Schemes for Antenatal Care in India
Primary Government Scheme: Janani Suraksha Yojana (JSY)
The Janani Suraksha Yojana (JSY), launched in 2005, is India's flagship conditional cash transfer scheme designed to promote institutional deliveries and reduce maternal mortality through financial incentives, transport assistance, and linkage to antenatal care services. 1, 2
JSY Program Components
The JSY scheme provides:
- Cash incentives to pregnant women who deliver in health institutions 1, 3
- Transport and escort services to facilitate access to delivery facilities 4
- Referral services for complicated cases requiring higher-level care 4
- Linkage to Accredited Social Health Activists (ASHA) who serve as community health workers connecting pregnant women to services 2, 3
Impact on Maternal Health Outcomes
JSY implementation has demonstrated measurable effects:
- Institutional deliveries increased by 42.6% in tertiary care settings following JSY implementation 1
- Antenatal registrations increased from 61.79% to 96.34% post-JSY 4
- Government health facility deliveries increased from 25.20% to 53.25% after scheme implementation 4
- Postnatal check-ups increased from 45.93% to 69.51% following JSY launch 4
Target Populations Benefiting Most
The scheme has particularly improved access for vulnerable groups:
- Rural, illiterate, and primary-literate women from lower socioeconomic strata showed increased institutional delivery rates 1
- Scheduled Castes/Scheduled Tribes (56.87%) and Other Backward Classes (60.2%) utilized government facilities more than general category women (43.68%) post-JSY 4
- Women with partners lacking formal education (AOR: 1.35) and household income ≤4,000 Indian Rupees (AOR: 1.47) were more likely to receive JSY benefits 2
Standard Antenatal Care Services in India
Minimum ANC Requirements
Indian maternal health guidelines mandate a minimum of 8 antenatal care visits throughout pregnancy to ensure maternal and fetal health monitoring 5:
- Continuity of care led by midwives (bidan) across antenatal, intranatal, and postnatal periods 5
- Patient-held health records to increase active participation in care 5
- Health behavior promotion and nutritional supplement distribution 5
Essential Screening and Monitoring
Core ANC services include:
- Blood pressure measurement for hypertension screening 5
- Hemoglobin testing for anemia detection 5
- Weight monitoring and fetal growth assessment 5
- HbA1c screening for women with diabetes history 5
- Routine ultrasound at 12 weeks and 20 weeks gestation for congenital anomaly screening 5
- Mental health screening for anxiety and depression disorders 5
Preventive Interventions
Evidence-based preventive measures:
- Low-dose aspirin (100-150 mg/day) initiated before 16 weeks until 37 weeks for women with preeclampsia risk factors 5
- Calcium supplementation (1200 mg/day) in populations with low dietary calcium intake 5
Tiered Facility System for Maternal Care
Level I: Basic Care (Puskesmas and Midwife Clinics)
Primary health centers manage normal pregnancies and deliveries with capabilities for:
- Routine intrapartum and postpartum care 5
- Stabilization protocols for complications requiring referral 5
- Access to obstetric ultrasonography, laboratory testing, and blood bank supplies 5
Level II: Specialty Care (District Hospitals)
Facilities with obstetrician-gynecologists handle high-risk cases including:
- Severe preeclampsia and hemorrhage management 5
- 24-hour anesthesia services for labor analgesia and surgical procedures 5
- Maternal-fetal medicine consultation access 5
Level III: Subspecialty Care (Regional Referral Centers)
Tertiary centers provide comprehensive maternal-fetal care with:
- 24-hour maternal-fetal medicine specialists 5
- Intensive care units for severe maternal complications 5
- Regional referral hub and teaching functions 5
Labor Monitoring: The Partograph
The partograph is a mandatory labor monitoring tool in India used to detect delivery complications early 5:
- Recording begins at active phase (cervical dilation ≥4 cm) 5
- Essential components include fetal heart rate, cervical dilation, fetal head descent, uterine contractions, maternal vital signs, and amniotic fluid status 5
- Facilitates early detection of prolonged or obstructed labor 5
- Enables timely referral decisions to higher-level facilities 5
Critical Gaps and Limitations
JSY Implementation Challenges
Despite widespread implementation, significant gaps persist:
- Only 27.3% of eligible women actually benefited from JSY scheme in urban slum populations 3
- Only 14.5% received cash benefits despite higher institutional delivery rates 3
- Scheme design focuses primarily on institutional delivery rather than comprehensive continuum of care from pre-pregnancy through postnatal period 6
Quality of Care Concerns
The increase in institutional deliveries has paradoxically increased high-risk presentations:
- Significant increases in eclampsia, preeclampsia, polyhydramnios, oligohydramnios, antepartum hemorrhage, postpartum hemorrhage, and malaria cases presenting at institutions post-JSY 1
- Anemia remains the most common morbidity factor both before and after JSY implementation 1
- Eclampsia, preeclampsia, and severe anemia continue as leading causes of maternal mortality 1
Service Delivery Gaps
Postnatal care remains inadequate despite JSY's focus on institutional delivery 6:
- Poor prenatal care and particularly deficient postnatal care contribute to persistent maternal deaths 6
- Scheme requires reassessment to include comprehensive maternal health services extending beyond delivery 6
Additional Government Initiatives
National Rural Health Mission (NRHM)
JSY operates under the broader NRHM framework, which provides:
- Infrastructure development for rural health facilities 6
- Human resource deployment including ASHA workers 2
- Supply chain management for essential medicines and equipment 6
Maternal and Child Health Block Grant (Title V)
Federal-state partnerships through MCH Block Grants support: