Article:
Understanding Institutional Delivery in India
Institutional delivery refers to the practice of giving birth in a medical institution under the overall supervision of trained and competent health personnel. It assures the availability of facilities designed to manage the situation and save the lives of the mother and child. Over the past decade-and-a-half, India has been encouraging institutional deliveries to promote safe childbirths. However, it has not significantly improved maternal and infant health indicators despite the increase in the number of institutional deliveries.
Trends in Institutional Delivery
The share of institutional deliveries in India rose to 88.6% in 2019-2021 (National Family Health Survey 5 – NFHS-5) from 40.8 % in 2005-06 (NFHS 3). A similar significant rise occurred in nine targeted states – Bihar, Uttar Pradesh, Uttarakhand, Madhya Pradesh, Rajasthan, Jharkhand, Odisha, Chhattisgarh, and Assam with Madhya Pradesh recording a notable increase by 64.5 %.
These states account for nearly half of India’s population, over 60% of maternal deaths, 70% of infant deaths and 12% of global maternal deaths. However, the Maternal mortality ratio (MMR), infant mortality rate, and neonatal mortality rate (NMR) have not matched the pace of institutional births’ growth.
Despite progress, these states continue to report the highest MMR, which surpasses India’s national average of 103. Most importantly, healthcare delivery and service utilization vary greatly between India’s states that outperform the national average and those lagging.
Government Initiatives Supporting Institutional Delivery
The central government has attempted to incentivize institutional deliveries through key initiatives:
Janani Suraksha Yojana (JSY): Launched in 2005, this program promises a direct cash transfer to women who deliver babies at medical facilities. The JSY aims to reduce maternal and infant mortality by promoting institutional delivery among pregnant women.
Janani Shishu Suraksha Karyakram (JSSK): Introduced in 2011, the JSSK provides free and cashless services to pregnant women, including deliveries and cesarean operations, as well as sick newborns up to 30 days after birth.
Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA): Launched in June 2016, it focuses on conducting special AnteNatal Check-ups (ANC) every 9th of the month to detect and treat cases of anaemia.
Pradhan Mantri Matru Vandana Yojana (PMMVY): Implemented countrywide from 1st January 2017, this maternity benefit program is implemented to provide maternity benefits.
LaQshya Programme: The Labour room Quality Improvement Initiative aims to enhance the quality of care in the labour rooms and maternity operation theatres in public health facilities.
Challenges and the Way Forward
Despite these government schemes, safe birth is not guaranteed merely by incentivizing institutional delivery. A more holistic approach is required to address infrastructure and human resource deficiencies. It is also necessary to strengthen the workforce involved in these programs’ delivery for significant change.
Moreover, the eligibility criteria for such policies need expansion, as presently they exempt those most in need. Monitoring and addressing data gaps are also crucial for India to ensure that every health center publishes their morbidity and mortality data regularly.
Additionally, state governments have introduced similar incentive-based schemes promoting institutional births like Shramik Seva Prasuti Sahayata Yojana in Madhya Pradesh, Janani Suvidha Yojana in Haryana, Ayushmati Scheme in West Bengal, Chiranjeevi Yojana in Assam and Gujarat, and Mamta Friendly Hospital Scheme in Delhi.
With focused attention on these areas, India can make significant strides towards reducing MMR and improving overall maternal and infant health. Ultimately, though, a comprehensive, multi-faceted, and integrated approach is needed to ensure the health and wellbeing of mothers and infants across the nation.