India's efforts towards improving maternal healthcare: a narrative review of government maternal health schemes

Raksha Yadav; Latha Venkatesan; Rajlaxmi Mundhra; Hemlata

doi:10.18203/2394-6040.ijcmph20263243

Authors

Raksha Yadav College of Nursing, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
Latha Venkatesan College of Nursing, All India Institute of Medical Sciences, New Delhi, India
Rajlaxmi Mundhra Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
Hemlata College of Nursing, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India

DOI:

https://doi.org/10.18203/2394-6040.ijcmph20263243

Keywords:

Maternal health schemes, Maternity benefit schemes, Maternal health programs, India, Sustainable development goals

Abstract

Maternal mortality is still a major public health concern. India stands second across the globe in absolute maternal deaths. Even though the country has reduced the maternal mortality ratio (MMR) from 570 in 1990 to 97 per 100,000 live births in 2020. The present narrative review traces the evolution of centrally sponsored Government of India maternal health schemes from 1952 to 2019, and examines their objectives, key interventions and outcomes against the national targets and sustainable development goal (SDG) 3. Literature was identified from PubMed/MEDLINE, Scopus, google scholar and the Cochrane library and supplemented by government policy documents, NFHS data and WHO/UNICEF reports and synthesized narratively in chronological order. From the family planning programme (1952) to the launch of SUMAN scheme in 2019, several schemes have strengthened the maternal health continuum of care in India. JSY and JSSK have significantly increased institutional delivery (41% in 2005 to 88.6%, NFHS-5) and reduced out of pocket expenditure. Continued persistence of socioeconomic inequities, disparities and urban–rural gaps limit universal coverage of maternal health schemes in India. India’s estimated 2023 MMR of 116 which means it is off track to meet the SDG 3.1 target of below 70 by 2030. India’s maternal health policy architecture is characterised by sustained government commitment. but equity-focused implementation, demand-side interventions and evidence-based programme refinement are crucial to achieving zero preventable maternal deaths.

References

Jelly P, Sharma SK, Saxena V, Sharma R. A Comprehensive Review of Causes and Determinants of Maternal and Infant Mortality in Uttarakhand. J Health Management. 2023;25(2):291-8.

Singh G, Chouhan R, Sidhu K. Maternal Factors for Low Birth Weight Babies. Med J Armed Forces India. 2009;65(1):10-2.

UNICEF Data. Trends in Maternal Mortality 2000 to 2020. 2015. Available at: https://iris.who.int/bits tream/handle/10665/366225/9789240068759-eng. pdf?sequence=1. Accessed on 15 May 2026.

Baten A, Biswas RK, Kendal E, Bhowmik J. Utilization of maternal healthcare services in low- and middle-income countries: a systematic review and meta-analysis. Systematic Reviews. 2025;14(1):88.

World Health Organization. Maternal mortality 2025. Available at: https://www.who.int/news-room/fact-sheets/detail/maternal-mortality. Accessed on 15 May 2026.

UNICEF Data. Trends in Maternal Mortality: 1990 to 2015. Available at: https://www.google.com/url? sa=t&source=web&rct=j&opi=89978449&url=https://data.unicef.org/wp-content/uploads/2015/12/ Trends-in-MMR-1990-2015_Full-report_243.pdf& ved=2ahUKEwj9kPOjopSHAxVyV2wGHUA7DR8QFnoECDUQAQ&usg=AOvVaw3E9gPoOVxcQcKkhvEij5B9. Accessed on 15 May 2026.

NITI Aayog. SDG India Index Baseline report. 2018. Available at: https://www.niti.gov.in/sites/default/ files/2020-07/SDX_Index_India_Baseline_Report_ 21-12-2018.pdf. Accessed on 15 May 2026.

Say L, Chou D, Gemmill A, Tunçalp Ö, Moller AB, Daniels J, et al. Global causes of maternal death: a WHO systematic analysis. Lancet Glob Health. 2014;2(6):e323-33.

Office of the Registrar General and Census Commissioner India. Cause of death statistics 2017-19. 2023. Available at: https://censusindia.gov.in/ nada/index.php/catalog/44752. Accessed on 15 May 2026.

India - Child Survival and Safe Motherhood Project (English). Washington, D.C.: World Bank Group. Available at: http://documents.worldbank.org/curat ed/en/783261468041992204/India-Child-Survival-and-Safe-Motherhood-Project. Accessed on 15 May 2026.

National Health Mission. Mission Parivar vikas. Available at: https://nhm.gov.in/images/pdf/prog rammes/family-planing/guidelines/MPV/MPV_guid elines.pdf. Accessed on 15 May 2026.

Sharma M. Child survival and safe motherhood. Indian J Public Health. 1992; 36(4):138-46.

Mavalanker DV. Review of the safe motherhood programme in India in the context of reproductive health: Achievements, issues and challenges. IIMA Working papers. 1999. Available at: http://vslir. iima.ac.in:8080/xmlui/bitstream/handle/11718/487/WP percent201999_1495.pdf?sequence=1&isAllow ed=y#:~:text. Accessed on 15 May 2026.

Implementation of Reproductive and Child Health Programme under Nation Rural Health Mission . Ministry of Health and Family Welfare; 2014. Available at: https://pib.gov.in/newsite/PrintRele ase.aspx?relid=108357. Accessed on 15 May 2026.

National Family Health Survey (NFHS-3) 2005-2006. Available at: https://dhsprogram.com/pubs/pdf /SR128/SR128_updated_09-22-2015.pdf. Accessed on 15 May 2026.

Comptroller and auditor general of India. Services under reproductive and child health (RCH). Report No. 25, 2017. Available at: https://cag.gov.in/uploa ds/download_audit_report/2017/Chapter_7_-_Services_under_Reproductive_and_Child_Health_(RCH)_of_Report_No.25_of_2017_Performance_audit_Union_Government_Reproductive_and_Child_Health_under_National_Rural_Health_Mission_Reports_of_.pdf. Accessed on 15 May 2026.

National Health Mission. Programme design for the RCH 2 PIP review. 2021. Available at: https://nhm. gov.in/images/pdf/monitoring/joint-review-mission/jrm-8-aide-memoire.pdf. Accessed on 15 May 2026.

World Bank Group. Data. Available at: https://data.worldbank.org/indicator/SP.DYN.TFRT.IN?locations=IN&view=chart. Accessed on 15 May 2026.

Ministry of health and family welfare. Janani Suraksha yojna: Features & frequently asked questions and answers. Available at: https://nhm. gov.in/WriteReadData/l892s/97827133331523438951.pdf. Accessed on 15 May 2026.

Janani shishu Suraksha karyakaram (JSSK). Available at: https://www.nhm.gov.in/index4.php ?lang=1&level=0&linkid=150&lid=171. Accessed on 15 May 2026.

National health mission. NHM. Available at: https://nhm.gov.in/index4.php?lang=1&level=0&linkid=445&lid=38. Accessed on 15 May 2026.

National health mission. Reproductive, Maternal, Newborn, Child, Adolescent Health and Nutrition (RMNCAH+N). Available at: https://nhm.gov.in/ index1.php?lang=1&level=2&sublinkid=822&lid=218. Accessed on 15 May 2026.

Maternal health division Ministry of health and family welfare. DAKSHATA: Empowering providers for improved MNH care during institutional deliveries operational guidelines. 2015. Available at: https://nhm.gov.in/WriteReadData/ l892s/81164783601523441220.pdf. Accessed on 15 May 2026.

Ministry of health and family welfare. Update on Kilkari Scheme. 2024. Available at: https://pib.gov. in/PressReleaseIframePage.aspx?PRID=2004362. Accessed on 15 May 2026.

National health mission. Pradhan Mantri Surakshit Matritva Abhiyan. Available at: https://nhm.gov.in/ index1.php?lang=1&level=3&sublinkid=1308&lid=689#:~:text. Accessed on 15 May 2026.

National health mission. Mothers absolute affection. Available at: https://nhm.gov.in/images/pdf/ Nutrition/MAA-Guidelines/Operational_Guidelines-MAA.pdf. Accessed on 15 May 2026.

Ministry of women and child development. Beti bachao beti pdhao operational manual. Available at: https://wcd.nic.in/sites/default/files/. Accessed on 15 May 2026.

Ministry of women and child development. Pradhan mantri matru Vandana yojana (PMMVY). Available at: https://www.myscheme.gov.in/schemes/pmmvy. Accessed on 15 May 2026.

National health mission. Labour room & quality improvement initiative. Available at: https://nhm. gov.in/index1.php?lang=1&level=3&sublinkid=1307&lid=690. Accessed on 15 May 2026.

NITI Aayog. Transforming nutrition in India: POSHAN Abhiyan. Available at: https://www. niti.gov.in/sites/default/files/2020-02/POSHAN_ Abhiyaan_first_progress_report_6_Feb_2019.pdf. Accessed on 15 May 2026.

Ministry of health and family welfare. Anemia mukt Bharat Operational guidelines. 2018. Available at: https://nhm.gov.in/images/pdf/Nutrition/AMB-guidelines/Anemia-Mukt-Bharat-Operational-Guidelines-FINAL.pdf. Accessed on 15 May 2026.

National Health Authority. Ayushman Bharat. Available at: https://nha.gov.in/PM-JAY. Accessed on 15 May 2026.

National Health Mission. Surakshit Matritva Aaswasan operational guidelines. Available at: https://nhm.gov.in/New_Updates_2018/NHM_Components/RMNCHA/MH/Guidelines/SUMAN percent20Guideline percent202020 percent20Web percent20Version.pdf. Accessed on 15 May 2026.

Raina N, Khanna R, Gupta S, Jayathilaka CA, Mehta R, Behera S. Progress in achieving SDG targets for mortality reduction among mothers, newborns, and children in the WHO South-East Asia Region. Lancet Reg Health Southeast Asia. 2023;18:100307.

Arora P. Maternal Mortality - Indian Scenario. Med J Armed Forces India. 2005;61(3):214-5.

Menon A, Arora P. Maternal health: Challenges and the way forward. Med J Armed Forces India. 2021;77(2):121-4.

UNICEF India. Maternal health. Available at: https://www.unicef.org/india/what-we-do/maternal-health. Accessed on 15 May 2026.

Singh NP, Jain PK, Saxena D, Takhelchangbam ND, Singh A. Hospital-Based Retrospective Cross-sectional Study to Analyse the Causes of Maternal Deaths at a Tertiary Health Care Facility. J Fam Med Prim Care. 2022;11(8):4603.

Mweemba C, Mapulanga M, Jacobs C, Katowa-Mukwato P, Maimbolwa M. Access barriers to maternal healthcare services in selected hard-to-reach areas of Zambia: a mixed methods design. Pan Afr Med J. 2021;40(4).

International Institute for Population Sciences (IIPS), ICF. National Family Health Survey (NFHS-5), India, 2019–21. Mumbai: IIPS; 2021. Available at: https://dhsprogram.com/pubs/pdf/FR375/FR375.pdf. Accessed on 15 May 2026.

Gupta SK, Pal DK, Tiwari R, Garg R, Shrivastava AK, Sarawagi R, et al. Impact of Janani Suraksha Yojana on institutional delivery rate and maternal morbidity and mortality: an observational study in India. J Health Popul Nutr. 2012;30(4):464-71.

Bhushan H, Ram U, Scott K, Blanchard AK, Kumar P, Agarwal R, et al. Making the health system work for over 25 million births annually: drivers of the notable decline in maternal and newborn mortality in India. BMJ Glob Health. 2024;9(Suppl 2):e011411.

Manna S, Singh D, Ghosal S, Rehman T, Kanungo S, Pati S. Out-of-pocket expenditure and its correlates for institutional deliveries in private and public healthcare sectors in India: findings from NFHS 5. BMC Public Health. 2023;23(1):1479.

Singh M, Sonkaria LK, Raghav P. Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA): new initiative to deliver quality maternal health care in India. MOJ Womens Health. 2017;4(2):37-8.

Dandona R, Majumder M, Akbar M, Bhattacharya D, Nanda P, Kumar GA, et al. Assessment of quality of antenatal care services in public sector facilities in India. BMJ Open. 2022;12(12):e065200.

Singh S, Hasan Z, Sharma D, Kaur A, Khurana D, Shrivastava JN, et al. Appraising LaQshya's potential in measuring quality of care for mothers and newborns: a comprehensive review of India's Labor Room Quality Improvement Initiative. BMC Pregnancy Childbirth. 2024;24(1):263.

Tolani H, Bandyopadhyay Neogi S, Pandey AK, Khan PK, Mishra SS. Contributing factors for reduction in maternal mortality ratio in India. Sci Rep. 2024;14(1):14883.

Bango M, Ghosh S. Social and regional disparities in utilization of maternal and child healthcare services in India: a study of the post-National Health Mission period. Front Pediatr. 2022;10:980177.

Sk MI, Paswan B, Anand A, Mondal NA. Praying until death: revisiting three delays model to contextualise the socio-cultural factors associated with maternal deaths in a region with high prevalence of eclampsia in India. BMC Pregnancy Childbirth. 2019;19(1):314.

Raina N, Khanna R, Gupta S, Jayathilaka CA, Mehta R, Behera S. Progress in achieving SDG targets for mortality reduction among mothers, newborns, and children in the WHO South-East Asia Region. Lancet Reg Health Southeast Asia. 2023;19:100307.

GBD 2023 Causes of Death Collaborators. Global burden of 292 causes of death in 204 countries and territories and 660 subnational locations, 1990-2023: a systematic analysis for the Global Burden of Disease Study 2023. Lancet. 2025;406(10513):1811-72.

GBD 2023 Causes of Death Collaborators. Global burden of 292 causes of death in 204 countries and territories and 660 subnational locations, 1990-2023: a systematic analysis for the Global Burden of Disease Study 2023. Lancet (London, England). 2023;406(10513):1811-72.

GBD 2023 Causes of Death Collaborators. Global burden of 292 causes of death in 204 countries and territories and 660 subnational locations, 1990-2023: a systematic analysis for the Global Burden of Disease Study 2023. Lancet. 2025;406(10513):1811-72.