.

The study found a number of demand and supply side barriers to the use of RSBY for health services at private hospitals, and identified concrete recommendations for addressing those barriers. On the demand side, lack of awareness about RSBY was the most common reason eligible families did not enroll, and among enrolled families, knowledge of specific benefits – especially FP and RH –  was often limited, which contributed to very low levels of use of RSBY for health services, in particular RH and FP services. Supply side barriers included problems with RSBY cards and confusion about paperwork, as well as providers’ concerns about the low reimbursement rates set for RSBY, and about delays and denials of reimbursements by the insurance companies.


The full report includes comprehensive findings and recommendations from this study, along with a graphic explaining the operational pathways of RSBY. Two briefs are also available: one focused on demand-side factors and the other on supply-side factors affecting awareness and use of RSBY for health services.