Janani Suraksha Yojana

The Janani Suraksha Yojana (JSY) is a flagship safe motherhood intervention under the National Health Mission (NHM) of the Government of India. Launched in April 2005, the scheme aims to reduce maternal and neonatal mortality by promoting institutional delivery among poor pregnant women. It represents a major step towards achieving universal maternal healthcare and ensuring that no woman dies during childbirth due to lack of medical attention.

Background and Objectives

Before the implementation of JSY, India faced alarmingly high maternal mortality rates (MMR) and infant mortality rates (IMR), largely due to home deliveries conducted without skilled birth attendants. The Reproductive and Child Health (RCH) Programme, initiated earlier, highlighted the need for a direct incentive-based scheme to encourage institutional deliveries.
Janani Suraksha Yojana was therefore introduced by modifying the National Maternity Benefit Scheme (NMBS). It sought to integrate financial incentives with healthcare services to ensure that pregnant women, especially from low-income households, could access antenatal, intranatal, and postnatal care at healthcare institutions.
The primary objectives of JSY include:

• Promoting institutional delivery among poor pregnant women.
• Reducing maternal and neonatal mortality through skilled care.
• Providing cash assistance for institutional and home deliveries under defined conditions.
• Enhancing access to antenatal and postnatal care in public health facilities.

Structure and Coverage

JSY is implemented by the Ministry of Health and Family Welfare (MoHFW) through the National Health Mission and operates across all states and union territories. However, the scheme gives special focus to the Low Performing States (LPS)—those with low institutional delivery rates and high maternal mortality. These states include Uttar Pradesh, Bihar, Madhya Pradesh, Rajasthan, Chhattisgarh, Jharkhand, Odisha, Uttarakhand, and Assam.
The scheme targets:

• All pregnant women in LPS delivering in government health facilities or accredited private institutions.
• BPL (Below Poverty Line) women, Scheduled Caste (SC) and Scheduled Tribe (ST) women in other states.
• Accredited Social Health Activists (ASHAs) who facilitate institutional delivery and postnatal care.

Cash Assistance and Incentive Structure

Under the Janani Suraksha Yojana, financial assistance is provided both to the mother and the ASHA worker who assists her. The assistance varies depending on the state’s performance category:
1. Low Performing States (LPS):

• Rural Areas: ₹1,400 to the mother + ₹600 to ASHA = ₹2,000 total.
• Urban Areas: ₹1,000 to the mother + ₹200 to ASHA = ₹1,200 total.

2. High Performing States (HPS):

• Rural Areas: ₹700 to the mother + ₹600 to ASHA = ₹1,300 total.
• Urban Areas: ₹600 to the mother + ₹200 to ASHA = ₹800 total.

The cash incentive is designed to cover transportation costs, food expenses during hospital stay, and incidental delivery costs, thereby encouraging women to opt for institutional care.

Role of Accredited Social Health Activists (ASHAs)

The ASHA plays a pivotal role in implementing JSY at the grassroots level. Acting as a community link between the healthcare system and rural households, ASHAs:

• Identify and register pregnant women early in pregnancy.
• Ensure antenatal check-ups and counselling.
• Facilitate transportation to healthcare institutions for delivery.
• Support the mother during and after childbirth.
• Promote immunisation and family welfare measures post-delivery.

ASHAs are provided monetary incentives for accompanying women to healthcare facilities, ensuring continuity of care, and reporting outcomes accurately. Their contribution has been vital in enhancing institutional delivery rates in remote and marginalised communities.

Implementation and Institutional Framework

JSY operates through a decentralised structure under NHM. Funds are disbursed from the central government to state health societies, which then allocate them to district and block health authorities. Cash benefits are usually paid directly into the beneficiary’s bank account through Direct Benefit Transfer (DBT) to ensure transparency.
Implementation involves multiple levels of monitoring:

• Sub-centres and PHCs (Primary Health Centres) – Responsible for registration and counselling.
• Community Health Centres (CHCs) and District Hospitals – Serve as institutional delivery points.
• State and District Health Societies – Oversee fund utilisation, performance audits, and reporting.

Impact on Maternal and Child Health

Since its inception, the Janani Suraksha Yojana has made substantial progress in improving maternal and neonatal health indicators across India. The scheme has contributed to a significant rise in institutional deliveries, particularly in rural and economically disadvantaged areas.
Key outcomes include:

• Institutional delivery rates increased from 39% in 2005–06 (NFHS-3) to over 88% in 2020–21 (NFHS-5).
• Maternal Mortality Ratio declined from 254 per 100,000 live births (2004–06) to 97 per 100,000 live births (2018–20).
• Infant Mortality Rate showed steady reduction due to improved neonatal care.

These outcomes highlight the success of JSY in bridging healthcare access gaps and encouraging the use of formal medical facilities during childbirth.

Challenges and Criticisms

Despite its achievements, the Janani Suraksha Yojana has faced several challenges in implementation:

• Delayed Payments: Instances of beneficiaries receiving financial assistance after significant delays.
• Quality of Care: Inadequate infrastructure and staff shortages in rural health centres.
• Overcrowding in Facilities: Increased institutional deliveries have sometimes led to strain on existing resources.
• Limited Postnatal Support: Focus has been mainly on delivery, with insufficient attention to postpartum care and neonatal follow-up.
• Awareness Gaps: Some eligible women remain unaware of their entitlements due to lack of community-level dissemination.

Independent evaluations have recommended measures such as strengthening health infrastructure, improving monitoring mechanisms, and ensuring timely disbursal of funds.

Integration with Other Schemes

Janani Suraksha Yojana operates synergistically with several other health initiatives to create a comprehensive maternal and child healthcare ecosystem. These include:

• Janani Shishu Suraksha Karyakram (JSSK): Provides free delivery, medicines, diagnostics, and transport to pregnant women and infants.
• Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA): Offers free antenatal check-ups by medical specialists on the 9th of every month.
• LaQshya Programme: Focuses on improving quality of care in labour rooms and maternity wards.

The integration of these schemes ensures continuity of care from pregnancy to postnatal stages, reinforcing JSY’s objectives.

Significance and Future Outlook

The Janani Suraksha Yojana stands as one of the most successful public health interventions in post-independence India. Its incentive-based model not only increased institutional deliveries but also brought behavioural change in maternal health-seeking practices.
In the future, the scheme is expected to focus on:

• Enhancing quality of institutional care through upgraded facilities.
• Expanding digital monitoring systems for better tracking of beneficiaries.
• Strengthening postnatal and neonatal services.
• Integrating with health insurance and universal healthcare initiatives.