Impact of Janani Suraksha Yojana on Institutional Delivery Rate and Maternal Morbidity and Mortality: An Observational Study in India

By Gupta, Sanjeev K.; Pal, Dinesh K. et al. | Journal of Health Population and Nutrition, December 2012 | Go to article overview

Impact of Janani Suraksha Yojana on Institutional Delivery Rate and Maternal Morbidity and Mortality: An Observational Study in India


Gupta, Sanjeev K., Pal, Dinesh K., Tiwari, Rajesh, Garg, Rajesh, Shrivastava, Ashish K., Sarawagi, Radha, Patil, Rajkumar, Agarwal, Lokesh, Gupta, Prashant, Lahariya, Chandrakant, Journal of Health Population and Nutrition


INTRODUCTION

The maternal morbidity and mortality have been recorded since antiquity and probably recognizing this fact, the universal declaration for human rights of 1948 in article 25 stressed that "Motherhood and childhood are entitled to special care and assistance" (1). Providentially, the maternal health issues continue to be at the forefront of global and national health policies in the last few years. The Millennium Development Goal 5 (MDG 5) calls for a three-fourth reduction in the maternal mortality ratio (MMR) by 2015 compared to 1990 levels (2-4). However, In spite all efforts, the progress in reducing maternal mortality is slow and, globally, an estimated 358,000 mothers died of pregnancy or related complications in 2008 (5). Approximately 99% (355,000) of these deaths occur in developing countries, 87% (313,000) in Africa and Asia, and more than half in 6 countries (India, Nigeria, Pakistan, Afghanistan, Ethiopia, and the Democratic Republic of Congo) only (5-6). Additionally, over 50 million pregnant women each year suffer from morbidity due to acute complications from pregnancy globally (7). The MMR in India during 2004- 2006 was 254 per 100,000 livebirths with wide geographical variations, which slightly declined to 212 per 100,000 livebirths in 2007-2009 (8-10). Eight socioeconomically-backward states: Bihar, Chhattisgarh, Jharkhand, Madhya Pradesh, Orissa, Rajasthan, Uttaranchal, and Uttar Pradesh, accounted for majority of maternal deaths in India (9).

Each death or long-term complication represents an individual tragedy for the woman, her partner, her children, and her family, although a large proportion of these maternal deaths is avoidable. The main causes are known, and more than 80% of maternal deaths could be prevented or avoided through either increasing the institutional deliveries or by improving the quality of care provided to the women (3-7). Unfortunately, as late as in 2005- 2006, the institutional deliveries in rural India were reported to be 28.9% (10-11). The Government of India gave high priority to promote institutional deliveries to improve maternal survival as part of national policy and also being a signatory for MDGs (4). Therefore, a well-known scheme Janani Suraksha Yojana or JSY was launched in April 2005 under the umbrella of National Rural Health Mission (NRHM) of India (see box) (12-13). In Hindi language, Janani means mother, Suraksha means protection, and Yojana means scheme. This study was planned with the objectives to assess the impact of JSY on institutional deliveries, maternal morbidity and mortality and to find out any bottlenecks in the implementation of this scheme.

MATERIALS AND METHODS

The study was conducted in the NSCB Medical College & Hospital of Jabalpur district of Madhya Pradesh state in India (The state falls in the category of low- performing states in terms of health indices in the country). This is the biggest tertiarycare hospital in this region and is the main referral centre for 8-10 adjoining districts of Madhya Pradesh. Jabalpur had a population of 1,276,853 in 2001; males formed 52% of the population, and 28.9% of the total population of the district lived in slums (14).

This observational study collected information on the number of deliveries and maternal deaths in the study hospital between August 2003 and August 2007. The maternal deaths due to abortion- related complications were excluded from the study.

The data were collected in two phases. In the first phase, the retrospective data were collected on maternal deaths from the records of Obstetrics and Gynecology Department of the Hospital for the period from 16 August 2003 to 15 August 2005 (two years). In the second phase, all deliveries conducted in the Obstetrics and Gynecology Department of the Hospital were prospectively followed up and any maternal complications, and mortality was recorded by the first two authors since 16 August 2005 until 15 August 2007, which covers a period of two years after implementation of JSY. …

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