by: Ms.Supriya Goswami, MHA-Health (2011-13)
In 1987, the “International community” resolved to reduce maternal mortality by the “safe motherhood initiative”. In 1994, “The International Conference on Population and Development” recommended reduction in maternal mortality by at least 50 percent of the 1990 levels by the year 2000 and further one half by the year 2015. The 2000 Millennium Declaration signed in US by 189 countries including India, has set the target of achieving 200 maternal deaths per lakh of live births by 2007 and 109 per lakh of live births by 2015. Out of the 8 Millennium Development Goals (MDG), the MDG 5 specifically focuses to Improve Maternal health.
The repeated needs of initiatives were due to failure in achieving the objectives every time.
In India, the “Janani Suraksha Yojana”(JSY), a conditional cash transfer scheme to incentivize women to have institutional delivery, was launched in 2005. The aim of JSY, also known as “Safe motherhood scheme”, is to decrease maternal and neonatal deaths.
According to JSY guidelines, after delivery in a Government or accredited private hospital, women would receive financial assistance as: In Non-high focus states, eligible women would receive Rs.600 in Urban areas and Rs.700 in Rural areas. Eligibility criterion is - having 1st or 2nd live-birth and carrying government issued BPL card or belonging to SC/ST. In the 10 High-focus states, all women irrespective of socio-economic status or parity would receive Rs.1000 in urban areas and Rs.1400 in rural areas. JSY also gives a small incentive of Rs. 500 to a BPL card holding women of age 19 years and older, for delivering at home, for 1st two live births.
JSY implementation occurs through community health workers as ASHAs, who receive Rs.200 in Urban areas and Rs.600 in rural areas per in-facility delivery assisted in high-focus states.
India’s Maternal mortality ratio(MMR) still being high, i.e. 212 per 1,00,000 live-births in the period of 2007-09, as indicated by Sample Registration System, clearly indicates the failure for proper implementation of JSY.
Government provision is needed but it is not enough for success as other factors too exist. Several possible explanations are there which need to be considered. Actually targeted population of poorest and uneducated women did not benefit much, so approaches to raise awareness and encourage them to take benefit are needed, such as communication strategies not based on literacy etc. Physical access to accredited facilities as well as Cultural barriers needs to be addressed. Quality of obstetric care needs to be taken care of with the load increasing on Health facilities due to JSY. The quality aspect could be considered by innovative strategies as - PPP based “Chiranjeevi Yojana” of Gujarat etc., but strict monitoring of healthcare quality maintained there is needed.
An important aspect is the continuous monitoring and evaluation of the programme, when it is progressing, as it would give an idea of what is working and what is not. This would give idea of what better could be done for making this country a safe place for the “mothers” as well as “infants”-the life that depends on them.
P.S. an interesting read on the issue of maternal mortality, 'Maternal Mortality: A Human Rights Emergency'
