India is one of the most high-risk places in the world to give birth, accounting for 12% of total maternal deaths worldwide. Most of these maternal deaths are preventable provided that the pregnant women have access to healthcare solutions to prevent or manage complications. In order to address the issues around safe motherhood, April 11 is celebrated as National Safe Motherhood Day every year, to commemorate the birth anniversary of Smt. Kasturba Gandhi, wife of Mahatma Gandhi.
Providing safe motherhood is among the top priorities of the government of India. The union government and many state governments have launched different schemes to facilitate safe motherhood for women belonging to different sections of society. Let us look at some of these programs.
Integrated Child Development Services Scheme (ICDS)
ICDS is an umbrella scheme with 6 components that are aimed at reducing infant mortality and child malnutrition, which are important components of safe motherhood. The important components of the scheme aimed at safe motherhood are Anganwadi Services Scheme, Pradhan Mantri Matru Vandana Yojana and POSHAN Abhiyan.
Aanganwadi services scheme
Aanganwadis are daycare centres set up by the government which are mainly aimed at providing nutrition and basic education to the children of underprivileged families but also support pregnant women and lactating mothers to ensure that the child’s growth and development is not hindered because of malnourishment of mothers.
Pradhan Mantri Matru Vandana Yojana
This is a maternity benefit programme being implemented in all districts of the country with effect from 1st January, 2017. Under this scheme, cash benefits are provided to pregnant women in their bank account directly to meet enhanced nutritional needs and partially compensate for wage loss. Beneficiaries of the scheme receive a cash benefit of Rs. 5,000 in three installments on fulfilling the following conditions:
– Early registration of pregnancy
– Ante-natal check-up
– Registration of the birth of the child and completion of first cycle of vaccination for the first living child of the family.
Additionally, the eligible beneficiaries also receive cash incentive under Janani Suraksha Yojana (JSY). Thus, on average, a woman gets Rs. 6,000.
POSHAN Abhiyan
POSHAN Abhiyan is aimed at ensuring nutritional security in the country to fight against malnutrition. The main focus for the program will be pregnant women, lactating mothers and young children.
National Health Mission
National Health Mission (NHM) was launched by the government of India in 2013 subsuming the National Rural Health Mission and the National Urban Health Mission. It was further extended in March 2018, to continue till March 2020. The main programmatic components include Health System Strengthening in rural and urban areas for – Reproductive-Maternal- Neonatal-Child and Adolescent Health (RMNCH+A), and Communicable and Non-Communicable Diseases. The NHM envisages the achievement of universal access to equitable, affordable & quality health care services that are accountable and responsive to people’s needs.
Accredited Social Health Activist (ASHA)
ASHA is a trained female community health activist. Selected from the community itself and accountable to it, the ASHA will be trained to work as an interface between the community and the public health system. The role of an ASHA is that of a community-level care provider. This includes a mix of tasks: facilitating access to health care services, building awareness about health care entitlements especially amongst the poor and marginalized, promoting healthy behaviours and mobilizing for collective action for better health outcomes and meeting curative care needs as appropriate to the organization of service delivery in that area and compatible with her training and skills.
Janani Suraksha Yojana
Janani Suraksha Yojana (JSY) is a safe motherhood intervention under the National Rural Health Mission (NHM). It is being implemented with the objective of reducing maternal and infant mortality by promoting institutional delivery among pregnant women. The scheme focuses on the poor pregnant woman with special dispensation for States having low institutional delivery rates. Under the JSY, eligible pregnant women are entitled to cash assistance irrespective of the age of the mother and number of children for giving birth in a government or accredited private health facility. The scheme also provides performance-based incentives to ASHA volunteers for promoting institutional delivery among pregnant women.
Janani Shishu Suraksha Karyakram
The Government of India has launched Janani Shishu Suraksha Karyakaram (JSSK) on 1st June 2011. It is an initiative to provide completely free and cashless services to pregnant women including normal deliveries and caesarean operations and sick newborn (up to 30 days after birth) in Government health institutions in both rural & urban areas. The scheme is aimed at motivating the people who still choose to deliver at their homes to opt for institutional deliveries.
Surakshit Matritva Aashwasan (Suman)
The Union Government has launched Surakshit Matritva Aashwasan (SUMAN) to provide quality healthcare at zero cost to pregnant women, new mothers and newborns. It aims to provide dignified and quality health care at no cost to every woman and newborn visiting a public health facility. Under the scheme, the beneficiaries visiting public health facilities are entitled to several free services. These include at least four ante natal check-ups that also includes one checkup during the 1st trimester, at least one checkup under Pradhan Mantri Surakshit Matritva Abhiyan, Iron Folic Acid supplementation, Tetanus diptheria injection.
The scheme will enable zero expense access to the identification and management of complications during and after the pregnancy. The government will also provide free transport to pregnant women from home to the health facility and drop back after discharge (minimum 48 hrs). Additionally, the pregnant women will be able to avail a zero expense delivery and C-section facility in case of complications at public health facilities. The scheme will ensure that there is zero-tolerance for denial of services to such patients.
Pradhan Mantri Surakshit Matritva Abhiyaan (2016)
Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA) is a fixed day strategy, every month across the country during which a range of quality maternal health services are envisaged to be provided as part of Antenatal Care.
Under the campaign, a minimum package of antenatal care services is to be provided to the beneficiaries on the 9th day of every month at the Pradhan Mantri Surakshit Matritva Clinics to ensure that every pregnant woman receives at least one checkup in the 2nd/ 3rd trimester of pregnancy. If the 9th day of the month is a Sunday/a holiday, then the Clinic should be organized on the next working day.
“LaQshya” (Labour room Quality Improvement Initiative) program was launched in 2019 in order to improve the quality of care in the labour room and maternity operation theatres in public health facilities. The aim of the program is to reduce preventable maternal and newborn mortality, morbidity and stillbirths associated with the care around delivery in the Labour Room and Maternity Operation Theatre (OT) and ensure respectful maternity care. Under the initiative, a multi-pronged strategy has been adopted such as improving infrastructure up-gradation, ensuring the availability of essential equipment, providing adequate human resources, capacity building of health care workers and improving quality processes in the labour room.
India has come a long way in improving maternal survival as Maternal Mortality Ratio (MMR) has reduced from 167 in 2011-13 to 130 in 2014-16, an impressive decline of 22% in the last few years. India is further committed to ensuring safe motherhood to every pregnant woman in the country.
