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
world’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 is a policy analyst with IndiaSpend. The views expressed are
personal. This article is the result of a collaboration between Video
Volunteers, a global initiative that provides disadvantaged communities
with story and data-gathering skills, and IndiaSpend, a data-driven,
non-profit, public interest journalism platform)
