Has Janani Suraksha Yojana of Government of India is having any success in Uttar Pradesh – A state of India with high level Maternal Mortality Ratio?

The Janani Suraksha Yojana (JSY) is one of the most important programmes under the overall umbrella of National Rural Health Mission by the Government of India and is aimed at reducing Maternal Mortality Ratio (MMR) and Neo-natal Mortality Rate by promoting institutional deliveries. Under the Scheme, cash incentives are provided to mothers and they are facilitated by Accredited Social Health Activists (ASHAs) (the name is different in some of the states like Rajasthan it is known by the name Sahyogini) to deliver their babies in a health facility. There are also provisions for cost reimbursement for transport and incentives to ASHAs for encouraging mothers to opt for institutional delivery. The scheme is fully sponsored by the Central Government and is implemented in all States and Union Territories, with special focus on low-performing States like EAG states where the Infant Mortality Rate (IMR) and MMR are the highest in the country.  Now after some time of its implementation, the situations are changing. There is also a provision for roping in the private sector by giving accreditation to willing private hospitals/nursing homes for providing delivery services. The Scheme has been implemented in all the nine Annual Health survey (AHS) States since 2005.

In the recent large scale survey of AHS, in order to gauge the spread and effectiveness of the JSY, ever married women aged 15-49 years were probed whether they had availed the maternity financial assistance for safe motherhood under the scheme in respect of their last two outcomes of delivery resulting in live / still births during the reference period, i.e., 2007-09. The percentage of mothers who availed financial assistance for delivery, percentage of mothers who availed financial assistance for institutional delivery and percentage of mothers who availed financial assistance for Government institutional delivery under JSY, all in respect of the last outcome of delivery resulting in live birth / still birth, have been calculated and presented in the recent Fact Sheet released by Office of Registrar General, M/O Home Affairs, GOI. Since the scope of JSY has been extended to domiciliary births also, these three sets of indicators have presented a holistic picture.

Take the case of Uttar Pradesh, which has most of the health development parameters low as compared to the other developed states of India.  For this flag ship scheme of Government of India which is more for eight EAG states (including this State), AHS is found that although in the State institutional deliveries are there about 46% (43% in rural area), but mothers who availed financial assistance for delivery under JSY are are just 16% (about 18% in rural UP) and mothers who availed financial assistance for institutional delivery under JSY are 31% (40% for rural UP).  It is also seen that the deliveries are most occurring in government facilities (75% for entire state and 81% in rural UP) only because of the financial assistance being provided for institutional delivery under JSY otherwise it is at home or in private facility.  Women in UP are more for private arrangement for having delivery as home deliveries are for about 54% and institutional deliveries in private facilities are 18 percent.  Government facilities need to get more confidence of this major chunk of eligible women for giving births to our future generation.  This is one of the major steps required in order to have control on MMR and IMR.