Mitigating Maternal Mortality and Child Mortality: The Transformative Impact of Janani Suraksha Yojana in India

The views expressed are those of the author and do not necessarily reflect the views of ASPA as an organization.

By Pooja Paswan
October 18, 2024

Maternal health in India has faced persistent challenges, particularly high maternal and neonatal mortality rates in rural and economically disadvantaged areas. To address this, the Government of India launched the Janani Suraksha Yojana (JSY) in 2005 under the National Rural Health Mission (NRHM). The program aimed to reduce the Maternal Mortality Ratio (MMR), which stood at 254 per 100,000 live births in 2004-2006, by promoting institutional deliveries. Since the inception of JSY, India’s MMR has declined to 97 per 100,000 live births in 2018-2020. JSY has played a key role in increasing institutional deliveries from approximately 47 percent in 2005-06 to 88 percent in recent years, contributing significantly to maternal and child health improvements across the country.

Why was Janani Suraksha Yojana required?

Prior to the introduction of Janani Suraksha Yojana (JSY) in 2005, India’s maternal health landscape was dire, with an MMR of 254 per 100,000 live births (2004-2006). The institutional deliveries, critical for reducing maternal mortality, were low, particularly in rural and underserved areas, resulting in significant health disparities between rural and urban populations. JSY was thus launched under the National Rural Health Mission (NRHM) by the Government of India to address these challenges. The program’s core objective is to reduce maternal and neonatal mortality by promoting institutional deliveries, especially among economically disadvantaged groups and vulnerable populations.

How Effectively Has JSY Been Implemented Across India?

Janani Suraksha Yojana  is a 100% centrally sponsored scheme under the National Rural Health Mission (NRHM). The scheme is financed entirely by the central government and implemented at the state level, ensuring a uniform approach across the country.

A key feature of Janani Suraksha Yojana is the engagement of Accredited Social Health Activists (ASHAs), who serve as a crucial link between the government and pregnant women, especially in low-performing states (LPS). ASHAs identify pregnant women, facilitate their registration for antenatal checkups (ANC), counsel them for institutional delivery, and provide necessary postnatal care.

How Crucial Are ASHAs in the Success of JSY?

ASHAs are central to Janani Suraksha Yojana ‘s implementation. They identify pregnant women as beneficiaries and facilitate their access to ANC services, including distributing iron-folic acid (IFA) tablets and administering tetanus toxoid (TT) injections. They counsel women on the benefits of institutional delivery and assist them in choosing a suitable healthcare facility. After the delivery, ASHAs ensure the newborn is immunized and provide necessary postnatal care. Their performance is assessed based on the number of institutional deliveries they facilitate, directly linking their compensation to successful outcomes. The ASHAs play a central role in the success of Janani Suraksha Yojana. Their responsibilities include identifying eligible pregnant women as beneficiaries, assisting them in obtaining essential certifications, facilitating at least three ANC checkups and identifying functional government health centers or accredited private institutions for delivery. They counsel women on the importance of institutional delivery, escort them to healthcare facilities and stay with them until they are discharged. Post-delivery, ASHAs also ensure the newborn’s immunization and provide support during the postnatal period. The effectiveness of Janani Suraksha Yojana largely hinges on the proactive involvement of these community health workers. However, regional disparities continue to hinder the program’s overall success. States like Assam, Uttar Pradesh, and Madhya Pradesh still have high Maternal Mortality Ratios (MMR), with Assam recording an MMR of 205 and Uttar Pradesh at 167​.

Who Qualifies for JSY Benefits and What Financial Support is Provided?

The eligibility criteria for Janani Suraksha Yojana beneficiaries vary between low-performing states (LPS) and high-performing states (HPS). In LPS, all pregnant women delivering in government health centers or accredited private institutions are eligible for the scheme. In HPS, only pregnant women from Below Poverty Line (BPL) families, aged 19 years and above, are eligible, as well as all Scheduled Caste (SC) and Scheduled Tribe (ST) women.

Cash assistance under Janani Suraksha Yojana is provided to encourage institutional deliveries. The amount varies based on whether the beneficiary resides in a rural or urban area. In rural LPS, women receive Rs. 1,400, while in urban areas, they receive Rs. 1,000. ASHAs receive an incentive of Rs. 600 in rural areas and Rs. 200 in urban areas for each institutional delivery they facilitate. In HPS, the amounts are slightly lower, with women in rural areas receiving Rs. 700 and ASHAs receiving Rs. 200. For home deliveries, eligible women receive Rs. 500 to support their delivery-related care.

How Are Funds Allocated and Managed Under JSY?

The funds for the Janani Suraksha Yojana are provided by the central government to states and districts, with designated amounts for grassroots-level implementation. The Auxiliary Nurse Midwives (ANMs) and Accredited Social Health Activists (ASHAs) utilize recoupable imprest funds to meet immediate expenses related to the care of beneficiaries. The program’s effectiveness is monitored through monthly meetings, where ANMs evaluate the work schedules and progress of ASHAs to ensure that the scheme is running smoothly and achieving its intended goals.

Way forward

In the future, the Janani Suraksha Yojana (JSY) holds the potential to further revolutionize maternal healthcare in India. By continuing to expand its reach, particularly in high MMR regions, and leveraging advancements in healthcare infrastructure and digital monitoring, the program can ensure more equitable outcomes across all states. Empowering ASHAs with enhanced training and technology could deepen community outreach, fostering better maternal and neonatal care. As India strives to meet global health goals, the continuous evolution of JSY will be pivotal in driving down maternal mortality and achieving universal access to quality maternal health services.

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Author: Pooja Paswan is the Chair of the PA Theory Network and Vice Chair of ASPA’s South Asian Section for Public Administration. An alumna of the John F. Kennedy School of Government, Harvard University, she is an Assistant Professor in the Department of Political Science at Jamia Millia Islamia University, New Delhi, India. Pooja holds a Ph.D. in Public Administration, specializing in Public Policy. She was the recipient of the ASPA 2019 Founders Fellow and serves as the Book Review Editor for the International Journal of Public Administration (IJPA). Her work spans development administration and public policy. She can be reached at her Academia profile and [email protected]. Twitter @poojapaswan. 

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