Analysis of Janani Suraksha Yojana (Maternal Protection Scheme) among Women of Western Uttar Pradesh

“It’s the International Day of the #Midwife! Midwives do not just attend births. They also provide antenatal and postnatal care and a range of sexual and reproductive health services, incl. family planning, detecting and treating sexually transmitted infection.”-

Dr Tedros Adhanom Ghebreyesus, Director General of World Health Organization, May 5, 2022[1]

Dear Editor,

Mattas et al.[2] make a SWOT analysis of a public-funded healthcare scheme run by the Union Government of India—Janani Suraksha Yojana—and assessed awareness about it among the beneficiaries in a northern state. They interviewed the expectant—women and having obtained the answers, prepared six tables—summarising all the key findings. Interested readers are able to get a hang of the undercurrents related to information about the scheme by going through the results and are grateful to the authors for their efforts. By preparing such an informative and concise piece, the investigators unfolded a curious and interesting area which may draw the attention of the researchers and other experts of the field. We need more such observational and thoughtful studies so as to get an idea prevalent among the masses regarding roadblocks in our dream of achieving higher number of institutional deliveries.

Nonetheless, there are certain points where we want more information from the authors and raise other curiosities so as to get a better view of the findings. Under a header of Materials and Methods, the writers mention to include married females above 19 years for this purpose. We want to underscore a point that underage and adolescent marriage is a reality here—more so in rural areas.[3] Therefore, we make an earnest request to include women in all the age groups for further studies. Similarly, why should a doctor be concerned with the marital status of a woman when caring for her well-being, we wonder. All the girls and women deserve our sympathy, care and good-wishes regardless of their marital status, and no one should be left behind and should be our aspiration. We sincerely believe that further observations will not discriminate against any mother on the basis of her age or marital status. Just to provide an example—if a woman’s husband dies, the widow may need public services more than others.

Among the study Results, the authors mention in Table 3 that close to one-fourth of women alone knew about center for caring to remain open round-the-clock. Hence, one can infer that many didn’t. Yet lived experience of women in rural areas may be different. Healthcare worker absenteeism is a big challenge where they don’t show up at their designated places of work.[4] Regardless of what schemes do the planners make on papers, sometimes ground reality may be explored on field-based surveys and we think that we can peep into the actual status by going through the people’s voice.[5] Recently, when victims of a stampede were brought to a public healthcare facility in UP, no satisfactory services were available there.[6] Then they were sent elsewhere. Hence, why’d we expect women to believe that otherwise such services run round-the-clock, we wonder. While measuring awareness and then increasing it, we’d also actually provide those services beforehand towards which a demand already exists.

The last poser in Table 3 is related to awareness about accredited private hospitals (in that area). The authors highlight that many did not know. But the status of private hospitals regarding accreditation may change over time. Sometimes hospitals lose empanelment due to fraud and another sort of hanky panky.[7] If women are not aware, that may be because they may have been returned from these facilities due to a different current status (present then).

Table 3 has a riddle regarding awareness about the payment of money for transportation to the health facility. The investigators underscore its lack. But policies in other states are different. In Uttar Pradesh, ambulance services are available to ferry pregnant women to and from healthcare centers and no payment is made to her directly.[8] Rather the Government pays to service-providers when they produce evidence in this respect and claim their dues.

If a pregnant woman and her family members have different impressions about the healthcare services, she may not always be ignorant. Rather she may be uttering what she avails there. Further prodding and insinuation may reveal what happens on the ground which may be different from what we plan in our offices and prepare its records and documents. Preparing charts and tables regarding awareness may be oversimplification of the scenario. Lived experiences of the cohort may reveal what the women actually get which may be different from what we intend to provide. The discrepancy opens a window to raise our awareness in this aspect. We’d dream to bridge the gap between what we supply v. what the women get. Moreover, the first step in that direction would be not to underestimate the wisdom of the women.

Conflicts of interest

There are no conflicts of interest.

Funding Statement

Nil.