Delivering unsafe despite JSY's crores

LUCKNOW: Heavy public investment of around Rs 300 crore under Janani Suraksha Yojana (JSY) of National Rural Health Mission (NRHM) might have increased the number of institutional deliveries in the state but still nearly 40% of the prospective mothers are not getting any ante-natal care before delivery.
As a result, 70% births are unsafe. Besides, in the absence of an authentic feedback, nobody knows if crores being spent on maternal care are actually yielding results.Neither there has been proper monitoring or distribution of iron tablets nor any mechanism to find whether women are consuming them or not.
The lapses at the ground level can be deciphered from the district level household survey (DLHS) conducted by the state government. It reveals that institutional deliveries have increased from 23% in 2006 to 25% in 2008 but the number of prospective mothers receiving full ante-natal care is below 4%.
The DLHS also reveals that over 40% of women in the state are not getting any ante-natal check-up during pregnancy period, whereas ideally there should be six visits of nursing midwives, the expecting mother should also get at least one tetanus injection and take iron tables regularly because 50% of them are anaemic.
The JSY was introduced by the government of India and implemented with the support of state governments with the aim to bring prospective mothers to hospital or provide them expert hand at home for delivery. While the mother gets Rs 1,400 for institutional delivery, trained midwives get Rs 600 per delivery.
The objective was to bring down high maternal mortality rate (MMR) and reduce infant mortality rate (IMR) in the country. The initiative has brought a change in southern states like Kerala but in UP performance is poor despite government spending over Rs 280 crore in 2008-09 under JSY and maternal care.
The DLHS data published recently shows that in the state capital, Lucknow, which can boast of better health services in comparison to other parts of the state, the number of institutional deliveries are 42%, highest in the state, but then only 11.6% prospective mothers are getting full ante-natal coverage.
Varanasi records 36.8% institutional deliveries but only 7.5% are getting full ante-natal care. In Kanpur city, institutional deliveries are 36.8% but full ante-natal care to only 5.3%. Besides Lucknow, Ghaziabad is the only district in the state to have full ante-natal coverage in two digits, that is, 12.3%.
Significantly, places mentioned above are only the high performing districts. In rest of the state, condition is very poor. Among low performers are Balrampur with 6.3% institutional deliveries, Banda 8.7%, Chitrakoot 8.8%, Hardoi 7.6% and Pilibhit 9.6%. In all these districts full ante-natal care is below 5%.
The DLHS data also shows that in five districts of the state, number of prospective mothers getting full ante-natal care is below 2%. Most shocking was the situation in Rae Bareli where the figure stood at 0.7%. Similarly, in Barabanki, it was 1%, Sultanpur 1.6%, Kaushambi and Unnao 1.7% each.
Experts say that institutional deliveries might have increased but because of poor ante-natal coverage, the MMR continues to be high. Further, bringing women to the hospital for delivery alone cannot save life. It also requires good nursing hands and hygiene, which most health centres in UP lack, they add.
"Nearly 50% deaths during delivery are because of haemorrhage as women are anaemic. Low cost interventions like training ground level workers to counsel prospective mothers for consuming iron tablets regularly can help a lot," said Dr Neelam Singh, gynaecologist and social activist associated with health projects.
Further, she said, the state health department also needs to launch a mass education and awareness campaign among masses at the ground level for making them aware of the importance of iron deficiency and good practices during the pregnancy period besides developing a feedback mechanism to assess the policy impact.
Government officials, however, said that situation is improving gradually. They admitted that results are good but not as per expectations. "Efforts made in 2008-09 will show results later. This financial year, JSY beneficiaries have increased to 15 lakh from 9.64 lakh in 2007-08," they claimed.