Assessing The Influence Of Healthcare Infrastructure On Infant Mortality In Urban And Rural Uttarakhand: An Overview

Janani-Shishu Suraksha Karyakram (JSSK) and Janani Suraksha Yojana (JSY) were launched with the objective of increasing institutional deliveries. But, its knowledge among the post-natal mothers is not known. This research evaluated the knowledge of two national health programs among post-natal mothers and found out the predictors of good knowledge about the entitlements of these programs. A cross-sectional study was conducted on a sample of consecutively recruited 339 post-natal mothers who had delivered in a tertiary care hospital of western India. Data were collected from November 2016 to February 2017 by interview method using a questionnaire with questions about knowledge regarding the entitlements of JSSK and JSY. Multivariable analysis was carried out for predictors of good knowledge. Among the 339 post-natal mothers, 30% had a good knowledge regarding JSSK. Only 24% had heard about JSSK; 54% knew regarding free transport to the place of delivery; only 22% and 13%, respectively knew about free inter-facility transport in case of complications for pregnant women and sick infants, while 96% knew regarding free drop-back facility. Only one-fourth of the mothers knew regarding monetary benefit under JSY, while 28% of them had actually received the benefit. The number of antenatal care visits, having an occupation and belonging to Hindu religion significantly predicts good knowledge among postnatal mothers regarding JSSK. Knowledge among the post-natal mothers regarding the entitlements of JSSK and JSY is less while comparing with published literature and needs improvement. Regular ante-natal care (ANC) visits might improve their knowledge of these programs. There is a need to create awareness among hospital staff for the provision of reimbursement of costs incurred by post-natal mothers. There is also a need to carry out demand generation activities among mothers regarding the entitlements of JSSK and JSY.

Maternal and child health care services' utilization data from the fourth round of district level household survey in India

Introduction: Poorer pregnancy outcomes are linked to inadequate antenatal care (ANC) and Postnatal care (PNC). Thus, adequate knowledge and utilization of these services among expectant mothers becomes the key to achieving healthy pregnancy outcomes. Objective: To assess the knowledge and utilization of ANC and PNC services among women who delivered in last 1 year residing in an Urban area of South-East Delhi. Methods: This was a cross-sectional study conducted among 150 women who delivered within the last one year residing in an urban area of South-East Delhi. Data collection between May 2024 to July 2024 was done with the help of pre-designed, validated, structured questionnaire using simple random sampling. Statistical analysis was done using SPSS which included computation of proportions and univariate analysis, which was done using chi-square test. Result: Good knowledge regarding basic ANC, Janani Suraksha yojana (JSY) and Pradhan Mantri Matru Vandana Yojana (PMMVY), Janani Shishu Suraksha Karyakram (JSSK), Anganwadi services and Home-based Newborn Care (HBNC) was reported by 140 (93.3%), 55 (36.7%), 127 (84.7%), 104 (69.3%), and 113 (75.3%) of the study participants, respectively. Good utilization of the services including basic ANC, JSSY and PMMVY, JSSK, Anganwadi services and HBNC was reported by 139 (92.7%), 13 (8.7%), 94 (62.7%), 104 (55.3%), and 113 (75.3%) of the study participants, respectively. Conclusion: The study reported good knowledge and utilization of basic ANC services. However, significant gaps were reported for the services provided under JSY, PMMY followed by JSSK, Anganwadi services and HBNC.

Janani Suraksha Yojana (JSY), a scheme launched by the central government of India, aimed to reduce maternal mortality by incentivizing institutional deliveries through conditional cash transfers (CCTs). An expansion to this initiative, the Janani Shishu Suraksha Karyakram (JSSK), incorporates free maternal and neonatal services. However, despite reported progress in improving access, questions remain about program efficiency and equity. This review synthesizes evidence on the strengths, weaknesses, opportunities, and challenges (SWOC) of the JSY/JSSK CCT component of the scheme. A narrative review of 19 studies on the cash transfer component of the Janani Shishu Suraksha Karyakram (JSSK), published between 2009 and 2025, was conducted using PubMed, Embase, and Google Scholar. Studies were thematically analyzed to assess CCT-related implementation, equity, quality of care, and health outcomes. Results: Strengths include increased institutional deliveries and improved access among marginalized populations. Weaknesses involve payment delays, persistent out-of-pocket expenses, and uneven quality of care. Opportunities include expanding incentives across the continuum of care, leveraging technology, and integrating with other schemes like PMMVY and Namo Shree Yojana. Challenges include regional disparities, implementation variability, and uncertainty around long-term behavioral change. While the JSY/JSSK CCT component has improved service uptake, its full potential requires stronger implementation, inter-scheme coordination, and quality assurance. Policymakers should prioritize equity, accountability, and integration to enhance maternal and newborn health outcomes.

The coronavirus disease (COVID-19) pandemic has significantly impacted healthcare services globally, with particular challenges observed in maternal and child health (MCH) care. This study aimed to assess the impact of the pandemic on MCH services in northern India, focusing on key government programs. Data were collected from four major MCH programs in India: Janani Suraksha Yojana (JSY), Janani Shishu Suraksha Karyakram (JSSK), Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA), and the Universal Immunization Program (UIP). The study compared MCH service utilization and outcomes during the pandemic period (March-September 2020) with the same period in 2019. Preliminary findings indicated a significant reduction in the utilization of MCH services during the pandemic, with a decrease observed in institutional deliveries, antenatal care visits, and immunization coverage. For instance, institutional deliveries declined by 30% compared with the previous year, with a similar decrease observed in antenatal care visits. Immunization coverage also decreased by approximately 25%, indicating a substantial decline in preventive care services. Challenges in accessing essential treatments for sick infants have also been reported, with a 40% decrease in the utilization of free treatment services under the JSSK program. The COVID-19 pandemic has substantially impacted MCH services in northern India, highlighting the vulnerability of these essential health programs during public health emergencies. Addressing the challenges identified in this study is crucial to ensuring the continuity and resilience of MCH services in similar settings.

Review question/objective The objective of this review is to synthesise the best available evidence on the experiences of women.s needs in maternity care and existing sustainable service models in rural areas. Specifically, the review questions are: 1. What are maternity care needs for women in rural areas? 2. What are existing models of sustainable services in maternity care in rural areas? Inclusion criteria Women who have child birth experience(s) in rural areas in developed countries such as Australia, England, USA, Canada, New Zealand and others. Since research on these topics aims to improve access and outcomes for women in rural areas, all women regardless of being classified as low risk or high risk should be included. Maternity services in rural areas should provide care for all women regardless of their health conditions. There is no any other restriction. Phenomena of interest The phenomena of interest are women.s experiences of maternity care in a rural setting. The review will focus on the whole period of maternal care including antenatal care, birthing and early postnatal care.

Background: Motherhood is the most important stage of a woman’s life but can be a life-threatening condition too. During pregnancy, any woman can develop life-threatening complications that require immediate medical care. Maternal mortality is unacceptably high. About 830 women die from pregnancy or childbirth-related complications around the world every day. Maternal health care services are the measures to ensure safe motherhood through promotive, preventive, curative, and rehabilitative health-care system. In view of the difficulty being faced by the pregnant women along with high expenditure on delivery, Ministry of Health and Family Welfare and state governments have launched many schemes to ensure better facilities for women during pregnancy and delivery. However, the success of these schemes depends on their utilization by antenatal and postnatal mothers. Aim and Objective: This study was planned to estimate the level of awareness about the various government maternal benefit schemes among and also to assess the utilization of maternal benefit schemes among those mothers. Materials and Methods: This was a community-based cross-sectional study. All the mothers who had delivered before 1 year from the start of the study were included in the study. The mothers were identified with the help of Accredited Social Health Activist worker and Anganwadi worker by door-to-door enumeration. A sample of 150 was studied. Non-probability convenience sampling was followed to select study participants. A structured interview method was used. Results: In the present study, most of the mothers (89.3%) were in the age group of 20–30 years with mean age of 24.3 years (± 3.4 years). The participant was considered as aware of the government scheme, if she had heard about the scheme and knows about certain key points of the scheme. Health care workers were the major source of information for mothers (62.5%) in our study area followed by friends and family for 17.5–9.2%, respectively. Majority of the mothers (65%) had utilized Anganwadi Nutrition Supplementation followed by Bhagyalakshmi Scheme and Janani Suraksha Yojana. Conclusion: Overall awareness regarding government maternity benefits scheme ranges from 6.3% (Madilu kit) to 77.6% (Integrated Child Development Services). The awareness about important Government Maternity Benefit Schemes specifically targeted to reduce maternal and neonatal mortality such as Thayi Bhagya scheme and Janani Shishu Suraksha Karyakram was low.

This cross-sectional study was designed to explore the impact of the availability of maternity care services on the infant mortality rates in nonmetropolitan (rural) counties in Florida. We evaluated the sufficiency of physicians providing maternity care in each rural county. We then constructed a mathematical model to compare physician availability with the infant mortality rates for each county, while controlling for socioeconomic variables. Thirty-one family physicians and 974 obstetrician-gynecologists were delivering babies in Florida in 1991. Forty-seven counties were lacking in maternity care services; 45 of these counties had family physicians who practiced in the county but did not provide maternity care services. There was a negative correlation in rural counties between availability of maternity care services and infant mortality (R = -0.42, R2 = 0.176, P = 0.012), implying that 17.6 percent of the variation in rural Florida's infant mortality was explained by a ranking in physician availability. Multivariate analysis revealed that increasing infant death rates can be predicted by decreasing physician availability (P = 0.003). A multiplicative risk model developed for this study demonstrated that the loss of 1 family physician delivering babies would predict the increase of infant mortality by 2.3 percent, and the loss of 1 obstetrician-gynecologist increased infant mortality by 9.6 percent. Access to maternity care for women in rural Florida is a problem that could be hampering Florida's ability to reduce its infant mortality rate. Family physicians appear to be the most geographically distributed health care providers in Florida; therefore, strategies should be developed to recruit Florida's rural family physicians into maternity care.

Using NFHS-4 data, this study explores the determinants of maternal health care programmes for eastern states of India, which include prenatal care and hospital delivery. To reduce unobserved heterogeneity in the analysis, we employed the Full Information Likelihood Method, also known as the Joint Estimation Technique, in conjunction with individual probit models. Like other studies, we found place of residence, wealth, caste, religion and level of education as significant contributor for demand for both services. But, unlike earlier studies, we found that women’s age increases the use of prenatal care and hospital delivery, and the child’s birth order influences getting prenatal care. To increase the utilisation of maternal health care services, we recommend investing in health infrastructure, increasing the Janani Suraksha Yojana (JSY) subsidy amount and coverage of the Janani Shishu Suraksha Karyakram (JSSK) scheme, and promoting awareness about various government programmes among women through the Accredited Social Health Activists (ASHAs). JEL Codes: I140, I150, I180, O150

Out-of-pocket expenditure (OOPE) is an obstacle in the path of getting universal health coverage in India. This study aimed to explore the OOPE, sources of funding, and experience of catastrophic expenditure (CE) for healthcare related to delivery, postpartum, and neonatal morbidity. A community-based, cross-sectional survey was conducted among a sample of 240 recently delivered women from the slums of Bhubaneswar, Odisha. Information on background, details of delivery, expenditure on delivery and on morbidities, and sources of funding was collected using a structured interview schedule. Only 29.6% of the households incurred OOPE, and the others incurred either nil OOPE or had a net income because of benefits received from Janani Shishu Suraksha Karyakram (JSSK), Janani Suraksha Yojana (JSY), and "Mamata" schemes of the government. The median total OOPE was found to be 2100 INR (100-38,620). Multivariate analysis found parity, place of delivery, type of delivery, and presence of morbidity to be significantly associated with incurring any OOPE. Nearly 15% of the households incurred OOPE exceeding 40% of the reported monthly household income including 9%, whose OOPE was 100% or more of the reported household monthly income. While mechanisms such as JSSK, JSY, and Mamata had benefitted the vast majority, around half of those who did incur OOPE experienced CE. Additional insurance facility for cesarean section delivery might reduce the excessive financial burden on households.

Does Australia's Health Policy Environment Create Unintended Outcomes for Birthing Women?

BackgroundOne of the constraints in the utilisation of maternal healthcare in India is the out-of-pocket expenditure. To improve the utilisation and to reduce the out-of-pocket expenditure, India launched a cash incentive scheme, Janani Suraksha Yojana (JSY), which provides monetary incentive to the mothers delivering in public facility. However, no study has yet examined the extent to which the JSY payments reduce the maternal healthcare induced catastrophic out-of-pocket expenditure burden of the households. This paper therefore attempts to examine the extent to which the JSY reduces the catastrophic expenditure estimate household expenditure on maternity, i.e., all direct and indirect expenditure.Materials and methodsThe study used data on 396 mothers collected through a primary survey conducted in the rural areas of the Varanasi district of Uttar Pradesh state in 2013-2014. The degree and variation in the catastrophic impact of households’ maternity spending was computed as share of out-of-pocket payment in total household income in relation to specific thresholds, across socioeconomic categories. Logistic regression was used to understand the determinants of catastrophic expenditure and whether the JSY has any role in influencing the expenditure pattern.ResultsResults revealed that the JSY beneficiaries on an average spent about 8.3% of their Annual Household Consumption Expenditure on maternity care. The JSY reimbursement could reduce this share only by 2.1%. The study found that the expenditure on antenatal and postnatal care made up a significant part of the direct medical expenditure on maternity among the JSY beneficiaries. The indirect or non-medical expenditure was about four times higher than the direct expenditure on maternity services. The out-of-pocket expenditure across income quintiles was found to be regressive i.e. the poor paid a greater proportion of their income towards maternity care than the rich. Results also showed that the JSY reimbursement helped only about 8% households to escape from suffering catastrophic burden due to maternity payments.ConclusionsIt can be concluded that the JSY appeared to have achieved only a limited success in reducing the economic burden due to maternity. To reduce the catastrophic burden, policy makers should consider increasing the JSY reimbursement to cover not only antenatal and postnatal services but also non-medical expenditure due to maternity. The government should also take appropriate measures to curb non-medical or indirect expenditure in public health facilities.Significance for public healthImproving the well-being of mothers is an important public health goal for India. For improving maternal health, it is necessary that mothers utilize maternity services. However, maternity often becomes an economic burden, especially for disadvantaged and poorer groups of the society. To encourage mothers to utilize services, India launched a conditional maternity benefit transfer scheme back in 2005. This study explored whether the scheme has been able to help alleviate the burden of maternity expenditure or not. The study finds that the scheme has been successful only partially to reduce outof- pocket expenditure suggesting that maternity is a costly affair in rural India. Since the scheme is unable to save mothers from catastrophic expenditures, it is also unable to save mothers from a wide ranges of health illeffects caused by catastrophic expenditure.

The study aimed at determining the current status of utilization of maternal care services among Barangay Health Stations in Impasugong, Bukidnon. The study utilized the random sampling technique in the selection of the respondents in this study. The multiple regression analysis revealed that there is a significant association between some of independent variables (preferred delivery attendant, complications experienced during childbirth and preferred place of delivery) and maternal health care services used in Impasugong. Further, the simple relationship between maternal health care utilization and its factors (social, economic and demographic) showed significant relationship of the use of prenatal care, place of delivery and assistance during delivery. Although delivery is mostly normal and some experienced complications during pregnancy, yet some suffered complications during childbirth. Most of the respondents utilized the barangay health facilities for prenatal but low in the utilization of Barangay Health Facilities during the stage of labor. The variables with significant relations are total family income, occupation, place of residence and civil status. That education was found to have an important impact on the use of maternal health services suggests that improving educational opportunity for women may have a large impact on improving utilization of such services. Women at higher parity levels were found to be less likely to have deliveries assisted by modern professionals implies that parity should be one of the criteria for targeting education campaigns in the benefits of safe motherhood programs. Highly recommended measures to improve services are: quality of health workers, development of basic health care facilities and building intervention programs such as better maternal health care, delivery by skilled birth attendant identification of high risk pregnancies and complications, and provision of a good referral system. Keywords - Maternal Care Services, Barangay Health Station, Skilled Birth Attendant, Place of Delivery, Assistance during Delivery

Effective, Respectful and Affordable Care: A call for Decentralized Maternal Care.

BackgroundThe National Health Mission (NHM), one of the largest publicly funded maternal health programs worldwide was initiated in 2005 to reduce maternal, neo-natal and infant mortality and out-of-pocket expenditure (OOPE) on maternal care in India. Though evidence suggests improvement in maternal and child health, little is known on the change in OOPE and catastrophic health spending (CHS) since the launch of NHM.AimThe aim of this paper is to provide a comprehensive estimate of OOPE and CHS on maternal care by public and private health providers in pre and post NHM periods.Data and methodThe unit data from the 60th and 71st rounds of National Sample Survey (NSS) is used in the analyses. Descriptive statistics is used to understand the differentials in OOPE and CHS. The CHS is estimated based on capacity to pay, derived from household consumption expenditure, the subsistence expenditure (based on state specific poverty line) and household OOPE on maternal care. Data of both rounds are pooled to understand the impact of NHM on OOPE and CHS. The log-linear regression model and the logit regression models adjusted for state fixed effect, clustering and socio-economic and demographic correlates are used in the analyses.ResultsWomen availing themselves of ante natal, natal and post natal care (all three maternal care services) from public health centres have increased from 11% in 2004 to 31% by 2014 while that from private health centres had increased from 12% to 20% during the same period. The mean OOPE on all three maternal care services from public health centres was US$60 in pre-NHM and US$86 in post-NHM periods while that from private health center was US$170 and US$300 during the same period. Controlling for socioeconomic and demographic correlates, the OOPE on delivery care from public health center had not shown any significant increase in post NHM period. The OOPE on delivery care in private health center had increased by 5.6 times compared to that from public health centers in pre NHM period. Economic well-being of the households and educational attainment of women is positively and significantly associated with OOPE, linking OOPE and ability to pay. The extent of CHS on all three maternal care from public health centers had declined from 56% in pre NHM period to 29% in post NHM period while that from private health centres had declined from 56% to 47% during the same period. The odds of incurring CHS on institutional delivery in public health centers (OR .03, 95% CI 0.02, 06) and maternal care (OR 0.06, 95% CI 0.04, 0.07) suggest decline in CHS in the post NHM period. Women delivering in private health centres, residing in rural areas and poor households are more likely to face CHS on maternal care.ConclusionNHM has been successful in increasing maternal care and reducing the catastrophic health spending in public health centers. Regulating private health centres and continuing cash incentive under NHM is recommended.