Seven years of Surakshit Matritva Aashwasan: a narrative review of implementation and outcomes

Abstract

The Surakshit Matritva Aashwasan (SUMAN) initiative was launched by India's Ministry of Health and Family Welfare on 10 October 2019. The major objective was to convert maternal and newborn health entitlements into an assured, zero-cost service guarantee with zero tolerance for denial of care. Databases like PubMed/MEDLINE, Scopus, Web of Science, CINAHL, Embase, DOAJ and Google Scholar were searched to carry out this narrative review. This was futher supplemented by government guidelines, Sample Registration System bulletins, and National Family Health Survey rounds three to six. All relevant data and documents published between October 2019 and September 2026 were pooled together to synthesise evidence on SUMAN's design, implementation, and outcomes. SUMAN converges existing maternal health schemes under one charter, but facility notification has proceeded unevenly. India's Maternal Mortality Ratio, already declining before SUMAN's launch (327 in 1999-2001 to 130 in 2014-16). It fell further to 97 in the year 2018-20. Institutional deliveries rose from 78.9% to 90.6% (NFHS-4 to NFHS-6). Respectful maternity care remains inconsistent. Pooled prevalence of disrespect and abuse during childbirth has been estimated between 54.5% and 85% across studies, birth companionship is merely provided despite LaQshya guidelines. Also, beneficiary awareness of SUMAN itself remains low. SUMAN represents a coherent policy architecture for assured maternal and newborn care. However, impact evaluation remains scarce, and implementation and respectful-care gaps warrant sustained monitoring and targeted research.