BMJ examines debate over government program to reduce maternal mortality in India

"An Indian government program to reduce the number of home births by giving expectant mothers cash grants has increased the number of hospital deliveries, but gaps in health care services are still causing avoidable maternal deaths, an alliance of health organizations has said," BMJ reports. "The health ministry's Janani Suraksha Yojana (Mothers Protection Program) provides a cash incentive of 1400 rupees (£16; €20; $25) mainly to poor and underprivileged pregnant women to give birth in hospital," the journal notes. According to the journal, "[t]he ministry said that the program had helped increase the proportion of hospital deliveries in India from less than 49 percent when it was launched in 2005 to more than 72 percent." However, BMJ adds, "[t]he National Alliance for Maternal Health and Human Rights, a non-governmental coalition, has said that India's health ministry has stirred demand and increased the number of hospital deliveries without paying enough attention to factors that determine maternal safety."

"[T]he maternal health alliance has cautioned that surveys across several states had shown that public health centers lacked the infrastructure to support women with high-risk pregnancies and that doctors and nurses were often unable to manage obstetric complications," the journal writes, noting, "Members of the alliance said that their surveys in six states -- Chhattisgarh, Gujarat, Jharkhand, Karnataka, Madhya Pradesh, and Uttar Pradesh -- indicated that auxiliary nurse midwives in health centers were not trained to spot high-risk factors in pregnancy such as severe anemia, infections, or pre-eclampsia." BMJ adds, "Earlier this month the alliance called on the health ministry to provide better training for health staff in emergency obstetric care, rigorous reviews of maternal mortality, and enforced public health standards in maternal health services" (Mudur, 10/31).