Many developing countries have implemented policies to encourage deliveries in formal health facilities to combat maternal and infant mortality. Evidence about their effectiveness remains limited and mixed, raising questions of whether health systems can improve child survival. This paper evaluates a Ghanaian policy that made facility births free using a regression-discontinuity-in-time design, along with difference-in-difference estimates, to measure effects on delivery decisions, health-service take-up, and mortality and health. We find large effects on facility births, particularly for the poorest mothers, which lead to substantial reductions in longer-run child mortality (but no change in neonatal mortality) and improvements in child health.
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