Government-Led Programs to Improve Maternal and Infant Health in India: a Systematic Review of Literature

Abstract

India has unacceptably high maternal and neonatal mortality rates (174 per 100,000 and 28 per 1000, respectively) due to lack of antenatal care, unskilled delivery, and poor access to emergency obstetric services. To meet the United Nation’s 2015 Millennium Development Goals, the government of India (GOI) implemented several programs to improve access to maternal healthcare services. The purpose of this systematic review is to synthesize and critically appraise the literature on government-led programs to improve maternal and infant health in India. Database searches were conducted in PubMed, Scopus, Medline, EBSCO, Cochrane Library, and CINAHL using key terms such as India, Indian women, Asian Indian, maternal care, antepartum care, postpartum care, skilled delivery attendance, rural healthcare access, and prenatal care. Articles published from January 1, 2002 to January 31, 2016 were included. Reviewers critically appraised the 32 qualifying articles using the Qualitative Assessment Review Instrument (QARI). Analysis of the literature identified one of the premier initiatives implemented in 2005 by the GOI, the Janani Suraksha Yojana (JSY) program. JSY uses conditional cash transfers for institutional delivery and employs Accredited Social Health Activists (ASHA) to promote maternal care in each India state. Studies show that programs have had minimal positive effect on maternal mortality rates (MMR), and the infrastructure of these healthcare systems is not ready to support a high level of quality of care. In conclusion, the GOI has made considerable effort to improve access to maternal care. Areas that need improvement include health promotion, infrastructure, and quality of care.