The latest official figures indicate that India is well short of meeting the Millennium Development Goals that pledged to reduce the country’s maternal mortality ratio (MMR) by three quarters and the infant mortality rate (IMR) by two-thirds. The Sample Registration System (SRS), 2013, records MMR at 167 per 1,00,000 live births and IMR at 40 per 1,000 live births with a majority of these infants dying within seven days of birth.
India’s high MMR and IMR are partly due to delayed diagnosis and limited access to health care. Additionally, rest during or after pregnancy is not an option for most women who are unorganised workers. According to the District Level Household Survey 3, nearly a quarter of women in India do not receive any antenatal care and over 50 per cent do not receive any postnatal care for up to two weeks.
In 2010, the Ministry of Women and Child Development (MWCD) launched the Indira Gandhi Matritva Sahyog Yojana (IGMSY) to address this critical situation. Leveraging the Integrated Child Development Scheme’s (ICDS) platform, the programme was piloted in 53 districts across the country.
The IGMSY provides partial wage compensation to pregnant and lactating women in order to promote rest and healthy feeding practices, as well as increase utilisation of healthcare services. Under the scheme, all pregnant women of 19 years and above, except those employed by the government (Central or State) or Public Sector Undertakings, for the first two live births were entitled to Rs. 4,000 per live birth, in three instalments. The scheme is conditional on timely registration, complete vaccination, attending counselling sessions and exclusive breastfeeding of the child.
In September 2013, the IGMSY cash incentive was increased from Rs. 4,000 to Rs. 6,000 to comply with the minimum maternity entitlement provision of the National Food Security Act (NFSA), 2013. Additionally the payment timeline was revised to two instalments of Rs. 3,000. However, the coverage and conditions were unaltered.
Poor implementationImplementation of the IGMSY has been neglected since its launch. Official data show that between the years 2010 and 2013, approximately only 28 per cent of the targeted beneficiaries were covered. At the end of 2014, the MWCD announced a proposed scale up of the IGMSY to 200 additional ‘high burden’ districts in 2015-16. Though this expansion did not comply with the NFSA’s mandate of maternal entitlements for the entire country, the willingness of the government to increase coverage of the IGMSY was seen by civil society as a step in the right direction.
However, the government’s lack of commitment to expansion of the IGMSY is betrayed through this year’s budget allocation of Rs. 438 crore, an increase of Rs. 80 crore from 2014-15. Given the absence of Centre-State cost sharing, this increased allocation of approximately one-fifth of last year’s budget is disproportionate to the proposed expansion of nearly four times the current coverage. This indicates the government’s decision to not scale up the IGMSY, which is a clear violation of the NFSA.
A qualitative study of the IGMSY was conducted by the Centre for Equity Studies, New Delhi, in 2014, in Bihar, Chhattisgarh, Jharkhand and Madhya Pradesh. The study revealed widespread neglect of the scheme over three years, with teething trouble still being faced in some districts.
It was found that most beneficiaries were unaware or misinformed about the scheme. One mother in Jharkhand believed that she was entitled to a maximum amount of Rs. 1,500. Without the government’s attention to awareness building, women fail to demand their entitlements. Several Anganwadi workers stated that a three-year gap between the first two children or sterilisation of the mother was essential for receiving IGMSY money for the second child. Such misinformation is a result of inadequate and improper counselling of women and training of workers.
Under the IGMSY, cash is only deposited into an account. Opening and accessing accounts is often expensive and time consuming because banks and post offices are often far from villages. In Madhya Pradesh and Chhattisgarh, banks and post offices were situated as far as 17-30 kilometres — a difficult terrain to traverse in some areas — and some of them are inefficient. IGMSY guidelines specify that the accounts should have to be zero-balance no-frill accounts. However, no woman reported having such an account. Initial deposits demanded from them ranged from Rs. 50-200 in post offices and Rs. 500-1,000 in banks. Such costs disincentivise participation in the programme.
The IGMSY guidelines recommend creation of State and district implementation cells. These cells were either absent or not fully staffed at the time of the study. This failure combined with no provisions for block-level cells, and frequent transfer of officials, negatively impacts IGMSY implementation, monitoring and quality record-keeping. The study also revealed that no system of IGMSY-related complaint filing, time-bound investigation or appeals system exists in Bihar, Jharkhand and Chhattisgarh.
Delayed payment was a trend across the four States with no sampled beneficiary receiving the first instalment of IGMSY cash during pregnancy. In Bihar and Jharkhand, the complete amount was generally received when the child was around one-year-old. Such delays undermine the objective of the scheme — to provide partial wage compensation during pregnancy to enable adequate rest.
Improving effectivenessDespite various issues plaguing the IGMSY, there is significant scope to improve implementation and effectiveness of the programme through compliance with the guidelines. Instead of focussing on the existing gaps, the MWCD around September 2014 proposed limiting the IGMSY to Antyodaya Anna Yojana and priority households i.e., the eligibility criteria for the Public Distribution System (PDS) under the NFSA. This proposal fails to account for the fact that maternal and child health is not merely an economic issue. It is as much a matter of improper practices, misinformation regarding care and delayed diagnosis. For this reason, having initial eligibility criteria that are largely economic are inadequate. Additionally, identification of beneficiaries for the PDS has been shrouded in conversations on digitisation and delayed verification of the Socio Economic and Caste Census, resulting in only 11 States implementing the NFSA till date. There is a real danger of these delays being extended to the IGMSY.
Given the above, what is required is a focus on the basics such as awareness building, establishment of implementation cells, a responsive grievance redress mechanism and a publicly accessible management information system. Most importantly, the government needs to commit to the realisation of the right to maternal entitlements of all women as defined in the NFSA.
(Vanita Leah Falcao and Jasmeet Khanuja are Research Associates at the Centre for Equity Studies, New Delhi. The views expressed are solely those of the authors.)
