Maternal and child mortality is not a new issue for India. As India makes strides towards achieving its Sustainable Development Goals (SDGs), reduction in maternal and child mortality take up the front-seat as crucial indicators of development. Maternal and child healthcare issues are no longer just a policy measure, but the right of every mother and child. Rather, they have taken on a fierier stance with the ever-increasing complications in pregnancy and childbirth. Every pregnancy is different and access to quality antenatal services goes a long way in the detection and treatment of the ensuing complications and concerns that it brings.


The policy-makers have made significant progress in maternal healthcare services through the implementation of several schemes around these issues in the past decade. From the emphasis on institutional deliveries and antenatal care coverage, to making available treatment guidelines and supportive supervision through training initiatives for healthcare professionals at various levels across the country, to putting together outreach platforms such as the Village Health and Nutrition Day (VHND), tremendous thrust is being placed on the betterment of maternal and child healthcare services and facilities in India.


The Premise for A National-Level Movement


Unfortunately, despite the numerous initiatives, the desired maternal and neonatal mortality rates continue to remain a matter of concern with an MMR of 167/1,00,000 live births. Each year approximately 44,000 women still die due to pregnancy-related complications, with around 6.1 lakh infants not living beyond their first 28 days! Malnourishment and lack of vital nutrients during pregnancy, lack of awareness and access to timely medical attention and care are still rife, especially in the rural and economically backward sections of the country, accounting for these high mortality numbers for both mothers and the children born to them. Undoubtedly, addressing this high maternal and infant mortality rate have become a matter of concern and priority for the government.


Recognizing the inextricable connection between maternal health and child mortality and the need for expecting mothers to remain healthy, the GOI has understood that a sound health and nutritional supplementation awareness, improved diet and nutrition during pregnancy and provision of timely health check-ups for the expecting mother at the grass-root levels are the key to ensuring a healthy pregnancy for the mother and a safe delivery to the child.


Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA): The Program


In view of the task at hand, the recent “Pradhan Mantri Surakshit Matritva Abhiyan” launched under the aegis of Hon’ble Prime Minister Shri Narendra Modi’s Ministry of Health and Family Welfare in partnership with UNICEF, is a step towards taking this challenge head-on and improving maternal and child health at a national level.


Launched in June 9, 2016 as part of the Reproductive Maternal Neonatal Child and Adolescent Health (RMNCH+A) Strategy, this program is a national-level campaign that strives to provide free-of-cost, assured and comprehensive antenatal care, including diagnostics and counselling services, universally to all pregnant women. The PMSMA, thus, guarantees a minimum package of quality maternal healthcare services as part of antenatal care in the 2nd/3rd trimesters of pregnancy through a fixed-day strategy, on the 9th of every month across the country at designated government health facilities.


The program also makes a systematic attempt to engage the private sector health practitioners in the campaign strategy development and to motivate them to work as volunteers towards generating awareness and bringing more of the private sector into the gamut of the Abhiyan. Facilitated through a National Portal and a Mobile application, the PMSMA leaves no stone unturned to garner enough engagement from the private/voluntary sector. The “IPledgeFor9” Achievers Awards have specially been devised to acknowledge and celebrate individual and team voluntary contributions for the program in states and districts across India.


  • Objectives

The program has been designed with the objective of improving the quality of care during antenatal visits and ensure that every pregnant woman gets at least one antenatal checkup in the 2nd/3rd trimester by a trained and qualified healthcare specialist. The PMSMA is designed to provide all applicable diagnostic services including early screening and management for existing clinical conditions including malnutrition, counselling around birth planning, identification and complication readiness for high-risk and early pregnancies with a special focus on adolescent pregnancies.


  • Empowering Mothers with Health: Key Benefits


The PMSMA initiative is a mission to empower women with health through proper diagnostic, counselling and care management. It empowers every woman, between their 3rd and 9th month of pregnancy, to approach any government hospital/public healthcare facility/accredited private hospital for free check-ups. In addition, the following centers, too are covered under the PMSMA program:


  • Rural Areas: Rural Hospitals, Sub-district/District Hospitals, Primary Health Centers, Community Health Centers.
  • Urban Areas: Urban Dispensaries, Health Posts, Maternity Homes


In addition, all information about the PMSMA services and the nearest government health facility designated for PMSMA services can also be received by pregnant women and their families through the ANMs/ASHAs/health-workers in their area.


To avail the benefits under the scheme, all beneficiaries require a one-time registration to the program. The registration entitles them to all the services under the PMSMA at the PMSMA Center and they are provided with a Mother and Child Protection Card (MCP Card) and Safe Motherhood booklet. Every beneficiary is mandatorily required to get their MCP cards filled by the ANM/Nurse at the PMSMA clinic. A sticker indicating the condition and risk factor (as under) of the beneficiary are added onto this card at each visit:


  • Green Sticker: No risk factor detected
    • Red Sticker: High-risk pregnancy
    • Blue: Pregnancy-induced hypertension
    • Yellow: Indicative of co-morbid conditions like STIs, hypothyroidism, diabetes, etc.


The following key services and benefits are available as part of the PMSMA program:


  • Examination: This involves taking the height/weight, blood pressure, pulse of the beneficiary, per abdominal examination, fetal heart beat examination by the Staff Nurse/ANM followed by the Medical Officer, before the routine laboratory diagnostics.


  • Lab Investigations: The following lab investigations with proper documentation are covered under the PMSMA program: CBC, hemoglobin, urine albumin, ESR, rapid malaria test, blood grouping, sugar, VDRL, HIV, screening for GDM & other basic investigations.


  • Ultrasonography (USG): All registered PMSMA beneficiaries would receive an USG examination by an Obstetrician, especially during the 2nd/3rd trimester of pregnancy.


  • Immunization & Supplementation: Vaccinations including Tetanus injections, folic acid, iron and calcium supplementation and any other medication prescribed by the Medical Officer are available free-of-cost under this scheme.


  • Counselling: All pregnant women are entitled to receive group counseling (in groups of 10-12) on nutrition, diet, sleep, care during pregnancy, identification of danger signs, regular ANC check-up, birth preparedness, institutional delivery, breastfeeding & post-natal care, post-partum family planning, contraceptives & safe sex, etc. In addition, they are also entitled to counselling about their entitlements and provisions under the Janani Suraksha Yojana (JSY) and Janani Shishu Suraksha Karyakaram (JSSK).


  • Transportation: PMSMA also provisions for state-owned ambulances/Private empaneled ambulances for pregnant women residing in inaccessible areas that lack public transport, those who are very poor or are from vulnerable communities, and for women with high-risk.


  • Coverage for High-risk Pregnancies: One of the critical components of the program involves the identification and follow up of high-risk pregnancies. Pregnant women with a red sticker on their MCP card are given special care and delivery options in a facility with assured emergency obstetric care services.


  • Abortions: PMSMA also covers unwanted pregnancies and provides safe abortion care services following proper counselling.


Participants: Their Roles in PMSMA


  • Professional Associations


As part of the PMSMA, private sector OBGY specialist/Medical Practitioners too are encouraged to volunteer their services and supplement the efforts of the government doctors at government health facilities in their districts on the 9th of every month. To mobilize support from medical associations like FOGSI/IMA/Saathi and Lions/Rotary Club, etc. and sensitize them towards the glaring maternal and infant health issues, the PMSMA recognizes and awards their efforts towards reduction of maternal and neonate death, especially in the high-priority districts. In addition, such professional associations also receive logins to validate the details of their volunteering members.


  • Government Organizations


The government functionaries such as the PMSMA State & District Level Committees, are more deeply associated with the program and support it through:


  • Implementation, planning and program management for logistics, availability of drugs and diagnostics, human resources, space, information dissemination, education and communication, etc.


  • Tracking & monitoring of high-risk pregnancies


  • Encouraging the private sector Obstetricians/physicians to volunteer their services at designated public health facilities through generating awareness, facilitating participation and recognizing their contributions.


  • Ensuring quick grievance redressals


Making a Difference: Surakshit Matritva Abhiyan in Action



Success Factors & Challenges


Like any other program, the PMSMA too is faced with several roadblocks and challenges that it must overcome to succeed. Lack of electricity in rural areas, chronic diseases, lack of infrastructure and mobile ambulances, and the growing instances of high-risk pregnancies bring to the fore immense challenges in the successful implementation of the program.


The role of the social organizations, the mindset of the civil society and an active participation from the private sector are pivotal to its success, especially at the grass-root levels. In addition, the preparation of the government in making the supporting mechanisms such as PHCs and sufficient staff available at the PMSMA facilities would also go a long way in ensuring the success of the scheme.




The PMSMA still has some scope of extending the basic tenets of its program to include a government-sponsored nutritional diet supply and access plan. Grass-root level organizations need to be created, activated and incentivized to extend the program outreach. However, prima-facie it would not be wrong to conclude that if followed through, this initiative holds the promise of ensuring a significant drop in both maternal and infant mortality rates.



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References › Central Government……/pradhan-mantri-surakshit-matritva-abhiyan-pmsma-a-free-c…/air-spotlight-summary-pradhan-mantri-surakshit-matritv