Current global health policies emphasize institutional deliveries as a pathway to achieving reductions in newborn mortality in developing countries.

There is however remarkably little evidence regarding a causal relationship between institutional deliveries and newborn mortality.

In this paper, the authors take advantage of a shock to institutional deliveries provided by the randomized rollout of a government performance-based financing (PBF) program in Rwanda, to provide the first estimates of this causal effect. Using a combination of difference-in-differences and regression discontinuity approaches, they find that program-induced increases in the rate of institutional delivery have not been successful in reducing the rate of newborn mortality.

The findings suggest that attempts to increase institutional deliveries without addressing supply-side constraints are unlikely to result in the large reductions in mortality that policy makers expect.