What schemes are available in India for antenatal care?

Antenatal Care Schemes in India

India operates several government-funded antenatal care schemes, with the Pradhan Mantri Matru Vandana Yojana (PMMVY) serving as the flagship conditional cash transfer program for maternal and child health, complemented by the Janani Suraksha Yojana (JSY) for institutional delivery promotion. 1

Primary Government Schemes

Pradhan Mantri Matru Vandana Yojana (PMMVY)

PMMVY is India's largest conditional maternity benefit program designed to improve maternal nutrition and child health through cash incentives linked to specific health-promoting activities. 2

• The scheme provides conditional cash transfers to pregnant women who complete specified antenatal check-ups, institutional delivery, and infant immunization requirements. 2
• Coverage reaches 95.9% in rural areas but drops to 53.1% in urban settings, indicating significant urban-rural disparities. 2
• The program has demonstrated effectiveness in improving utilization of antenatal check-ups, childbirth registration, and child immunization services. 2
• PMMVY beneficiaries show significantly better health service utilization compared to non-beneficiaries, with higher rates of four antenatal check-ups (OR 0.74 for non-beneficiaries, p=0.04) and child immunization (OR 0.43 for non-beneficiaries, p<0.001). 2

A notable operational challenge is that 26.2% of beneficiary women spent the cash incentive on needs unrelated to nutrition or health, suggesting gaps between intended and actual use. 2

Janani Suraksha Yojana (JSY)

JSY, launched in 2005, focuses specifically on promoting institutional delivery through conditional cash transfers to reduce maternal and infant mortality. 3, 4

• The scheme contributed to increasing institutional delivery rates from 40% in 2004 to 73% in 2012. 5
• In rural Mysore, 51.6% of pregnant women reported receiving JSY benefits. 3
• Factors associated with receiving JSY benefits include: partner lacking formal education (AOR 1.35,95% CI 1.01-1.80), household income ≤4,000 Indian Rupees (AOR 1.47,95% CI 1.04-2.09), and delivery in public institutions (AOR 1.23,95% CI 1.01-1.51). 3

A critical limitation is that birth attendants at JSY facilities demonstrate poor competence in emergency obstetric care, with mean EmOC competence scores of only 5.4 out of 20, and 75% of participants scoring below 35% of maximum. 5

Standard Antenatal Care Services Under Government Programs

Indian maternal health guidelines mandate a minimum of 8 antenatal care visits throughout pregnancy, aligned with international standards. 1, 6

Core Screening and Monitoring Components

• Blood pressure measurement at each visit for hypertension screening. 1
• Hemoglobin testing for anemia detection, which is essential given India's high prevalence of maternal anemia. 1
• Weight monitoring and fetal growth assessment at regular intervals. 1
• HbA1c screening for women with diabetes history to prevent maternal and fetal complications. 1
• Routine ultrasound at 12 weeks and 20 weeks gestation for congenital anomaly screening. 1
• Mental health screening for anxiety and depression disorders. 1

Preventive Interventions

• Low-dose aspirin (100-150 mg/day) initiated before 16 weeks until 37 weeks for women with preeclampsia risk factors. 1, 6
• Calcium supplementation (1200 mg/day) in populations with low dietary calcium intake, which is particularly relevant in India. 1, 6
• Distribution of nutritional supplements and health behavior promotion as part of routine care. 1

Tiered Facility System for Maternal Care

India operates a three-tiered facility system for maternal care delivery, ensuring risk-appropriate care at each level. 1

Primary Health Centers (Level I)

• Manage normal pregnancies and deliveries with capabilities for routine intrapartum and postpartum care. 1
• Equipped with protocols for stabilization and referral of complicated cases. 1
• Have access to obstetric ultrasonography, laboratory testing, and blood bank supplies. 1

Secondary Facilities with Obstetrician-Gynecologists (Level II)

• Handle high-risk cases including severe preeclampsia and hemorrhage management. 1
• Provide 24-hour anesthesia services for labor analgesia and surgical anesthesia. 1
• Offer access to maternal-fetal medicine specialist consultations. 1

Tertiary Centers (Level III/IV)

• Provide comprehensive maternal-fetal care with 24-hour maternal-fetal medicine specialists available onsite. 1
• Maintain intensive care units for pregnant women with severe complications. 1
• Function as regional referral centers and educational hubs. 1

Labor Monitoring Tool

The partograph is a mandatory labor monitoring tool in India used to detect delivery complications early and facilitate timely referral decisions. 1

• Recording begins at active phase when cervical dilation reaches ≥4 cm. 1
• Essential components include fetal heart rate, cervical dilation, fetal head descent, uterine contractions, maternal vital signs, and amniotic fluid status. 1

Common Pitfalls and Implementation Challenges

Despite high awareness of schemes (97.8% among beneficiaries, 94.2% among non-beneficiaries), significant operational challenges persist. 2

• Urban slum populations remain underserved, with only 27.3% benefiting from JSY in trans-Yamuna Delhi despite 71% institutional delivery rates. 4
• Belonging to Hindu religion and having more than 6 antenatal check-ups were significant predictors of JSY utilization, suggesting religious and healthcare access disparities. 4
• Beneficiary enrollment and software utilization present ongoing operational difficulties. 2
• The competence gap in emergency obstetric care at JSY facilities means that increased institutional delivery rates have not translated proportionally into maternal mortality reduction. 5

Targeted interventions should focus on difficult-to-access urban slum areas, expansion of scheme coverage, and urgent improvement in birth attendant competence at managing obstetric complications to maximize the impact of these schemes. 4, 5