Widespread consequences of poor maternal health in India
Health, well-nourished mothers are more likely to raise healthy, well-nourished children. This is in part because women provide nutrition to their children both in the womb and during breastfeeding. In fact, women’s bodies provide much of the nourishment for growing children during the crucial first 1,000 days of life, when the course of their physical and cognitive development is determined. Thus a mother’s net nutrition has large effects on her child’s early-life human capital accumulation.
Unfortunately, India, which is home to one fifth of the world’s births, has no monitoring system to track maternal nutrition indicators such as pre-pregnancy body mass and weight gain during pregnancy. Further, there is no monitoring system that allows us to say how many babies are born at low birth weights. However, evidence suggests that India, despite its economic progress, has among the highest rates of low birth weight in the world. One way that we know that birth weights are so low is that in India, a large number of babies die in the first month of life. A national survey has shown that low birth weight is the leading cause of these deaths. Poor maternal nutrition is a major cause of low birth weight.
There is a large body of research demonstrating the adverse impacts of low birth weight on long run outcomes such as cognitive ability, schooling, wages, and adult health and productivity. This suggests that mothers in India were healthier and better nourished, economic productivity and human welfare would improve as well. Despite the importance of nutrition during pregnancy, recent r.i.c.e. research on maternal nutrition in India finds that over 40% of pre-pregnant women are underweight, and that weight gain in pregnancy is inadequate for fetal growth.
Government programs are not doing enough to address poor maternal health
Janani Suraksha Yojana (JSY)
India’s largest program for improving neonatal health and preventing neonatal deaths does not focus on improving maternal nutrition, and improving birthweight but rather on encouraging women to give birth in hospitals. The JSY scheme has used cash incentives to increase the number of births in hospitals, but neonatal and maternal mortaliy have not improved as a result. A recent r.i.c.e. study found that the JSY cash transfer to new mothers is actually much less than the government advertises because much of it is used to pay for deliveries, which are supposed to be free. Like many other studies of the JSY program, this study also finds that women receive abysmal health care both before and during delivery, and are often mistreated at the hospital.
Integrated Child Development Services (ICDS)
The ICDS is a program that is intended to give food to pregnant women and young children. However, the program is very poorly implemented, especially in the states with the most undernourished women. Thus, it has done little to improve maternal nutrition. Less than 30% of women received any food supplements from the government’s ICDS program during their last pregnancy, despite the fact that ICDS is intended to be universal.
What is r.i.c.e. doing now?
The r.i.c.e. team produces policy relevant research about maternal and child health in India. We have written about the scope of maternal undernutrition, and the failures of the JSY program. We have also written about the poor status of young women in India society, which contributes to poor maternal nutrition, and to low birth weight.
We are currently investigating and working with other organizations to develop policy recommendations about maternity entitlements, a cash transfer program for pregnant women that was written into the National Food Security Act (NFSA). At present, these and other programs in the NFSA are not being implemented. If the government does implement maternity entitlements, the details will matter. It will be difficult to deliver entitlements to pregnant women, and it will be difficult to encourage households to spend this money to improve the nutrition of pregnant women. But we believe that implementing this program and getting the details right is of the utmost importance: India’s high rates of neonatal mortality and child stunting, and all of the lost human potential that these statistics represent demand much more attention than they currently receive.
In the future we hope to advocate for national level monitoring of maternal and infant health.