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On 4 September, the ministry of women and child development (MWCD) was issued a notice by the Supreme Court questioning its failure to implement the maternal cash entitlement guaranteed in the National Food Security Act, 2013 (NFSA). Section 4 of the NFSA entitles all pregnant and lactating women to Rs6,000, if they are not receiving similar entitlements under another law. The previous government had used an existing pilot of a conditional cash transfer scheme (CCT) to implement this entitlement. A reflection on this approach is required to determine its appropriateness for implementing the NFSA guaranteed maternal cash entitlement.

The Indira Gandhi Matritva Sahyog Yojana

Since 2010, a CCT called the Indira Gandhi Matritva Sahyog Yojana (IGMSY) has been piloted in 53 districts. CCTs provide beneficiaries cash on fulfilment of certain requirements.

The IGMSY aims to improve maternal rest and nutrition, and child health by incentivising appropriate care practices such as ante-natal checks (ANCs), vaccinations and breastfeeding. It is limited to the first two live births of women aged above 18 years. In September 2013, the MWCD revised the IGMSY cash amount from Rs4,000 to Rs6,000, in keeping with the NFSA-defined maternal cash entitlement. While choosing a CCT, the then United Progressive Alliance (UPA) government ignored the fact that for a CCT to be impactful there should be adequate supply of services. In other words the IGMSY will achieve its aims if there is adequate supply of healthcare services, medication, staff and infrastructure in the form of healthcare centres, banks and equipment. Furthermore, women must know about entitlements, conditions and processes.

Status of IGMSY-related services

The nation-wide Rapid Survey on Children 2013-14 (RSOC) conducted by the MWCD and the United Nations Children’s Fund indicates serious shortfalls in the supply of IGMSY-related services. For example, under the IGMSY it is mandatory for mothers to attend three counselling sessions within three months of delivery. The RSOC shows that 65% village child-care centres provide nutrition and health education (NHE) and 61% have ANCs. Awareness about these services is low amongst pregnant women, with 17% aware of NHE and 30% aware of ANCs. Thus, increased service provisioning and awareness building among women is needed.

Shortages also exist in infrastructure and staffing. For instance, RSOC data shows that 28% of village centres do not have functional weighing scales for babies and 48% do not have one for adults. MWCD data indicates that as of March 2014 nearly one-third posts of block-level supervisors and project officers were vacant. Such shortages will likely affect the quality of implementation and monitoring.

IGMSY cash is only paid into a bank or postal account. Distance from banks, inefficient functioning and long waiting hours often require women to forgo multiple days’ wages. Given the inadequate provisioning of healthcare and banking services crucial to the IGMSY, it is premature to implement a conditional maternal cash entitlement. Provisioning and monitoring of the supply of these necessary services is essential, prior to incentivizing demand for them.

What issues do CCTs ignore?

In India, socio-cultural factors prevent women from demanding and accessing adequate health services, rest and nutrition. Due to patriarchal practices, men often make financial decisions in a household. This prevents many women from using IGMSY cash for nutrition and rest during or after pregnancy. CCT also ignores the special attention vulnerable groups require. RSOC data for children aged 12-23 months shows 62% of Scheduled Castes (SC) and 56% of Scheduled Tribes (ST) receive the full set of recommended vaccinations, as compared to nearly 72% of other children (excluding other backward classes).

Need of the hour

The government must recognize that the IGMSY eligibility criteria and conditions contravene the NFSA that entitles all women to a maternal cash entitlement. For this reason it should provide universal and unconditional cash entitlement. Though maternal cash entitlements are necessary, non-financial factors also affect women’s rest, nutrition and health. Community- and family-level interventions are required to reduce women’s work burden. Targeted interventions, which look beyond financial incentivization, are required to address health-service utilization within vulnerable groups.

Finally, there is a need to evaluate if implementing a cash transfer programme has become the end, instead of one of the means to improving maternal and infant health. If the current government ignores non-cash-based initiatives, the effectiveness of cash transfers that it is championing will be undermined and it will render the improvement of maternal and child health an unattainable goal.

Vanita Leah Falcao and Jasmeet Khanuja are, respectively, a researcher with specialization in social-welfare policy and research associate with the Institute of Social Studies Trust

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