Maternal Health Scenario of Assam
3.3. Operational Schemes on Maternal Health
ANC is high 79.3 percent (vs. at national level 75.1 percent) as compared to Muslim 66.6 percent (vs. at national level 74.6 percent) and Christian women 63.3 percent (vs. at national level 75 percent). Likewise, only 69.7 percent of Scheduled Tribe women received ANC (vs.
at national level 65.9 percent) while it is high among women belonging to Scheduled Caste and Other Backward Class as 79.8 percent (vs. at national level 72.7 percent) and 81.9 percent (vs. at national level 74.7 percent) respectively.
In the case of institutional births, the report found that 22 percent of delivery took place at health institutions (vs. at national level 47 percent). Occurrence of institutional delivery is higher, in urban setup, among wealthy family, and among women who have received 10 or more years of education. Use of contraceptive among married women of 15-49 years of age groups is only 57 percent, whereas only 48 percent of contraceptives used as modern method of family planning in the state. However, there is disparity in usage of contraception as utilization is higher among the urban women (66 percent) as compared to rural women (55 percent).
Based on the above discussion, it is clear that the trend of maternal mortality has been declining in the subsequent years. At the same time, utilization of maternal health care services is very low in the state compared to the national average. In such cases, Government initiatives are needed to encourage women for utilization of reproductive care and facilities, probably at subsidized cost. In what follows we discuss various national and state government schemes on maternal health which are currently operational in Assam.
a. State Programmes:
Government has introduced The Mamoni Scheme in 2008 to provide “Nutritional Food to Pregnant Women” for the welfare of mother and child health. It is a conditional cash transfer programme. It provides monetary assistance of Rs. 1000 (in two instalments) to every pregnant woman during her pregnancy. The first instalment of Rs. 500 is provided during 2nd ANC check-up and the other instalment of Rs. 500 is given in her 3rd ANC check- up. This scheme includes three antenatal check-ups and motivating the expecting mother for institutional delivery in nearby health institution.
Mamta Scheme was introduced during 2010 to ensure post-delivery hospital stay of 48 hours of the mother and the newborn. At the time of discharge after the recommended hours, a
―Mamta kit‖ is provided to mother that containing baby powder, baby oil, mosquito net etc.
This scheme provides an incentive for adequate post-natal care to mother and the baby.
In order to combat anemia several schemes were implemented under National Rural Health Mission during 2012-2013. Along with the National Iron Plus Initiatives, Assam Government has introduced Mission Tejaswee during 2014-15. The purpose of these schemes is to meet the challenge of high incidence of anemia in various age groups. Under these schemes, IFA tablets are distributed among children including age group of 6 months to 5 years, adolescent girls and boys, pregnant and lactating mothers and women in reproductive age groups.
Additionally, Government has also introduced ambulance service like Adoroni Service (2012). Under this scheme, pregnant women get free transport facility to the health institutions for their delivery and similarly, drop-home facility is provided when the mother and the infant are discharged from hospital.
b. National Schemes:
Janani Suraksha Yojana (JSY) is a safe motherhood intervention under National Rural Health Mission launched during 2005 for promoting institutional delivery among pregnant women living under Below Poverty Line (BPL). It provides cash assistance with delivery
and post-delivery care. Under this scheme, for delivery in government hospital and accredited hospitals, mother will get Rs. 1400 in rural areas and Rs. 1000 in urban areas.
Further, Janani Shishu Suraksha Karyakram (JSSK) was launched in 2011 for providing care to pregnant women, sick newborn and free delivery including caesarean section and free treatment in public health institutions viz. drugs, diet, diagnostics, blood transfusion if required.
Another important strategy of Government of India was to introduce Accredited Social Health Activists (ASHA), who acts as a community worker to bridge the gap between health personnel and village women. The general norm under the guideline of NRHM programmes is that one ASHA worker per 1000 population. The purpose of the ASHA worker is to monitor the pregnant women as well as encourage her for antenatal care and delivery in government hospital. They are supposed to provide important information regarding family planning methods and nutritional diet for better health of the mothers and her newborn to villagers. Along with that, government has also taken the initiative to distribute nutritional foods among mothers, adolescent girls, children up to age of 0-6 years and pregnant women through Anganwadi Centers22 in both rural and urban areas.
Government of India has also introduced Mobile Medical Unit (MMU) in 2007. MMU is mobile vehicle with a team of doctors and other medical staff. It is fully equipped with the latest medical equipment and medicines to delivery of health-care services in rural and remote areas.
Government has taken up some initiatives at state and national level to reach the pregnant women in order to reduce maternal mortality and improve reproductive health of women as well. However, utilization of maternal health care is determined by immediate environment of an individual.23
22 The Integrated Child Development Service Scheme (ICDS) is one of the Government initiatives to provide healthcare, nutrition and education services to the children below six years including the pregnant women and lactating mothers. For effective implementation of this programme, Anganwadi center are the focal component where Anganwadi Workers (AWW) deliver the services in close coordination with ANM and ASHA workers of that locality. For example: they jointly organize health camps, conduct health education and awareness programs, home-visit, delivering care during pregnancy and delivery etc. (UNICEF, 2011; Paul et al., 2013).
23 For further elaboration see Chapter V and Chapter VI.