What are the Janani Suraksha Yojana (JSY) and Janani-Shishu Suraksha Karyakram (JSSK) programs?

JSY and JSSK: Indian Government Maternal Health Programs

Janani Suraksha Yojana (JSY) and Janani-Shishu Suraksha Karyakram (JSSK) are India's flagship conditional cash transfer and free maternal care programs, respectively, designed to reduce maternal and neonatal mortality by promoting institutional deliveries and eliminating financial barriers to facility-based childbirth.

Janani Suraksha Yojana (JSY)

Program Overview

• JSY was launched in April 2005 under India's National Rural Health Mission (NRHM) as a conditional cash transfer scheme to accelerate reductions in maternal and neonatal mortality through institutional deliveries 1, 2.
• The program provides cash incentives to women who deliver in public health facilities, along with transport assistance, escort services, and referral support 2.
• JSY represents a targeted intervention to address the approximately 55,000 maternal deaths occurring annually in India due to pregnancy and childbirth-related conditions 1.

Program Impact and Utilization

• Post-JSY implementation demonstrated substantial increases: antenatal registrations rose from 61.79% to 96.34%, government facility deliveries increased from 25.20% to 53.25%, and postnatal check-ups improved from 45.93% to 69.51% 2.
• Program uptake reached 76% of deliveries in studied populations, with 81% of mothers below the poverty line delivering within the program 3.
• Socially disadvantaged groups benefited disproportionately: Scheduled Castes/Scheduled Tribes (56.87%), Other Backward Classes (60.2%), illiterate women (88.14% among those with primary education), and lower socioeconomic classes (71.83%) showed higher utilization rates 2.

Key Program Features

• Cash incentive delivery: Most program participants (90%) reported receiving the cash transfer within two weeks of delivery 3.
• Prior knowledge: 90% of women had awareness of the JSY program before delivery 3.
• ASHA worker involvement: The program utilizes Accredited Social Health Activists (ASHAs) as community-level volunteers, though their influence on delivery location decisions appears limited 3.

Barriers to Full Utilization

• Women who remain at risk of home delivery include those who are uneducated, multiparous, or lack prior knowledge of the JSY program 3.
• Persistent obstacles include poor infrastructure, lack of quality care, difficulties accessing incentives, corruption in disbursement, negative healthcare personnel behavior, and inadequate information dissemination 1.
• Geographic barriers: Poor and expensive transport facilities combined with difficult terrain limit access, particularly in rural areas 1.

Janani-Shishu Suraksha Karyakram (JSSK)

Program Overview

• JSSK was launched in 2011 as an expansion of maternal health services, providing cashless institutional delivery to all pregnant women, including free transport, diet, and comprehensive care 4.
• The program eliminates out-of-pocket expenses for institutional delivery, addressing a critical financial barrier to facility-based childbirth 4.

Program Impact

• Institutional deliveries increased 2.7-fold (from 197 to 537 deliveries) following JSSK implementation (p < 0.001) 4.
• In some regions, the scheme operates under state-specific names, such as Mukhya Mantri Janani Shishu Swasthya Abhiyan (MMJSSA) in Jharkhand 1.

Key Facilitators and Barriers

• Primary facilitator: Ambulance service provision under JSSK emerged as the most important factor enabling institutional deliveries 4.
• Primary barrier: Family pressure and decision-making by elders in the household remained the most significant obstacle to facility-based delivery 4.

Integration with Broader Maternal Health Framework

• Both JSY and JSSK operate within India's tiered facility system, which includes primary health centers for normal pregnancies, facilities with obstetrician-gynecologists for high-risk cases, and tertiary centers for comprehensive maternal-fetal care 5.
• These programs complement the mandatory minimum of 8 antenatal care visits and use of the partograph for labor monitoring as standard components of Indian maternal health guidelines 5.

Clinical Implications

Addressing Remaining Gaps

• Targeted interventions are needed for women who continue to deliver at home, particularly those who are uneducated, multiparous, or geographically isolated 3.
• Infrastructure improvements must address poor facility quality, inadequate staffing (particularly the need for second ANMs at sub-centers), and corruption in incentive disbursement 1.
• Family-level decision-making interventions should specifically target elder family members who influence delivery location choices 4.

Program Optimization Strategies

• Energizing sub-centers for delivery services would substantially increase access to maternal and child health services in underserved areas 1.
• Improving ambulance services represents the highest-yield intervention for increasing institutional delivery rates under JSSK 4.
• Enhanced awareness campaigns are essential, particularly in urban slum populations where only 27.3% benefited from JSY despite 71% institutional delivery rates 6.