How Schemes Fail Women: Delivery on Hospital Veranda Equals No Aid

Government schemes meant to give maternity entitlements have failed women beneficiaries on the ground.

(Illustration: Kamran Akhter/The Quint)

Usha Devi, a 15-year-old resident of a district in eastern Uttar Pradesh, was expecting her first child.

Though she was underage, a local ASHA (Accredited Social Health Activist) worker had filled the PMMVY form on Usha’s behalf. The PMMVY or Pradhan Mantri Matru Vandana Yojana offers maternity entitlements to marginalised women across India.

And then a problem arose which made it almost impossible for Usha Devi to get any benefit of the maternity scheme.

Usha Changed to ‘Pusa’ in Aadhaar Card, Denying Benefit

Usha Devi’s Aadhaar card mentions her name as ‘Pusa’, putting a question mark on her very identity.

Speaking to activists who had gone to UP as part of the survey, Usha Devi’s mother-in-law said:

“ASHA didi had told us that we would get Rs 5,000 in three instalments. We were not informed about age limit. In the eight months of pregnancy all we received was 1 packet of sattu (powdered barley or gram) and one round of vaccination at the local school.”

Once a pregnant woman has registered her name at the local anganwadi, under the provisions of the ICDS (Integrated Child Development Services) Scheme, she’s entitled to health check-ups as well as food supplements every month, along with two doses of Tetanus immunisation.

Usha Devi holding her Aadhaar card in which her name has been mistakenly mentioned as ‘Pusa’.(Photo courtesy: Fatehveer Singh/ Jaccha Baccha Survey 2019)

According to Anmol Somanchi, a researcher at IIM Ahmedabad who was part of the Jaccha Baccha survey, errors in Aadhaar card can be life-threatening to those seeking immediate medical help and/or financial assistance:

“Demographic data glitches (eg typos in Aadhaar number, misspelling of names, wrong date of birth on Aadhaar, mismatch between Aadhaar card and other records, etc.) can all lead to the PMMVY application getting rejected or delayed. In most cases, these errors crept in for no fault of the women who were applying for PMMVY, but they are paying the price for it. Further, the processes for making these corrections are not clearly laid out or communicated.”

Anmol Somanchi, Researcher, IIM Ahmedabad

Are Maternity Entitlements Reaching the End Beneficiary?

A recent report called ‘Jaccha Baccha Survey 2019’ has revealed several anomalies in the implementation of maternity benefit schemes. The report also claims that the recently launched scheme, PMMVY, by the Centre is riddled with problems.

Only 39 percent women eligible for maternity benefits under the PMMVY (Pradhan Mantri Matru Vandana Yojana) received the first installment of the mandatory Rs 5,000 during child birth, states the Jaccha Baccha Survey, conducted in June 2019.

The survey which was conducted in six states – Chhattisgarh, Himachal Pradesh, Jharkhand, Madhya Pradesh, Odisha and Uttar Pradesh – further states that ‘PMMVY covers less than one fourth of all births as things stand’.

Before we delve into the shortcomings of the government-run programme, let’s first understand what the scheme is all about:

What is the PMMVY Scheme?

Launched in September 2017 by the Centre, PMMVY (Pradhan Mantri Matru Vandana Yojana) is aimed at providing financial assistance of Rs 5,000 to pregnant women (19 years and above) for the first child birth. The scheme is applicable in all districts across India.

The cash incentive is given in three installments: Rs 1,000 on registration of pregnancy, Rs 2,000 after six months of pregnancy and Rs 2,000 after child birth and first round of vaccination.

Was there a maternity benefit scheme prior to PMMVY?

Yes. After the National Food Security Act came into force in 2013, a maternity benefit scheme, called the Indira Gandhi Matritva Sahyog Yojana, was launched in 53 districts. Under the scheme, Rs 4,000 cash incentive was given to women for up to two child births.

(Infographic: Arnica Kala/ The Quint)

What has been the criticism against the newly launched scheme?

Critics say it violates the National Food Security Act 2013 by restricting the benefit to only one child birth.

Section 4 of the National Food Security Act states:

“Every pregnant and lactating mother shall be entitled to [nutritious food and] maternity benefit of not less than rupees six thousand, in such instalments as may be prescribed by the Central Government”.

The newly launched scheme by the Centre has not only reduced the scope of benefit by giving entitlement only for first child, it has also reduced the amount from Rs 6,000 to Rs 5,000.

Delivered Baby on Hospital Veranda, Yet Benefit Denied

When Sarita Devi approached the hospital for delivery in 2018, her family had found that doctors were not available as they were on holiday.

She delivered the baby on the hospital veranda with her female in-laws beside her.

Sarita had filled a form under the Janani Suraksha Scheme, another government-run programme, that offers cash incentive of Rs 1,400 for delivery.

However, when Sarita’s family tried to claim compensation under the Janani Suraksha Scheme, the concerned authorities were "not sure" whether the delivery happened at the hospital and thus, refused to release the amount.

“She was denied the money as they were not sure if the baby was born in this hospital as it happened in the absence of hospital staff, on a ‘self-declared holiday’," reveals the Jaccha Baccha survey as part of their findings.

Sarita Devi, from eastern UP, had to deliver her child on hospital veranda yet was denied benefit under the Janani Suraksha Scheme.(Photo courtesy: Vyom Anil/ Jaccha Baccha Survey 2019)

Anmol who has been closely associated with the ‘Jaccha Baccha Survey 2019’, explains why denial of benefits on such flimsy grounds is problematic.

“Since the hospital staff weren’t around when she delivered, they refused to count it as an institutional birth. Sarita’s case highlights the deplorable state of public health in UP where the helpless and vulnerable (in this case a Dalit woman) pay the highest price.”

Anmol Somanchi, Researcher, IIM Ahmedabad

Mortgaged Land, Took Loan To Bear Cost of Treatment

For Rani Gope, who lives in Odisha, trouble began soon after delivery in February 2019. Her family had to rush the child to another government hospital in Rourkela due to certain complications.

Rani’s son was referred to a private hospital which compelled the family to mortgage their land for Rs 50,000 and borrow another Rs 50,000 from relatives.

The PMMVY scheme hasn’t been implemented in Odisha. However, the state government has its own Maternity Benefit Scheme that runs by the name of ‘Mamta’.

Rani Gope sitting with her husband.(Photo courtesy: Sweta Dash/ Jaccha Baccha Survey 2019)

Rani did receive the first instalment of Rs 3,000 after enrolling for the ‘Mamta’ scheme. The full compensation under the scheme is Rs 5,000 in two instalments.

But even the first instalment wasn’t enough to cover expenses after childbirth that pushed Rani’s family into a cycle of debt. Even though the fault was not entirely of the government hospital, Rani’s case explains how maternity entitlements are not enough to cover all the expenses.

“The public healthcare system can certainly be faulted for its inability to provide timely care and pushing families to seek expensive alternatives in the private sector, even when they cannot afford it.”

Anmol Somanchi, Researcher, IIM Ahmedabad

Findings of the 2019 ‘Jaccha Baccha Survey’

The ‘Jaccha Baccha Survey’, done by a team of researchers under economists Reetika Khera and Jean Dreze, had a sample size of over 700 women.

In response to an RTI, the government admitted that between April 2018 and July 2019, 38 lakh beneficiaries enrolled under the PMMVY scheme had received the third instalment. When compared to the total number of live births, the effective coverage of the scheme comes to around 14 percent.

(Infographic: Arnica Kala/ The Quint)

Abortion in First Pregnancy, No Benefit For Second Child

Geeta Devi, a resident of Himachal Pradesh, had enrolled for the PMMVY in 2018. Since Geeta had an abortion in the fourth month after her pregnancy was registered, she did not receive any monetary benefits.

When Geeta conceived for the second time in 2019, she went to fill in the PMMVY form again but the local anganwadi worker told her that since this is her second child, on technical grounds, her application won’t be accepted.

But since PMMVY scheme is applicable for first live birth, she should have received the due compensation the second time after she delivered the baby. But even the supervisor of local anganwadi told her that she can’t avail the benefits of the scheme.

Geeta Devi was denied benefit of PMMVY scheme as she had applied for the second time after having an abortion when she had conceived for the first time.(Photo courtesy: Meghna Yadav/ Jaccha Baccha Survey 2019)

For those who haven’t enrolled for any government scheme, the plight is even worse.

In MP, Kunta Kol, an Adivasi woman, was not enrolled under any maternity benefit scheme. She delivered the baby in ambulance while on her way to the hospital and had to pay around Rs 2,000 from her own pocket.

The ‘Jaccha Baccha Survey 2019’ has not only highlighted inconsistencies in Aadhaar-linked scheme but also made a case for better ante-natal care for women who often suffer due to poorly implementation of government programmes.

While Uttar Pradesh, Madhya Pradesh and Jharkhand have been termed as the laggard states in the latest survey, states like Chhattisgarh, Odisha and Himachal Pradesh have been termed as leader states.