New Delhi: Up to 88% of eligible women in the country did not receive benefits under the Centre’s maternity benefits scheme in 2018-19, according to the Right to Information (RTI) query with the Ministry of Women & Child Development. The Pradhan Mantri Matru Vandana Yojana (PMMVY) can imbibe much from the state maternity benefits schemes being implemented in Odisha and Tamil Nadu, where many more women are eligible.

A six-state survey found that in Odisha, 67% of all nursing women had received benefits under the state’s maternity scheme, Mamata. Odisha decided to continue with its Mamata scheme instead of switching to PMMVY, which was introduced in 2017, because the state scheme worked better, officials said.

In Tamil Nadu, which pioneered the concept of state maternity benefits in the country with its Dr Muthulakshmi Reddy Maternity Benefit Scheme (DMMBS) in 1987, 76% of women had utiltised maternity benefits and 95.3% were aware about the scheme, according to a different 2019 survey.

India has made progress but is yet to reach the Sustainable Development Goals’ (SDG) targets for maternal and newborn mortality rates. For every 100,000 pregnant women, 122 women died during pregnancy or soon after childbirth in the country between 2015-17, much higher than the SDG maternal mortality ratio (MMR) target of 70 per 100,000 live births. In 2018, the country’s neonatal mortality rate (stillbirth, or death during the first 28 days) was 22.7 per 1,000 live births, according to a UNICEF report, whereas the SDG target is 12 per 1,000 live births.

India’s infant mortality rate (death of a baby in the first year) of 33 per 1,000 live births is also higher than the global average of 29.4, and worse than that of neighbours Nepal (28), Bangladesh (27), Bhutan (26), Sri Lanka (8) and China (8), IndiaSpend had reported in June 2019.

Support--in terms of awareness, nutrition, rest, access to healthcare, medicines, etc--to pregnant women and lactating mothers is critical to reduce mortality rates. The six-state Jaccha-Baccha Survey (JABS) was conducted in June 2019 to examine the state of pregnant and nursing women.

The survey

Researchers and student volunteers, led by development economists Jean Dreze and Reetika Khera, asked 706 women (342 pregnant, 364 nursing) about their needs during pregnancy, if they had access to nutritious meals, ate more than usual (eggs, fish and milk), if they got extra rest, had access to healthcare services, if they visited doctors during pregnancy and whether they shouldered financial responsibilities during pregnancy and delivery.

The women were interviewed in 60 anganwadis (childcare centres) in one district each in Himachal Pradesh, Uttar Pradesh, Madhya Pradesh, Jharkhand, Chhattisgarh and Odisha. Of the six, five states (barring Odisha) give maternity benefits to women under the PMMVY. The scheme offers Rs 5,000 in conditional compensation to pregnant women for wage loss so that they can take adequate rest before and after the delivery of their firstborn. The central government gives this benefit to women in three instalments for the first live birth only.

The researchers also filed a Right to Information (RTI) query with the Ministry of Women & Child Development, which has been implementing the scheme since inception.

States have wider umbrellas

The Centre’s scheme is exclusionary, riddled with data glitches and in violation of the National Food Security Act, 2013, the researchers found.

For instance, the fertility rate (average number of children borne) in India is 2.2, and so the PMMVY scheme excludes a large proportion of pregnant women because it is restricted to giving benefits solely for the first child. The Jaccha Baccha Survey estimated that PMMVY excludes 55% of pregnant women in India because of this restriction.

Ninety-two percent of pregnant women did not benefit under the PMMVY in five of the six surveyed states, the Jaccha Baccha Survey found. Nationwide, 12% of women had received all three instalments of the Rs 5,000 entitlement in 2018-19, according to the ministry’s response to the researchers’ RTI query.

Half the eligible women received at least one instalment under the scheme in the same period, the ministry said in the RTI response. For the 27 million annual estimated births in India, 25% (6.7 million) women received any maternity benefits under the PMMVY in 2017-18, according to the researchers.

Source: Jaccha Baccha Survey, 2019
Note: Figures in percentage

The researchers found increased coverage in Odisha, which gives benefits to women for two live births. People belonging to the particularly vulnerable tribal groups are entitled to receive money for the birth of every child. “This is important for the state to save the tribals’ dwindling population,” said Rasmita Saha, state coordinator for Mamata.

Pregnant and lactating women receive a conditional cash transfer of Rs 5,000 for each live birth under the Mamata scheme. Two in three nursing women had received some benefits while three in four women had received their first instalment under Mamata in 2019, according to the Jaccha Baccha Survey.

Between 2011-12 and 2018-19, about 3.7 million women had benefited from the Mamata scheme, according to the state’s Women and Child Development Ministry. In 2018-19 alone, nearly 500,000 women received Rs 251.71 crore, according to the state’s ministry.

The Tamil Nadu scheme, DMMBS, had the widest umbrella to include as many women as possible. The DMMBS grants benefits to women for two live births. Women receive a cash incentive of Rs 18,000 in five installments, including a nutrition kit worth Rs 2,000 for each live birth. In over three decades of the scheme’s existence, the quantum of entitlement has increased from Rs 300 for every live birth to Rs 18,000.

Besides, when it started in 1987, DMMBS was meant solely for agricultural labourers in rural areas. In 2006, the scheme universally included all women below the poverty line (defined as those with annual household income of less than Rs 24,000).

The scheme now goes beyond the ‘below the poverty line’ criterion to include seasonal labourers, women who are heads of their families and women unable to educate their children. Women can become eligible by virtue of the nature of their family’s occupation, housing and transport, too.

The DMMBS umbrella is so wide that Sri Lankan refugee women too are eligible to receive maternity benefits. These policy tweaks have meant that, on average, nearly 600,000 women benefit from the scheme every year, according to Tamil Nadu’s Health and Family Welfare Department.

As of 2017-18, some 4.7 million pregnant women had received financial assistance worth Rs 4,337 crore under the scheme, named after Muthulakshmi Reddy, the first Indian woman to graduate from the Madras Medical College in 1912.

“We realised after consulting various stakeholders that implementing PMMVY in Odisha would have meant restricted benefits for women, which they would receive under Mamata,” said Saha. “Implementing both PMMVY and Mamata would’ve led to confusion for the frontline workers and increased paperwork. We wanted a streamlined and simpler scheme.”

Ease of procedure, benefits transfer

The maternity benefits schemes in both Odisha and Tamil Nadu rely on simple procedures and few barriers, unlike the Centre’s PMMVY.

For instance, to register for Tamil Nadu’s DMMBS scheme, potential beneficiaries are required to furnish three-four documents to establish their identity and prove their eligibility. Less than 6% women had faced any difficulty either in applying for DMMBS or in getting their entitlement, according to a 2010 survey of 207 women in two districts in Tamil Nadu. The same survey reported that 86% of women had received the money within the first six months after delivery.

Among those who had applied for PMMVY, one-fifth, or 116 women from five states, reported experiencing Aadhaar-authentication problems, according to the Jaccha Baccha Survey; the scheme necessitates both the parents’ Aadhaar irrespective of the woman’s marital status. Applications were also rejected due to a mismatch between Aadhaar and other records, according to the survey, even as 15% of women reported bank-related problems.

In Odisha, women received their money despite Aadhaar-authentication complications, the Jaccha Baccha Survey found. “Mamata’s objective is to safeguard pregnancies. It is not concerned with the woman’s marital status,” said Saha, the scheme’s coordinator.

Odisha also reduced the number of instalments to disburse the entitlement amount, making the process easier. The Rs 5,000 entitlement under Mamata was initially given in four instalments. It is now given in two instalments within a 12-month period after delivery.

To receive benefits under PMMVY, women have to fill a 23-page form three times--one each for the three instalments in which the Rs 5,000-entitlement is disbursed.

Both the Centre’s PMMVY and Odisha’s Mamata schemes, however, violate the conditions of the National Food Security Act, 2013, according to Khera. The Act stipulates a benefit of Rs 6,000 to pregnant women for the first two live births. Both the PMMVY and Mamata benefits fall short by Rs 1,000; the Centre’s scheme also falls short because it restricts the benefit to the firstborn.

Political will and role of anganwadis

There was a larger political will that gave rise to the better functioning of the Mamata scheme, said Sameet Panda of the Odisha chapter of the Right to Food Campaign, an advocacy group.

The jaanch (verification) and Mamata committees at the block-level (10 villages constitute one block) brought transparency in the functioning of the scheme. Mamata’s success is also attributed to a partnership with local officials and anganwadi workers.

Each anganwadi worker receives an incentive of Rs 200 for each Mamata beneficiary, unlike for the Centre’s PMMVY scheme. The anganwadi worker and the ward member (a local representative in the panchayat) receive direct funds from the state government into their joint account to procure rations.

Since 1975, the Integrated Child Development Services (ICDS, the government’s supplementary nutrition programme) provides take-home rations for pregnant women, lactating mothers, and children, along with providing hot, cooked meals for children at anganwadi centres.

Women and children disliked the ready-to-eat mixture that was distributed at anganwadis in Uttar Pradesh, according to the Jaccha Baccha Survey. In contrast, anganwadis in Odisha gave eggs in midday meals and as part of the take-home ration to mothers and children.

“Self-help groups have led women to become empowered and educated [in Odisha],” said Neha Saigal, Associate Director of IPE Global, a development consultant group. “They have become more aware of their entitlements. Several self-help groups make and provide take-home ration to anganwadi centres too.”

A tale of two schemes

“Uttar Pradesh is the eternal straggler, while Odisha’s own Mamata scheme works relatively well,” the survey said, pointing to the differences in the health and overall condition of pregnant women in the two states.

The survey’s findings for Odisha echoed the results of an earlier study. Maternity benefits have helped women get adequate rest during pregnancy and spend sufficient time with their infants, a study on the impact of Mamata in the state’s most-populous district, Ganjam, had found in 2018. As many as 97% of women had said they felt a sense of empowerment and independence compared to the past.

(Ali is a reporting fellow with IndiaSpend.)

This story was first published here on Healthcheck.

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Sana Ali