Women in J&K await help under PMMVY months after childbirth: How internet shutdown wrecked efforts to lower infant deaths
The near-six-month-long internet shutdown following the abrogation of Article 370 hit fresh registrations under PMMVY, a scheme crucial to lowering infant deaths in the region as well as disbursal of monetary aid to pregnant women who had already registered for childbirth at hospitals under the scheme
The erstwhile state of Jammu and Kashmir had been particularly looking at expanding the reach of PMMVY to ensure delivery takes place at hospitals, and thus lower the risk of death for both the child and the mother
Incentives provided under the Pradhan Mantri Matru Vandana Yojana (PMMVY) encouraged women to register for childbirth at hospitals as it covered some of the cost of delivery and expenses thereafter
However, during the near-six-month-long internet shutdown following the abrogation of Article 370, fresh enrolment of pregnant women under PMMVY as payments to those already registered was drastically hit
Several pregnant women said that they were either not aware of the scheme or had not received any financial assistance even after registering under the scheme
Twenty-six-year-old Meema Jan gave birth to her first child earlier this month in a crowded ward of the Lal Ded (LD) Hospital, an old and shabby maternal health facility in Srinagar, Kashmir. Although she had registered for cash assistance under the Pradhan Mantri Matru Vandana Yojana (PMMVY) in the month of November, Meema didn't receive any financial aid on time. As a result, her poor husband had to pay for all the expenses at the hospital, right from medicines to food.
Under the PMMVY, pregnant women are provided with cash assistance of Rs 5,000 in instalments to pay for some of the expenses incurred during and after childbirth. Delays in payments under the Central Government scheme have, however, been common in Kashmir. Several pregnant women said that they were either not aware of the scheme or had not received any financial assistance even after registering under the scheme.
During the near-six-month-long shutdown following the abrogation of Article 370, fresh enrolment of pregnant women under the scheme was drastically hit. Payments took a hit as well.
Although 2G mobile internet connectivity has been restored across the state — restricted access to 2G internet was initially resumed only in the districts of Kupwara and Bandipora and was extended to all parts of the Union Territory of Jammu and Kashmir on 25 January — officials say that work on payments is slow due to erratic connectivity and low speed. In many cases, women are made to visit several government offices to receive the assistance promised under the scheme.
Last year in November, Meema's husband, Mohammad Yaseen, had registered for assistance under PMMVY at one of the Anganwadi offices in the outskirts of Kawoosa in Srinagar. He had submitted all her documents including her Aadhaar number but wasn't paid any money at the time of the birth of his first child.
Yaseen, who works as a mason, said that the money could have helped him bear the expenses at the hospital. "I had to spend several thousand rupees at the hospital on food and medicines," he said.
Why is PMMVY crucial for Jammu and Kashmir?
The Union Territory (UT) of Jammu and Kashmir witnesses high infant deaths ever year. Due to inadequate health infrastructure, a number of poor pregnant women from the Valley also die during childbirth. The number of infant deaths registered per thousand births in 2017 was reported to be 23, while as it was 24 in 2016.
Over the years, though infant deaths have witnessed a decline, the infant mortality rate (IMR) is nowhere near the single-digit figures the authorities hope to reach in the next few years. In the erstwhile state of Jammu and Kashmir, the IMR had fallen significantly from 52 in 2006 to 26 in 2015. In 2011, the IMR was 41, it was 39 in 2012, 37 in 2013, 34 in 2014 and 26 in 2015. Overall, India's national average in 2011, 2012, 2013, 2014, 2015 and 2016, respectively, was 44, 42, 40 and 39, 37 and 34.
To reduce the infant deaths further, authorities have been looking at ways to ensure that deliveries are carried out in hospitals to lower the risk of deaths. Incentives provided under the PMMVY encourages women to register for births at the hospital, said a senior health department official.
Under the PMMVY, direct cash is being transferred to the bank accounts of pregnant women to meet their enhanced nutritional needs and compensate them for any wage losses. The benefits are provided in three instalments after the women had registered for delivery at a government hospital.
Internet shutdown cause delays in registrations under PMMVY, payments
However, according to officials, due to months of internet shutdown, the newly created UT is lagging behind in the target set by the Union Ministry of Women and Child Development to enrol new (55,000) women for the cash assistance programme (PMMVY) in the financial year 2019-20. Only 31.5 thousand women have been registered for the scheme till mid-January.
Officials who are overseeing the implementation of the scheme said that the "work of transferring the cash was done only after the online enrolment of the women".
"We couldn't do any work in the month of August due to internet blockade. Though the internet was restored in some of the district offices of the Integrated Child Development Scheme (ICDS), it remained blocked in most parts of Kashmir hitting our work," said Idress Ahmad Wani, officer-in-charge of the PMMVY for Jammu and Kashmir.
"Each month we used to register at least 3,500 to 4,000 beneficiaries and the enrolment has been hit now," he said.
The erstwhile state of Jammu and Kashmir had been particularly looking at expanding the reach of PMMVY as the numbers of infant deaths had remained high in the former state. However, the internet shutdown acted as an additional roadblock and many women who have registered for the scheme are not getting paid.
The government had launched a door-to-door campaign to facilitate enrollment of pregnant women under the PMMVY from 6 to 11 January across the UT of Jammu and Kashmir. "Campaign focuses on enrolment of all eligible beneficiaries through a door to door visit. Matru Shakti Rashtra Shakti," a tweet about the scheme read.
Lack of infrastructure and awareness also responsible
But in both the UTs of Jammu and Kashmir and Ladakh, not all the hospitals are equipped with the facilities to carry out deliveries due to which pregnant women from rural areas are shifted to the LD Hospital in Srinagar city for childbirth.
Women from different parts of Kashmir where maternal healthcare facilities do not exist travel to the LD Hospital for childbirth.
Mubeena, 25, is one such woman. She had travelled several kilometres from her house at Qazibagh in Budgam to Srinagar for delivery. She said that the doctors referred her from the district hospital in Budgam to LD Hospital saying that they lacked the facilities to handle her delivery nearer home. She too didn't receive any aid under PMMVY on the delivery of her child even though she had registered for the programme in the second month of her pregnancy.
Authorities said that the facilities to carry out deliveries have been expanded to the village level in some districts to reduce infant deaths. "We have some 19 designated delivery points including at the sub-district and primary health centre level. In some areas which are hard to reach, we have even designated a sub-centre as a delivery point where the delivery cases could be handled," said Fazil Kochak, Chief Medical Officer of Kulgam district.
He said that besides the assistance that is being provided under the PMMVY, " for every institutional delivery we transfer Rs 1,400 into the accounts of rural women and for urban women we give Rs 1,000 under the Janani Suraksha Yojana (JSY)".
A senior official posted with the National Health Mission (NHM) here said that they are looking at "reducing the IMR in the Jammu and Kashmir to single-digit numbers by 2022 and the schemes like the PMMVY would help achieve those numbers".
Wani said that under PMMVY rural women are encouraged to go for regular checkups at the hospitals and the money is provided in the three instalments. "For the first single childbirth, we provide Rs 1,000 after the woman had registered at the nearest Anganwadi centre and then we provide her Rs 2,000 after six months of pregnancy and then Rs 2,000 after three months of immunisation of the child. This is apart from the assistance that women get from the health department. The idea is to increase institutional deliveries and to prevent deaths," he said.
But lack of awareness remains a problem. Shugufta, 34, said that she was not even aware of PMMVY. A resident of Budoobagh area of Khanayar in Srinagar, she said, "None from the government officials told me about the scheme. None at the hospital at LD told me about it."
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