Bijayini Mohanty :
Numbers of developmental schemes has been implemented in India as well as states. But the high Maternal Mortality Rate (MMR) is always been a serious issue. As part of India’s Millennium Development Goals, the United Nations has set the target of 200 maternal deaths per one lakh of live births by 2007 and 109 by 2015 which is still far away from the target (167), and if we see the picture of Odisha it is 222 (NITI Aayog, Govt of India).
The latest census shows that Kerala brought down the ratio to 61, in Tamil Nadu the number is 79 and Maharashtra also brought down the ratio to 68 which is much less than 109 per one lakh live births (NITI Aayog, Govt of India). Odisha can adopt the best possible ways to reduce its MMR as well.
The National Health Survey 2015-16 (NFHS-4) data shows, Odisha shown remarkable improvement in both Post Natal Care i.e 73.3% and Janani Suraksha Yojana, has displayed a prominent levels of maternal health. Even the percentage of Institutional birth has increased more than double in these ten years which is one of the main reasons of decreasing Maternal Mortality Ratio (MMR) in the State.
Many research studies shows that one of the main cause of declining Maternal Mortality Ratio (MMR), Neo-Natal Mortality (NNM) and Infant Mortality Rate (IMR) in the state as well as in India is the Institutional deliveries or facility-based births. Still many women especially in rural area and even in urban slums who are lower income group still prefer to deliver babies at home without the presence of a skilled attendant and reasons can be more like, economic problems, family pressure, lack of knowledge on health, risk factors and lack of road and communication etc. As per census 2011, Odisha has around 23% of tribal women, most of them are living in the most remote areas LWE infested, with limited accessibility to health services. Though Odisha has made considerable progress in curving the rates of maternal mortality, still a lot needs to be done.
Maternal and child mortality can be reduced by promoting institutional deliveries. To achieve this, the Indian government as well as the State Govt., Odisha has introduced some maternity benefit schemes.
One of the significant maternity schemes is Janani Suraksha Yojana (JSY); is a safe motherhood intervention under the National Rural Health Mission (NRHM) being implemented with the objective of reducing maternal and neo-natal mortality by promoting institutional delivery among the poor pregnant women. Janani Suraksha Yojana (JSY) was implemented in Odisha in June, 2006. Both the women and the ASHAs are given cash assistance of Rs. 1400/- and Rs. 600/- for ensuring a safe institutional delivery, in rural area. But in Urban area, the mother’s package is Rs. 1000 and ASHA package is Rs. 400 per delivery. For home delivery, mother’s (she must belong to BPL) package is Rs. 500.
The success of Janani Suraksha Yojana (JSY) has been mixed so far- the percentage of mothers availing financial assistance is about 60% in Odisha (Annual Health Survey 2011).
Secretary, WCD, Govt of India, announced during a national level consultation on dt: 22.02.2017 that Janani Surakshya Yojana (JSY) is going to be closed next year. JSY will subsume in Maternity Benefit Program, which is providing higher amount for institutional delivery. As we all know it helps in increasing the institutional delivery and that is one of the main reason the state’s Infant Mortality Rate (IMR) and Maternal Mortality Ratio (MMR) is decreasing, though the rate is slow. Even the doctors and nurses of Govt. hospitals just before delivery and after the delivery at least keeping eye on the health of both child and mother, which will be neglected if Janani Surakshya Yojana (JSY) will be no more.
Again if JSY will be closed, then there will be a loss of Rs.400/- of each beneficiary. Research work by Odisha Khadya Adhikar Abhiyan says that more than 50% of the cash beneficiaries getting under maternity schemes use to spend on health care of both mother and child, and rest of the amount is being spent for better food consumption and even family are able to do little savings from that amount. But unfortunately, if they lose a small amount even that will affect their life cycle. While there are hundreds of news coming that Children and mothers are suffering with severe Anaemic in the state as well as nation, govt.’s declaration to stop Janani Surakshya Yojana (JSY) will how far be justifiable?
The cash maternity entitlement under National Food Security Act (NFSA) has been conceptualised as a wage compensation for being away from work as well as a social protection for pregnant and lactating women. Although it has been almost two years since the passing of the NFSA, the Government is yet to operationalize this entitlement through a universal scheme. It is expected that the Indira Gandhi Matritva Sahyog Yojana (IGMSY), which was launched on a pilot basis in 2010 and in Odisha it is restricted to two districts i.e Sundergarh and Bargarh districts in Odisha, but it supposed to be universalised to meet the requirements of the NFSA, again is still a big question.
To address the situation and alleviate the problem of maternal and infant under nutrition, Government of Odisha (Department of Women and Child Development) has envisaged a state-specific scheme for pregnant and lactating mothers called “MAMATA’- a conditional cash transfer maternity benefit scheme. The scheme will provide monetary support to the pregnant and lactating women which will enable them to seek improved nutrition and promote health seeking behaviour.
After the enactment of NFSA, the provision of Maternity benefit has changed a bit. And it was also informed that the maternity benefit of Rs.6,000/- may be provided in three instalments through Direct Bank Transfer mode. The three instalments will be Rs. 3000/-, then 1500 and again Rs. 1500/- respectively based on conditions. It is declared that as it was announced by the Hon’ble Prime Minister, the new rules to be implemented from 1st January, 2017. But there is a contradiction that the Odisha Govt. has already announced for two instalments under the state maternity entitlement scheme named as MAMATA. The second instalment of Rs. 1,500/- would be provided after delivery of the child on producing a certificate from the Medical Officer that the delivery has taken place in a medical facility approved by Health & Family Department. This is not mentioned in the new MAMATA guideline and also the medical certificate can be manipulated.
And as usual this will be connected with Aadhaar. It means those who don’t have Aadhaar card will be excluded from getting the benefit.
There are lot of questions in its implementation in the state now, as there are contradiction of rules between the centre and state.
Bijayini Mohanty is Bhubaneswar based Social Anthropologist working with Odisha Khadya Adhikar Abhiyan. She has worked in different Asian & African countries on women health issues.