According to an EU-funded study, the programme needs to be supported by quality healthcare services for better outcomes
The ambitious Maternity Benefit Programme (MBP) may be a step in the right direction on many counts; however, as per a European Union funded study, it may not do much to help India bring down its Maternal Mortality Rate (MMR) as the Centre hopes it would. The report by MATIND, a project coordinated by the Department of Public Health Sciences/Global Health at Karolinska Institutet, Stockholm, Sweden, says there is no association between cash benefit schemes and MMR reduction.
Prime Minister Narendra Modi, in his address to the nation on December 31 announced pan-India expansion of the MBP known as the Janani Suraksha Yojana in all the districts with effect from January 1. The government launched the cash incentive scheme in 2005 to reduce maternal and neonatal mortality through the promotion of institutional births by providing cash incentives to women who give birth in a health institution. A conditional cash transfer scheme, it awards money to women who deliver in a public health facility.
The MATIND project evaluated the effect of the cash benefit scheme on MMR in Madhya Pradesh and nine other low performing states of India. "India launched the JSY conditional cash transfer programme to promote institutional births. During implementation of the JSY, India witnessed a steep increase in the proportion of institutional deliveries — from 40 per cent in 2004 to 73 per cent in 2012. However, maternal mortality reduction follows a secular trend," the report states.
"Analysis of data in MP and nine low performing states showed that proportion institutional births increased from a pre-programme average of 20 per cent to 49 per cent in five years. The proportion of institutional births had a small negative correlation with the district MMR. Scientific models did not establish significant association between institutional birth proportions and MMR," the report says.
Researchers emphasise that a competent management of complications, when women deliver in facilities under the JSY, is essential for reduction in maternal mortality for a successful programme outcome.
"Our analysis confirms that although inequality in access to institutional delivery persists, it has been reduced since the JSY program began. However, the presence of higher maternal mortality with slower pace of decline in the poorest areas and the inequalities in the availability of emergency obstetric care (EmOC) during the cash incentive programme suggests that the incentive alone is not sufficient to achieve equity in maternal health outcomes," the report says.
"The programme needs to be supported by provision of quality healthcare services including EmOC, and improved targeting of disadvantaged populations could be considered. Access to emergency obstetric care by competent staff can reduce maternal mortality," it says.
According to Indian government reports, while MMR in 2010-2012 was 178 per one lakh live births, it dropped to 167 per one lakh live births in 2011-2013. Though India has seen one of the fastest declines in MMR, however, the current number of maternal deaths is still unacceptably high.
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