India, which has, the highest number of women dying in childbirth, introduced Janani Suraksha Yojana (JSY), a scheme which gives a cash incentive of around 1,400 rupees (around 30 US dollars) to women who deliver in health care facilities.

It was introduced in 2005 and its objective is to reduce maternal and neo-natal mortality by promoting institutional delivery among poor, pregnant women. The number of women getting treatment health care centers has since then gone through the roof from 700,000 in 2005-06 to more than 10 million in 2010-11. As a result, maternal deaths have decreased by 17 percent. The scheme applies to women above the age of 19 who live below the poverty line or belong to a certain caste or tribe. It is limited for upto two successful births,

Quality compromised

While most agree that the JSY scheme has succeeded in its main objective, some say that the quality and quantity of the care is not yet up to par. Brigid McConville, the Director of The White Ribbon Alliance for Safe Motherhood UK, told Deutsche Welle that the health care centers are often swamped with women who are driven by the cash incentive.

"Sometimes women give birth on the porch of the health care center," says McConville. This is because there may not be a free bed or not enough trained nurses to take care of them properly, but they still go to the health center so they can receive the cash. She says while the number of women going to the health care centers his high, the quality is often poor. "It’s an excellent first step, but the follow-up has not yet taken place," says McConville.

Dr. Sanghita Bhattacharyya, a senior public health specialist at the Public Health Foundation of India, says women should stay at the hospital for at least 48 hours as some of the greatest problems can occur in the days right after the birth. But due to the lack of beds, many women are often sent home within hours of delivery. "Before rolling out the JSY, they should’ve taken care of resources in terms of humans, equipment, supplies, and infrastructure." Despite the rise in institutional deliveries, the availability of doctors and nurses has stayed the same.

A new scheme

Though the JSY offers a cash incentive it does not quite cover the full cost of child delivery, as Baneen Karachiwala, a Project Coordinator at Belaku Trust, a non-profit organization dedicated to community health research and action, points out. "So how do the poor manage? They take loans, very large last minute loans with high interest," she says.

A new scheme, the Janani-Shishu Suraksha Karyakram (JSSK), was introduced in June. It "supplements the cash assistance given to a pregnant woman under Janani Suraksha Yojana and is aimed at mitigating the burden of out-of-pocket expenses incurred by pregnant women and sick newborns," according to a government website. The entitlements under this new scheme would include free medicine, free transport to a health clinic, and free treatment of ill newborns for up to 30 days, to name a few.

Karachiwala is not optimistic about the new scheme. She believes "this new JSSK scheme will definitely increase the problem of crowding unless they concentrate on improving the infrastructure and human resources."

Still not perfect

It may have a circular effect, Bhattacharyya warns. "If women didn’t get good quality in first delivery, they will not come for another one. They’ll be spending more than the 1,400 rupees they receive, so they may not think it’s worth it." She says that there has already been in a huge jump in the last three years of women delivering in hospitals, but she doesn’t think that it will significantly increase in the coming years.

To fight a downward spiralling cycle, the government must change the quality and conditions of care. The ministry has slowly realized that quality must be improved and is now thinking about the next step. Union Health and Family Welfare Minister Shri Ghulam Nabi Azad noted that quality ante-natal and post-natal services are one of the significant lifesavers for mothers and infants.

Unfortunately quality has not yet become part of the system, according to Bhattacharya. "Quality should be part of day to day (life) and not an isolated factor. The process of quality needs to be embedded within the system."

Author: Shivani Mathur
Editor: Sarah Berning