India accounts for a fifth of the total childbirths in the world, with a maternal mortality rate of 113 per 1,00,000 live births. On January 1, 2017, the Government rolled out the Pradhan Mantri Matru Vandana Yojana (PMMVY), where a ‘cash incentive of ₹5,000 is provided directly to the bank/post office account of pregnant women and lactating mothers for the first living child of the family (subject to fulfilling specific conditions relating to maternal and child health)’. It is aimed at improving health-seeking behaviour and to compensate for wage loss for pregnant women, particularly in the unorganised sectors. However, the performance of the scheme has been deficient, necessitating urgent need for improvement especially when the novel coronavirus pandemic has resulted in economic shocks for 260 lakh women who deliver on an average a child each year in India.
How the PMMVY fares
Since its inception, the PMMVY has covered 2.01 crore women nationally, disbursing a total amount of ₹8,722 crore. But the annual estimate of the targeted beneficiaries by the Government of India has remained the same over the years. While the estimated eligible population of pregnant and lactating mothers in India was 128.7 lakh for 2017-18 (as in a report by the Centre for Policy Research 2019-20), the target set by the Government was 51.70 lakh beneficiaries, which is only 40% of the eligible population. This means that we have an exclusion error of at least 60% since 2017, as the target has remained unchanged over the years. Further, the enrolment and disbursements under the scheme have witnessed a downward fall in the last two years, as in the data provided by the Ministry of Women and Child Development (WCD) in response to my parliamentary questions. In 2020-21, more than 50% of registered beneficiaries did not receive all three instalments and there was a 9% drop in enrolment under the scheme.
Despite the Government’s continued emphasis on maternal and child health, the overall budget for women and child development was reduced by 20% for 2021-22. Additionally, Budget allocation for the PMMVY has also been slashed as it has been clubbed under SAMARTHYA along with multiple other schemes such as Beti Bachao Beti Padhao, Mahila Shakti Kendra and Gender Budgeting/Research/Training. The overall budget of SAMARTHYA is ₹2,522 crore, which is nearly equivalent to the budget of PMMVY alone in the previous financial years.
States show the way
While the Centre rolled out the PMMVY scheme at the national level, States such as Odisha, Telangana and Tamil Nadu, respectively, chose to implement State-specific schemes for maternity benefits in the form of MAMATA (2011) or the maternity entitlement scheme, the KCR Kit (2017), which has items such as baby oil, soaps, mosquito net and dresses, and the Dr. Muthulakshmi Reddy Maternity Benefit Scheme (MRMBS) with relatively increased coverage and higher maternity benefits. Odisha’s MAMATA, for instance, has been offering a conditional cash transfer of ₹5,000 as maternity benefit for up to two live births for more than a decade now.
In a comparative analysis between the PMMVY and MAMATA for 2020-21, the PMMVY shows poor performance with a 52% drop in the number of beneficiaries covered while MAMATA showcased a 57% increase in women who received all the instalments. The scheme stands as a testament to an inclusive and efficient implementation of the maternity benefit programme, thereby serving as promising evidence for the Centre to improve the PMMVY in line with the Odisha Government Scheme.
Steps to take
Here is the way forward for the PMMVY. Extend the maternity benefit under the PMMVY to the second live birth.
The predecessor scheme, the Indira Gandhi Matritva Sahyog Yojana was applicable for two live births. Of the total live births in India, 49.5% comprises first-order births and 29.9% are second-order births, as per Sample Registration Survey 2018. It is imperative to include second live birth under the maternity benefit cover particularly for women in the unorganised sector who are more vulnerable to economic shocks and nutrition loss for all child births.
There must be an increase in the maternity benefit amount. Since the primary objective of the PMMVY is to provide partial wage compensation, we need to revisit the maternity benefit amount offered under the scheme. Most women continue to work during and post-pregnancy since they cannot afford to lose wages; additionally, they also spend on out-of-pocket expenses during pregnancy. The current entitlement of ₹5,000 provided over one year amounts to one month’s wage loss (as per the Mahatma Gandhi National Rural Employment Guarantee Act wage rate of ₹202). In line with the Maternity Benefit Act, 1961 which mandates 12 weeks of maternity leave for women with two or more children, pregnant and lactating mothers should receive 12 weeks of wage compensation amounting to ₹15,000.
Simplify the process
Eliminate correction queues. Further, the implementation gaps in the PMMVY scheme lead to reduced coverage. These gaps stem from a lack of awareness within targeted beneficiaries and process level challenges. The current registration form requires a mother and child protection (MPC) card, husband’s Aadhaar card, bank passbook and registration form for each of the three instalments, resulting in delayed, rejected or pending applications. A simplification of the process can result in increased registration of beneficiaries.
To fulfil India’s commitment towards the Sustainable Development Goal of improving maternal health, an ambitious Prime Minister’s Overarching Scheme for Holistic Nourishment (POSHAN) Abhiyan and a national maternity benefit scheme are promising initiatives by the Centre. However, targets can be achieved only if we revisit the design and implementation of this scheme, drawing lessons from States such as Odisha which are successfully prioritising maternal health and nutrition in a pragmatic manner.
Amar Patnaik, a Member of Parliament, Rajya Sabha, from Odisha, was Principal Accountant General under the Comptroller and Auditor General of India (CAG). He is also an advocate