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antenatal care in IndiaIndia is home to one-fifth of all births but has no monitoring systems for basic maternal health and nutrition. A research brief published by the rice institute finds that India has far worse maternal nutrition rates than sub-Saharan Africa – a region much poorer with higher fertility rates. With improper antenatal care being linked with long term effects on the height, weight, cognition and productivity of a child, global attention has been brought to the antenatal care inequalities found in India.

Antenatal Care in India Today

Access to antenatal care in India depends strongly upon the geographic location and socioeconomic status of expectant mothers. Between 50 and 74 percent of expectant mothers in India receive prenatal care services – with a large gap in the distribution of these services.

According to a study done in 2011, 357,777 women in Delhi received at least three antenatal care check-ups, more than the entire state of Uttarakhand which had 153,202 women receive the same level of care.

Further studies showed that  “some states, such as Kerala and Goa, more than 93 percent of women used ANC [Antenatal Care] four times or more, while in Bihar and Nagaland, this figure was less than 17percent,” highlighting the substantial inequalities of access to antenatal care in India.

Current Government Initiatives

Currently, several government programs are in place to increase access to antenatal care services throughout India but have not shown largely promising results. India’s largest program for improving neonatal health, Janani Suraksha Yojana (JSY), uses cash incentives to encourage birthing in hospitals.

However, a study done in 2014 found that the cash transferred to new mothers is much less than advertised, due to how much of it goes towards paying for delivery services – which are meant to be free. In addition, this program only encourages women to give birth in hospitals, rather than address pressing maternal health problems in India – such as maternal nutrition and low birthweight.

Meanwhile, the Pradhan Mantri Matru Vandana Yojana (PMMVY) government program dispenses 5,000 rupees for expecting and lactating mothers. However, this is only available to first-time mothers.

The Integrated Child Development Services (ICDS) is intended to give food to expectant mothers and their children but is poorly implemented – with less than 30 percent of women having received food the ICDS program during their last pregnancy.

Looking Ahead

In order to improve access to antenatal care in India, studies suggest “policy and programme managers should shift from improving the ‘average figures’ to the ‘distribution’ of programme/health care indicators across the sub-groups of populations which need them most.”

The rice institute also notes that rather than rely on outdated surveys for indicators of maternal health, the government finally establish a national monitoring system allowing policymakers to view changes in maternal health over time.

With proper government oversight, the future of antenatal care in India looks promising, as suggested by a study published in The Lancet found that mortality rates for neonates declined by 3.3 percent annually between 2000 and 2015 due to government intervention.

– Shreya Gaddipati
Photo: Unsplash

Maternal Mortality in India
USAID and its partner organizations implemented the development impact Utkrisht bond in February 2018. Many believe this is an innovative and cost-effective solution to end preventable maternal and child deaths in India.

The Utkrisht bond is targeted to assist the State of Rajasthan, where 80,000 babies die annually from inadequate medical care. But proponents hope the model can be used throughout India, which accounts for 20 percent of maternal and child deaths globally.

The development impact bond was announced in November of 2017 by USAID Administrator Mark Green at the Global Entrepreneurship Summit in India. It is expected to provide 600,000 women with improved healthcare access and potentially save 10,000 moms and newborns.

The bond works as a public-private partnership. Investors grant providers of maternal care with upfront capital. Then, outcome funders pay back the investors their principal plus a return if pre-agreed metrics are achieved. The investor, in this case, is the UBS Optimus Foundation, which has committed about $3 million. The organization works with philanthropists to bring sustainable benefits to vulnerable children.

Up to 440 private health facilities will then be operated with assistance from Population Services International (PSI) and the Hindustan Latex Family Planning Promotion Trust (HLFPPT), which also are co-investors providing 20 percent of the required capital. PSI is a global health nonprofit and the HLFPPT is an Indian nonprofit that works with maternal care.

In order to maximize success, private facilities are the focus of the Utkrisht bond. They host more than 25 percent of institutional deliveries in Rajasthan and are used by women of all socioeconomic backgrounds, yet little has been done to improve their quality of care.

USAID and Merck for Mothers, a nonprofit with the goal to end maternal mortality, have each committed up to $4.5 million that will be paid if the heath facilities meet accreditation standards. This is a highly cost-effective method to save lives according to World Health Organization standards, which is particularly exciting to USAID.

“The pay for success approach ensures appropriate stewardship of U.S. taxpayer dollars, while unlocking both private capital and government resources for health,” USAID states.

While this is the first development impact bond targeted toward health, the future of the Utkrisht bond looks promising. If it is successful, more initiatives can be implemented that involve private-public cooperation and effective use of taxpayer money to save the lives of many women and children around the world.

– Sean Newhouse

Photo: Flickr