maternal health

Modi's rebranded maternity benefits scheme may actually reduce extent of coverage

The government may allow benefits for only the first child instead of two as the plan previously did.

In his address to the nation on December 31, Prime Minister Narendra Modi announced that a maternity benefits programme would be expanded to all districts of India from January 1. The programme he was referring to had been started by the Congress-led government as a pilot project in 2010. It had already been expanded across the country under the National Food Security Act 2013 but the government never allocated the funds for it to be implemented.

Now, even as the Bharatiya Janata Party government has made a renewed promise to offer a cash transfer of Rs 6,000 to pregnant women who check into hospital to deliver their babies, it is actually reducing the extent of coverage of the scheme. While the original programme provided for cash transfers to women for two births, the Ministry for Women and Child Development is set to limit the scheme to the birth of the first child only, The Indian Express reported on February 18.

Even before this reduction, though, the maternity benefits scheme was plagued by delays and inefficiencies.

That is obvious in Pharsiya, an interior panchayat in Chhattisgarh’s Dhamtari district, a three-hour bus ride from the capital Raipur. All the 700 families here fall below the poverty line. The Kamar Adivasi, a particularly vulnerable tribal group, are among the poorest people here. Most own no land and work as daily wage labourers on farms or gather and sell head-loads of fuelwood in the village market, earning about Rs 30 a day.

Sukhbati Kamar, a Kamar Adivasi woman in her early 20s, gave birth for the first time five months ago. Under the Indira Gandhi Matritva Sahyog Yojana maternity benefits scheme started by the Congress government, Sukhbati is entitled to a cash transfer of Rs 6,000.

She sat on the floor of her hut breastfeeding her infant. “I received Rs 1,400 in my bank account three months after my son was born, but did not receive any money before the delivery,” she said. She added that she had used to money to stock up on rice and vegetables, and also buy a sari.

Sukhbati’s husband, Halal Kamar, who works as a farm hand, earns Rs 100 as daily wages. “We did everything as per what the mitanin [health worker] told us,” he said. “My wife registered at the anganwadi, obtained a mamta card, and went to the hospital for the delivery, but I do not know why we have not received most of the money yet.”

Sukhbati Kamar, an Adivasi, received only Rs 1,400 of the Rs 6,000 maternity entitlement.
Sukhbati Kamar, an Adivasi, received only Rs 1,400 of the Rs 6,000 maternity entitlement.

The Indira Gandhi Matritva Sahyog Yojana, a conditional cash transfer scheme, was started on a pilot basis in 53 districts in 2010. The scheme provided for a cash transfer of Rs 4,000 to pregnant and lactating women in three installments for upto two childbirths.

This is meant as a wage supplement to support women working in the unorganised sector on farms, in brick kilns, and as migrant workers on construction sites. The money is meant help them breastfeed for at least six months and also get sufficient nutrition during and after a pregnancy. Good health of the mother affects the birth weight of an infant significantly.

Long-delayed expansion

When the National Food Security Act was enacted in July 2013, maternity benefits cash transfers were expanded to women in all districts. The amount was increased to a cash transfer of Rs 6,000. This sum was to be paid in two installments for up to two live births – Rs 3,000 in seventh to ninth month of pregnancy and an equal amount six months after the delivery.

However, even three years after the National Food Security law was passed, this expansion did not take place. The Ministry of Women and Child Development in an affidavit in the Supreme Court on October 30, 2015, said that the Ministry of Finance was still examining expenses.

After Modi announced on December 31 that the maternity benefits programme would be expanded – once again – to all districts, the Ministry for Women and Child Development ministry announced new guidelines. While earlier the first installment of the cash transfer was made in the third trimester of the pregnancy, under the new rules, the first installment of Rs 3,000 is to be given in the first three months of the pregnancy, after the pregnancy is registered, a second installment of Rs 1,500 after an institutional delivery, the third installment three months after delivery and vaccinations.

Experts say the move to give the cash transfer early in the pregnancy could have significant positive outcomes by creating the potential for the woman to eat well when they are pregnant. In existing pilot districts like Dhamtari, there were delayed payments and gaps in coverage.

Maternal health activists have welcomed the expansion of the scheme but have questioned the inadequate budget provisions. They have also raised concerns about the implications of the new guidelines on the existing coverage of the scheme.

Delays and exclusion

In Dhamatari, two among seven Kamar pregnant women received partial entitlements of between Rs 1,400 and Rs 3,000 after giving birth. Both said they had used part of the money to purchase food stocks after the birth of the infant.

In Kudmudpara, a Gond Adivasi village in Sankara panchayat in Dhamtari, 85 women have received cash transfers as maternity benefits since 2014, said anganwadi workers. But now, none of the seven women here who qualify for coverage received the first installment in first three months of their pregnancy. Pyari Gond said she had not received the full benefits even though her infant was now eight months old.

“If the government pays Rs 6,000, then it will take six years for full benefits to reach,” said an elderly woman named Samari Gond, during a late evening meeting of the village mahila sangh – women’s group.

Added Nuniya Gond, another woman at the meeting, “Bank mein bahut natak hota hai.” It is not a straightforward process in the bank.

Said Budhiarin, the health worker of Kudmudpara village: “Perhaps it is our weakness, that we cannot make the district officials act in a timely manner.”

There have been other barriers as well. The ministry in a statement on January 3 stated that “cash transfers would be Aadhaar-linked though the individual bank/post office account etc. in direct benefit transfer mode”. Aadhaar is a 12-digit biometrics-linked unique identity number issued by the government. Some beneficiaries expressed preference for bank cheques over direct benefits transfer into bank accounts.

“Earlier, we received the payments in a cheque at the hospital, which we could encash any time, but now the government puts it in the bank,” said one beneficiary of the scheme. “It is not easy to find out when the money has reached, we have to physically to the bank to verify and confirm.” Not all women gathered at the meeting had mobile phones or know how to activate SMS services for alerts on receipt and withdrawals of funds from their bank accounts.

Nirmala Gond said she had received the whole entitlement of Rs 6,000 in one installment after her first pregnancy in 2014, instead of receiving any funds in early pregnancy. “My relative is a mitanin,” she said. “She told me I should make sure to spend the money on eating and so on, not on buying jewellery.”

But six months into her second pregnancy, she was unsure if she would receive the benefits as she has not been able to enroll for Aadhaar.

“I received the first transfer in my old bank account in 2014,” she said. “But now the bank is asking I must link my account to Aadhaar. I enrolled in Aadhaar two years back, but did not receive an Aadhaar number in the post.”

Gond had lost the enrollment identity slip, and was unable to retrieve it. She narrated how she had traveled to Nagri, the block center 12 kilometers away, twice during her pregnancy to enroll in Aadhaar. She was rejected both times as the database identified this as a case of duplicate enrollment.

Nirmala Gond is not unsure if she will be able to receive her maternity benefits during her ongoing pregnancy since she has not been able to correctly enroll in Aadhaar.
Nirmala Gond is not unsure if she will be able to receive her maternity benefits during her ongoing pregnancy since she has not been able to correctly enroll in Aadhaar.

Diane Coffey, a demographer and executive director of Research Institute for Compassionate Economics who interviewed beneficiaries of the scheme in Chhindwara in Madhya Pradesh, said delays and erratic payments were a big problem in other districts as well.

“Women who had a first or second child were getting the Rs 6,000 transfer, but never during pregnancy, which is the time when it would help them buy food to improve child health by the most,” said Coffey. “ The women usually received Rs 3,000 rupee transfer in the first year and another Rs 3,000 transfer in the second year, though sometimes Rs 6,000 came all at once.”

Coffey explained that early transfers mattered as most of the nutritional damage to children is already done by the age of two.

“The move to give the transfer earlier in pregnancy has the potential to help women eat more during pregnancy, an improve birth outcomes,” she said. “In order for this smart policy change to have a good effect, it will be essential for the government to give women the first transfer very quickly upon registration of the pregnancy, and to train health workers to educate women that the purpose of the transfer is to promote weight gain in pregnancy.”

Where is the money?

In the Budget, finance minister Arun Jaitley announced Rs 2,700 crore for the maternity benefits schemes. Civil society activists have pointed out this is a fraction of what it would cost to make cash transfers to every woman working in the unorganised sector and is inadequate to cover the total number of beneficiaries,

Economist Jean Dreze has calculated that there are an estimated 2.6 crore birth every year. Assuming that 10% births were already covered with the mothers being in the formal sector of the economy, it will cost Rs 14,000 crore per year to provide maternity entitlements of Rs 6,000 per birth for 2.3 crore births – 10% less than 2.6 crore.

Now, the Ministry for Women and Child Development might limit the scheme to the birth of the first child.

Development economist Dr Dipa Sinha said this paucity of funds will affect those who are most vulnerable. “In many cases in rural areas, a woman may be already be breastfeeding when she becomes pregnant a second time,” she pointed out. “It is these higher order (second onward) pregnancies that are more at risk, and the infant is at greater risk of malnutrition and morbidity as the mother is usually more anemic. If the government reduces coverage to only the first birth, they will leave out the more vulnerable women.”

This reporting project has been made possible partly by funding from New Venture Fund for Communications.

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