Last year, in eastern Bihar’s Phulwari Sharif, 24-year-old Masahun Khatun was five months pregnant when she fell in the courtyard of her house. For the next three weeks, Masahun and her husband shuttled between government hospitals and private practitioners, spending over Rs.40,000 on healthcare, as they tried to get an abortion. Masahun did not survive and her husband, a daily-wage labourer, is struggling to raise their four kids. This is their story:
Almost a decade after the government launched the Janani Suraksha Yojana (JSY, Mothers’ Protection Programme) to reduce maternal and infant mortality by promoting institutional delivery, too many Indian mothers die of causes related to childbirth.
India’s MMR, or maternal mortality ratio (number of maternal deaths per 100,000 live child births), was 178 in 2010-12, worse than poorer countries such as Myanmar and Nepal, and about the same as Laos and Papua New Guinea, according to WHO data. As many as 50,000 pregnant women die every year in India during childbirth, according to this UN report.
The positive news is that the MMR has declined from 212 in 2007-09. Some states, such as Kerala (66), Tamil Nadu (90) and Maharashtra (87) have MMRs that match countries like Brazil (69), the Philippines (89) and Cuba (80).
Assam (328), Uttar Pradesh (292), Uttarakhand (292), Rajasthan (255), Odisha (235), Madhya Pradesh (230), Chhattisgarh (230), Bihar (219) and Jharkhand (219) have the eight worst maternal mortality rates in India. These numbers match some of the worldÂ’s poorest countries, such as Mauritania (320), Equatorial Guinea (290), Guyana (250), Djibouti (230) and Laos (220).
The JSY gives pregnant women who deliver babies at home and live below the poverty line a cash assistance of Rs.500, irrespective of the woman's age and number of her children, to give birth in a government or accredited private health facility.
The scheme focuses on poor, pregnant women, with a special focus on states with low institutional delivery rates: Uttar Pradesh, Uttarakhand, Bihar, Jharkhand, Madhya Pradesh, Chhattisgarh, Assam, Rajasthan, Odisha, and Jammu and Kashmir.
The scheme also provides performance-based incentives to women health volunteers known as ASHA (Accredited Social Health Activist) to promote institutional deliveries.
A direct transfer of JSY benefits to the bank accounts of pregnant women started in 2013 and is now underway in 121 of 640 Indian districts. JSY beneficiaries have increased from 0.7 million in 2005-06 to 10.4 million in 2014-15, an indicator that many pregnant women know of the scheme.
About 900,000 ASHAs get performance-based incentives to motivate pregnant women to give birth in health facilities. Of the 10.4 million JSY beneficiaries in 2014-15, a large majority (nearly 87 percent) live in rural India.
As many as 60 percent of women in Uttar Pradesh acknowledged paying money from their own pockets for certain services, according to an assessment of JSY conducted by United Nations Population Fund in Bihar, Madhya Pradesh, Odisha, Rajasthan and Uttar Pradesh in 2012.
Women in Madhya Pradesh reported the lowest out-of-pocket expenditure, Rs.299, followed by Bihar with Rs.719, and Uttar Pradesh at Rs.839. Those in Rajasthan spent Rs.1,350, and in Odisha Rs.1,639, the UNPF study showed. Households spent an average of Rs.5,544 per childbirth in rural areas, according to a recent survey by the statistics ministry.
(Prachi Salve, the author is a policy analyst and the views expressed are personal)