Results Data from 51 studies ( 15 more than previous review s ) and 22 cash transfer and voucher programmes  suggest that approaches tied to service use ( either via payment conditionalities or vouchers for selected services ) can increase use of antenatal care , use of a skilled attendant at birth and in the case of vouchers , postnatal care too .
The strongest evidence of positive effect was for conditional cash transfers and uptake of antenatal care , and for vouchers for maternity care services and birth with a skilled birth attendant .
However , effects appear to be shaped by a complex set of social and healthcare system barriers and facilitators .
There are few studies to indicate that programmes have led to improvements in quality of maternity care or maternal and newborn health outcomes .
Background Cash transfers and vouchers are forms of ‘ dem and -side financing ’ that have been widely used to promote maternal and newborn health in low- and middle-income countries during the last 15 years .
Impact of Financial and Educational Interventions on Maternity Care: Results of Cluster Randomized Trials in Rural China, CHIMACA
To report on the design and basic outcomes of three interventions aim ed at improving the use and quality of maternity care in rural China :  financial interventions , training in clinical skills , and training in health education . Community-based cluster r and omized trials were carried out in one central and two western provinces between 2007 and 2009 : ( 1 ) financial interventions covered part of women ’s costs for prenatal and postnatal care , ( 2 ) training of midwives in clinical skills was given by local maternity care experts in two- or three-group training courses , ( 3 ) health education training for midwives and village doctors were given by local experts in health education in two- or three-group training courses . A survey was conducted in a stratified r and om sample of women who had been pregnant in the study period . 73 % of women ( n = 3,673 ) were interviewed within 1–10 months of giving birth . Outcomes were compared by the different intervention and control groups . Adjusted odds ratios were calculated by logistic regression to adjust for varying maternal characteristics . Most of the differences found between the groups were small and some varied between provinces . The financial intervention did not influence the number of visits , but was associated with increased caesarean sections and a decrease in many ultrasound tests . The clinical intervention influenced some indicators of care content . There was no consistent finding for the health education intervention . Financial and training interventions have the potential to improve maternity care , but better implementation is required . Unintended consequences , including overuse of technology , are possible
Results Data from 51 studies ( 15 more than previous review s ) and 22 cash transfer and voucher programmes  suggest that approaches tied to service use ( either via payment conditionalities or vouchers for selected services ) can increase use of antenatal care , use of a skilled attendant at birth and in the case of vouchers , postnatal care too .
The strongest evidence of positive effect was for conditional cash transfers and uptake of antenatal care , and for vouchers for maternity care services and birth with a skilled birth attendant .
However , effects appear to be shaped by a complex set of social and healthcare system barriers and facilitators .
There are few studies to indicate that programmes have led to improvements in quality of maternity care or maternal and newborn health outcomes .
Background Cash transfers and vouchers are forms of ‘ dem and -side financing ’ that have been widely used to promote maternal and newborn health in low- and middle-income countries during the last 15 years .