JSY Maternal Health Scheme

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Janani Suraksha Yojana (JSY) is a safe motherhood intervention run by the Government of India’s National Rural Health Mission (NRHM) to reduce the mortality rate of mothers and newborn babies. PACS partners have been helping socially excluded communities to understand and access the benefits under this scheme.

What is the Janani Suraksha Yojana scheme?

The aim of the JSY scheme is to encourage poor pregnant women to give birth in registered health institutions where medical staff are on-hand if something goes wrong.

Launched in April 2005, the JSY scheme is being implemented in all States and union territories of India. However, there is a special focus on Low Performing States (LPS) – those where less than 25% of women give birth in a health institution. Six of the seven PACS states - Bihar, Chhattisgarh, Jharkhand, Madhya Pradesh, Odisha and Uttar Pradesh – are classified as low performing.

In these low performing states, ASHAs - Accredited Social Health Activists – are responsible for helping poor pregnant women to access the benefits under JSY.

The role of an ASHA is to:

  • Identify pregnant women in their area who are eligible to benefit from the scheme.
  • Explain the benefits of institutional delivery to pregnant women.
  • Help pregnant women to register for and receive at least 3 ante-natal checkups, including tetanus injections and Iron Folic Acid tablets.
  • Assist pregnant women to obtain the necessary certifications including a JSY card and a bank account.
  • Prepare individual micro-birth plans for pregnant women, including identifying a nearby health institution where they can be referred for delivery.
  • Escort pregnant women to the pre-determined health centre when their babies are due and stay with them until they are discharged.
  • Arrange immunisations for newborns, including a BCG immunisation against TB.
  • Visit women within 7 days of birth for a post-natal visit.
  • Provide breastfeeding support.
  • Promote family planning

Under the scheme, cash assistance is provided for both the mothers and the ASHAs.

In rural low performing states, mothers receive 1600 Rupees when they arrive and register at the health institution to give birth. This money meets the cost of delivery and provides a small, additional cash incentive.

The ASHA receives 600 Rupees when accompanying a woman to a health institution for delivery. This money pays for her board and lodging whilst staying with the pregant woman.

The ASHA also receives a cash incentive per delivery. She receives this after she has made her final postnatal visit to the beneficiary and the baby has been immunised against TB.

Suki was helped by the women's group in her community (supported by PACS) to access JSY services when she was pregnant.

Why is JSY an issue for socially excluded groups?

According to the India Exclusion Report (2013/14) only 52% of women in India access ante-natal care and even fewer (38.7%) give birth in an institutition. Indeed, for every 100,000 live births, 767 mothers die and 57 out of every 1000 babies die before their first birthday.

Amongst socially excluded groups these figures are worse. For example, only 33% of Dalit and Muslim women give birth in institutions and the figure for tribal women is even less: 17.7%. 62 out of every 1000 babies from tribal communities die before their first birthday, whilst this figure is 66 for Dalit communities.

These figures reveal some of the issues that socially excluded groups face in accessing maternal health care. For Dalit communities, health workers are usually from higher castes and often deny them treatment or refuse to touch them due to their historical status as “untouchable”. If treatment is provided, quality of care is often poor and unacceptable attitudes are frequently encountered.

Tribal communities often live in remote areas making access to healthcare institutions difficult. Language barriers also make it difficult to interact with health workers and a lack of understanding and education make tribal groups wary of accessing modern medicine.

For Muslim communities, the 2006 Sachar Committee report noted that the level of service provision, including water, sanitation and public health facilities, are in short supply in Muslim areas.

In short, the access to health and nutrition services for these groups is negatively affected due to widely-held discrimination against them based on their identities and, ultimately, this leads to poorer maternal health for these groups.

In the Indra Basti Slum in Madhya Pradesh, members of the Women's Community Group supported by PACS partner KSHITIJ make regular door-to-door visits to ensure that women, especially those who are pregnant, access their health rights under schemes such as JSY.

What work has PACS done on JSY?

PACS has been working on the issue of JSY to:

  • Increase community awareness about the entitlements of pregnant women to maternal healthcare services under JSY, and the importance of these services to both mother and baby health. This has been achieved through working with members of Self Help Groups. 
  • Increase the representation of socially excluded groups (especially women) in health committees, ensuring that they have a voice.
  • Support local health committees (and especially the members from socially excluded groups) to monitor JSY services, working with local service providers to improve institutions and to raise issues when discrimination and malpractice occur. 

Akhtari has been working with local government officials to campaign for a women-friendly delivery service in her district in West Bengal.

What impact has PACS work on JSY had?

  • 240,713 women have been supported to give birth in an institutiton under JSY (or a similar State-level maternal health scheme).
  • 209,314 of these women received full benefits (including ante-natal and post-natal care, cash payments and breastfeeding support).

Find more JSY case studies on the PACS Learning Zone.

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