London | India’s ambitious programme to provide monetary incentives for women to give birth in health facilities instead of home has not reduced maternal deaths as much as expected, especially in poor areas, a new study has claimed.
The so called Janani Suraksha Yojana (JSY) programme, launched in 2005 to reduce maternal and neo-natal deaths, successfully increased births at facilities, but due to its implementation in a fragile health system context, it was less effective at reducing fatalities, said Bharat Randive, Doctoral student at the Umea University in Sweden.
While the programme can improve service utilisation, it will not reduce maternal and neo-natal deaths unless the socioeconomic inequalities in access to facility-based care are also addressed and the care is of good quality, said Pune-based Randive.
Emergency obstetric care, which is essential to save lives of pregnant women and babies, is grossly unavailable at public facilities in the poor states of India that form a global hotspot for avoidable maternal deaths, he added.
For the research, Randive looked at nine Indian states and compared access to care and health outcomes in rich and poor areas. The poor areas of these nine less developed states had 135 more maternal deaths for every 100,000 births and the decline in maternal deaths during the programme in these areas was four times slower than in the rich areas.
As all facilities in the JSY programme are not equipped to provide higher level care, obstetric referral services, which are expected to be saving lives of women and newborns, are important for JSY success. However the findings indicate poor quality of referral services, Randive said.
The referrals were associated with higher chances of adverse outcomes at birth and there were a high number of deaths even when women were referred from facilities within the desired two-hour transfer time, he said in his doctoral dissertation.
At its implementation, key government officials and non-government stakeholders were critical of the appropriateness of the cash transfer programme and highlighted the importance of strong health systems and good quality services for the programme to succeed at reducing mortality, he added.