Alarming Decline In Access To Maternity Benefits

Urgent action is needed to check the decline in the access to the most important national-level maternity benefit scheme. The government must take immediate steps for this, particularly in the context of states like Gujarat and West Bengal where the sharp decline in 2021-22 has been particularly distressing.

According to the latest available data, maternity benefits which should be available for all child-births could reach only about one-third or so. What is most shocking is that over a period of two years there was a decline of 40% in the total number of women receiving the benefits from the biggest maternity scheme of the Union Government.

In 2013 the National Food Security Act made available certain maternity benefits to Indian women, a step which was appreciated widely. Section 4 of this law stated that every pregnant and lactating mother shall be entitled to (nutritious food and)maternity benefit of not less than Rs. 6,000, in such installments as may be prescribed by the Central Government.

In order to meet this legal commitment clearly an additional budgetary amount was needed which should have been made available per year since then. On the basis of assuming a population of 132 crore then, a birth rate of 20 per thousand and an effective coverage of 90%, it was estimated that the annual budget needed for implementing this legal commitment is around Rs. 14,000 crore.

Even after allowing the government adequate time for operationalising this legal entitlement, from financial year 2015-16 onwards, this commitment and spending of Rs. 14,000 crore per year must have been available. Actually this should have increased with inflation, but even if we do not provide for this increase for the time being, then during the seven financial years 2015-16 to 2021-22, Rs. 98,000 crore should have been provided.

However, when we look at the actual expenditure on this, then what is needed for one year (Rs. 14,000 crore ) was actually spent over a period of seven years. In other words Indian mothers were deprived of Rs. 84,000 (Rs. 98,000-Rs. 14,000) crore during this period of seven years, in the context of their legal entitlement of maternity benefit.

The spending has been largely done after a scheme to implement this legal entitlement was launched in 2017. This is called the Pradhan Mantri Matru Vandana Yojana (PMMVY).

Hence even after allowing for almost two years for preparing for implementation of this legal entitlement, during 2015-16 and 2016-17 there was negligible allocation. In 2017-18 there was an allocation of Rs. 2,700 crore but later the budget estimate was reduced.

This reduction took place to an even greater extent in the next year. The cut was very heavy in 2020-21, from budget allocation of Rs. 2,500 crore to just Rs. 1,300 crore.

When the government formulated detailed guidelines for PMMVY in 2017, ignoring original legal provisions it decided to restrict the maternity benefits only to the first living child and even this was reduced to Rs. 5000 (instead of the minimum provision of Rs. 6,000 provided originally in the law), to be paid in three installments.

Further, the procedures for availing these benefits were made so complicated that it became difficult for many mothers to avail them. This was seen particularly in the poorest and least educated sections where this benefit is needed the most.

These benefits have sometimes been denied to women who gave birth at home (these may have been due to imposed circumstances or reasons beyond their control), or who did not have an Aadhaar card or other relevant documents.

To be eligible and to get each of the three installments, several long forms have to be filled. Documents required to be furnished by them include MCP Card (Mother-Child Protection Card), the Aadhaar card of the mother and her husband, bank pass book, linking of bank account with aadhaar. Even minor discrepancies in documents can sometimes lead to denial of payment.

The mother applying for maternity benefits depends on local functionaries like anganwadi workers and depending on how much time they can devote to a case where some complication exists, the application may not be successful.

Even after all the efforts have been made, online applications for these payments can be rejected or returned with error due to a number of factors, or even if application is accepted payment may not reach in time. Sometimes mistakes lead to payment being deposited in a wrong account. Getting them corrected is another challenge.

Despite all these problems, at least some progress in covering the first child birth was made and by 2019-20 about 96 lakh (9.6 million) mothers received at least some PMMVY benefit. However in the next two years this declined to 75 lakh and 61 lakh respectively, a very big decline of 40% in 2 years.

In 2019-20 in the case of 36% births the first installment under PMMVY was received. By 2021-22 this declined to 23%. If we add the probability of nearly 10% of total births receiving maternity benefits in the organised sector under various provisions, this means that a total of about 33% births were covered in 2021-22 by maternity benefits.

Of those 23% were under PMMVY, testifying to the importance of this scheme despite its poor progress. However, if we look at the payment of all three installments, then in 2019-20 these were received in the case of 22% of births, a number which declined to just 13% in 2021-22, a shockingly low performance.

Information on this important scheme has not been readily available, a problem made more complicated by the merging and renaming of several related schemes. This latest information became available through an RTI filed by Prof Jean Dreze and Prof. Reetika Khera.

Clearly, what has happened in the course of implementing the maternity benefit component of the national food security law has been unjust. Corrective measures need to be taken urgently.

The arbitrary action of restricting the benefits to only the first living child should be dropped in favor of covering all births. If at all there is some urgent requirement to restrict, at least the first three living children should be covered.

The arbitrary reduction from Rs. 6,000 to Rs. 5,000 should also be rolled back. The original payment of Rs. 6,000, revised upwards on the basis of inflation, should be provided.

An annual budget based on this upward revision should be ensured to meet this legal commitment which is also justified in view of its health benefits for mothers and children. In addition the provisions for availing this maternity should be simplified and several arbitrary requirements should be avoided.