Assessing demand-side financial interventions for maternal and neonatal health in Bihar, India

India has implemented demand-side financing programs, including Janani Bal Suraksha Yojana (JBSY) and Pradhan Mantri Matru Vandana Yojana (PMMVY), to reduce financial barriers and improve maternal and neonatal health outcomes. This study assesses their implementation and equity in Bihar, India. A cross-sectional survey across eight districts (N = 1,247) with qualitative interviews (n = 42) revealed severe deficits in awareness, coverage, and timeliness. Notably, 69.7% of women were unaware of PMMVY, and 13.7% were unaware of JBSY. Registration rates were low: 56.0% for JBSY and 2.4% for PMMVY. Only 39.0% of JBSY beneficiaries received payments within 30 days post-delivery. Significant socioeconomic inequities emerged: women from scheduled castes/scheduled tribes and those without formal education were markedly less likely to register or receive benefits. While JBSY beneficiaries incurred lower out-of-pocket expenditure (INR 1,509 vs. INR 2,619), persistent costs, delays, and informal payments undermined financial protection. Qualitative findings identified complex documentation, low digital literacy, and distrust in banking as barriers to Aadhaar-linked direct benefit transfers (DBT). Overall, the potential of conditional cash transfers remains constrained by low awareness, delayed payments, restrictive eligibility, and structural inequities. Strengthening impact requires robust awareness campaigns, simplified DBT systems with grievance redressal, targeted outreach to marginalized groups, and supply-side improvements.