Health schemes for improving maternal health inIndia

Deepak Sharma, Naveen Krishan Goel, Munish Kumar Sharma,

Meenal Madhukar Thakare
Department of Community Medicine, Govt. Medical College, Chandigarh

Introduction

Maternal Health is avital parameter for assessing the quality of health services ina country.
Maternal Mortality Ratio is used for recording maternal health status of a community. It is
defined as the number of maternal deaths per 100,000 live births from any cause related to or
aggravated by pregnancy or its management and not due to accidental or incidental causes1. In
the end of the last decade, Maternal Mortality Ratio (MMR) in India was pegged at 556 per lakh
live births. In 2000 it stood at 374 per lakh live births. Subsequently, in the year 2011-2013 it
declined to 167 and currently in 2015 it stands at 130 per lakh live births2. The decline has been
most profound in Empowered Action Group (EAG) states namely Uttar Pradesh, Uttarakhand,
Madhya Pradesh, Chhattisgarh, Bihar, Jharkhand, Rajasthan, Odisha. This remarkable pace of
decline can be attributed to the government of India schemes aimed at improving maternal
health. In this writeup the currently implemented various government of India schemes for
improving maternal health have been delineated.

I. Schemes
Pradhan MantriMatruVandanaYojana : It is beingimplementedsince January 2017. In
this scheme pregnant women and lactating mothers are given cash benefit of ₹5,000
which is payable in instalments. The first instalment is worth1000which the beneficiary
gets on early registration of pregnancy. The second instalment of 2000 is paid once the
antenatal women completes six months of pregnancy and gets done at least one ante-
natal check-up (ANC). The final instalment of 2000 is done after child birthand he/she
receives the first cycle of immunization namely BCG, OPV, pentavalent vaccine. The
objective of the scheme is to provide partial compensation for the wage loss in terms of
cash incentives so that the woman can take adequate rest before and after delivery of
the child. It also improves the health seeking behaviour of the ANC mothers3.

a. Pradhan MantriSurakshitMatritvaYojanaAbhiyan: This scheme is being implemented

since year 2016. The objectiveis improving the quality and coverage of Antenatal Care
by doing timely detection, referral, treatment and follow-up of high risk pregnancies.
It aims at reaching out to all pregnant women who are in the 2nd & 3rd trimesters of
pregnancy. The check-up is envisaged on 9thday of every month. If this day of the
month is a holiday, then the check-upis organized on the next working day. In this
scheme, antenatal check-up isprovided at public health facilities as well as private
clinics. The service is provided by the Medical Officer and Obstetrics and Gynaecology
specialist4.
 b. Janani Suraksha Yojana (JSY). It is a centrally sponsored scheme launched in the year
2005. The objective is to reduce the number of maternal and infant deaths by
promoting institutional delivery among pregnant women. In this scheme pregnant
women are entitled for cash assistance for giving birth in a government or accredited
private health facility. The beneficiaries are poor pregnant woman. The cash
assistance for mothers in rural area is Rs 1400 in low performing states and Rs 700 in
high performing states. In urban areas the benefit is Rs 1000 in low performing states
and Rs 600 in high performing states. Cash assistance is also given to ASHA worker to
cover the incidental charges5.
c. Janani Shishu Suraksha Karyakaram (JSSK): Government of India launched this
scheme on the year 2011. In this scheme all pregnant women who give child birth in
governmenthealth facilities are entitled for free facilities. These are cashless delivery
services, free caesarean section, free treatment of sick new-born, free
medicines/consumables, free diagnostic tests, free diet during indoor stay, free blood
transfusion, free pick up and drop facility from home to health institutions6.
d. DAKSHATA – The objective of this scheme is to strengthen the intra-partum and
immediate postpartum care by enhancing the competency of the health care
providers in performing evidence-based practices as per the established labor room
protocols and standards. Also it aims at improving the availability of essential supplies
and commodities in the labor room and accountability of service providers through
improved recording, reporting and utilization of data. A dashboard of key indicators
will be created to record data. The in-charge of the facility will monitor these key
indicators on a regular basis towards ensuring improved monitoring at the targeted
facilities. The duration of this training program will be 3 days. Health care providers
will be trained by designated trainers in small batches. The sessions will focus on skill
practice using a checklist. An Observed Structured Clinical Examination (OSCE) will be
used during skill practice to assess the learning7.
II. Implementation status of schemes
The various health schemes have resulted in improved maternal health indicators.
Under PMMY scheme money is being transferred to the accounts of the beneficiaries.
Under the PMSMYA scheme comprehensive and quality antenatal checkups for
pregnant women is being done across India. High-risk pregnancies identified are
referred to a specialist or a higher health facility for appropriate care.JSY has resulted in
an increase number of antenatal mothers delivering in institutions.The JSSK scheme has
resulted in increasingaccess to health facilities by doing away with out of pocket
expenses on medical inpatient care and transportation required to take pregnant from
home to the health facility and back. As per data available from National family Health
Survey, institutional delivery in the rural areas of India has increased to 75.1% in 2015-
16(NFHS-IV) from 31.1% in 2005-06(NFHS-III). The mothers who had at least 4
mandatory antenatal care visits (%) has increased to 51.2% (NFHS-IV) from 37.0 %(
NFHS-III)8.

III. Conclusion
 The Millennium development goals (2000-15) had listed one of the targetsof reducing
maternal mortality ratio (MMR) by three quarters from 1990 to 2015 (reducing the
MMR from 560 in 1990 to 139 in 2015). Post the year 2015, the Sustainable
Development Goal (SDG) target list the target of decreasing MMR to 70 deaths per
1,00,000 live births by the year 2030. For reaching this goal some issues need focus9.
The available MMR data shows that maternal mortality in India varies significantly
between States (Kerala’s MMR=46; Assam’s 237). These regional disparities must be
addressed by implementing programs that improve the coverage of essential maternal
health and strengthening health care infrastructure. While maternal health schemes are
playing an important role in reducing maternal mortality, it is crucial that society at large
plays a role. There should be an end to gender discriminatory practices which deter
women from accessing reproductive and sexual heaths services. Child marriage and
domestic violence are the evils of the society need to tacked and put to an end.Girl child
education should be stressed. Available evidence shows that educated girls are more
likely to exert influence in limiting the size of their families in adulthood. With collective
efforts of government and society it should be ensured that no woman in India loses her
life to a preventable cause.

References

1. Maternal health. Available from URL: http://unicef.in/Whatwedo/1/Maternal-Health.

Accessed on 24-10-2018.
2. Maternal mortality ratio. Available from URL: http://niti.gov.in/content/maternal-
mortality-ratio-mmr-100000-live-births. Accessed on 20-10-2018.
3. Pradhan MantriMatruVandanaYojana. Available from
URL: http://www.wcd.nic.in/sites/default/files/PMMVY%20Scheme%20Implemetation%
20Guidelines%20._0.pdf. Accessed on 10-10-2018
4. Pradhan MantriSurakshitMatritvaYojanaAbhiyan .Available from
URL: https://pmsma.nhp.gov.in/. Accessed on 18-10-2018
5. Janani Suraksha Yojana (JSY). https://www.nhp.gov.in/janani-suraksha-yojana-jsy-_pg
6. Janani Shishu Suraksha Karyakaram. Available from URL: http://nhp.gov.in/janani-
shishu-suraksha-karyakaram-jssk_pg. Accessed on 19-9-2018
7. Dakshata. Available from URL: http://nhm.gov.in/nrhm-components/rmnch-a/maternal-
health/dakshata/dakshata-3-days-training.html#. Accessed on 10-10-2018
8. National family health survey 4. Available from
URL: http://rchiips.org/nfhs/factsheet_NFHS-4.shtml. Accessed on 10-08-2018
9. Sustainable development goals. Available from
URL: http://www.undp.org/content/undp/en/home/sustainable-development-
goals.html. Accessed on 10-09-2018