The Indira Gandhi Matritva Sahyog Yojana (IGMSY) Scheme is a special intervention designed to target pregnant and lactating mothers on a pilot basis. Reaching out to pregnant and lactating mothers and ensuring implementation and monitoring would be a challenging task.
The Scheme “Indira Gandhi Matritva Sahyog Yojana (IGMSY)” – Conditional Maternity Benefit(CMB) Scheme would be implemented through the platform of Integrated Child Development Services(ICDS) Scheme. The focal point of implementation would be the Anganwadi Centre(AWC) at the village.
Committees for steering and monitoring would be set up to oversee the effective implementation of the scheme at all levels. States may decide the necessity of Steering and Monitoring Committees as one or two separate Committees. The Committees would consist of heads of health, NRHM, Water and Sanitation, Rural Development and Panchayati Raj Institutions besides Planning and Finance. States may have additional members as deemed necessary.
At the State, District and grassroots level, the scheme would be implemented through ICDS infrastructure. At the State and District levels, the State/District ICDS Cell would be responsible for the implementation of the IGMSY, while at the grassroots level, the ICDS Project lead by the Child Development Project Officer (CDPO) and the AWC would be responsible for the implementation of the scheme. In order to ensure effective implementation of IGMSY, as a special intervention, additional staff of two personnel : one coordinator and one programme assistant would be provided in every State and District ICDS Cell.
Main Objectives of the Scheme
- To improve the health and nutrition status of pregnant & lactating women and infants by:
- Promoting appropriate practices, care and service utilisation during pregnancy, safe delivery and lactation;
- Encouraging the women to follow (optimal) IYCF practices including early and exclusive breast feeding for the first six months;
- Contributing to better enabling environment by providing cash incentives for improved health and nutrition to pregnant and lactating mothers.
Target Group of the Scheme
- Pregnant Women of 19 years of age and above for first two live births (benefit for still births would be as per the guidelines of scheme)
- All Government/PSUs (Central & State) employees would be excluded from the scheme as they are entitled for paid maternity leave.
Coverage
Geographical Coverage : The scheme would be implemented as a pilot project. In order to ensure national coverage and diversity of implementation experiences, IGMSY would be piloted in 52 identified districts amongst all the States/UTs across the country. Out of these 52 districts, 11 each are selected from good and weak performing districts, 26 from medium performing districts and 4 are UTs. A mix of good performing, poor performing and medium performing districts have been selected to test check the success of implementation viz-a-viz. demand and supply. The districts have been selected from across the country based on six indicators which are available from DLHS-3. These were given equal weightages. The indicators are :-
- Percent literate Female Population (Age 7+),
- Mothers registered in the first trimester when they were pregnant with last live birth/still birth (%),
- Mothers who had at least 3 Ante-Natal care visits during the last pregnancy (%),
- Institutional births (%),
- Children (12-23 months) fully immunized (BCG, 3 doses each of DPT, and Polio and Measles) (%) and
- Children breastfed within one hour of birth (%).
The beneficiaries: Pregnant and lactating women In order to estimate the number of pregnant and lactating women that would be covered under the IGMSY, the surveyed population of P & L Women under ICDS(225 lakh) has been taken into consideration. 75 % percent of women in the 52 selected districts have been estimated to avail benefits initially under IGMSY, since it is a self selecting scheme. Based on these calculations, the scheme would cover around 13.8 lakh pregnant and lactating women from these 52 selected districts.
The rationale and benefits of the conditions can be explained as under:
A. Care during pregnancy and delivery: The focus of IGMSY is to improve nutritional and health status of pregnant and lactating women across the country by partly compensating for their wage loss and encouraging increased access to supplementary nutrition under ICDS Scheme.
a) Early Identification and Registration of pregnancy: Early registration of pregnancy is essential for availing facilities offered by the health care services to assess the health and nutritional status of the pregnant woman. It also helps to screen for complications early in the pregnancy. Early identification and registration of pregnancy is being promoted by the Government of India primarily through National Rural Health Mission (NRHM) and Janani Suraksha Yojana (JSY). IGMSY would also facilitate early registration of pregnancies in target districts through conditional cash transfer. Although, registration of pregnancy should ideally be within two months, under IGMSY registration within four months of pregnancy would be the first milestone for receiving cash benefits of Rs.1500/- at the end of second trimester. Every registered mother under the IGMSY would have a Mother and Child Protection Card. Early registration at the AWC would also ensure that the woman gets the benefit of Supplementary Nutrition(SNP) and regular counseling under ICDS during the pregnancy. The woman should have attended at least one counseling session at the AWC or VHND for the condition to be fulfilled.
b) Antenatal Care (ANC): During the ANC at the health center, vital milestones of pregnancy are noted. Ideally, apart from the ANC at registration, three ANCs are necessary and are mandated under NRHM. Periodic antenatal check-ups help in early detection, management of complications, timely advice and appropriate referral. This can help improve maternal and neonatal survival. ANC is a key entry point for a pregnant woman to receive a broad range of health promotion and preventive health services, including nutritional support and prevention and treatment of anemia and other infectious diseases associated with reproductive health Under the NRHM, the Village Health and Nutrition Day (VHND) is organized once every month at the AWC in the village. On this day, AWWs, ASHAs and other health workers mobilize the villagers, especially women and children, to assemble at the AWC. The ANM and other health personnel are also required to be present at AWC on this day to provide maternal health care to pregnant women from the community.
ASHA and other health workers should ensure that every pregnant woman registered under the IGMSY receives the required ANCs. In order to receive the cash benefits under the IGMSY, every pregnant mother would have to mandatorily attend at least one ANC. Monthly supply of Iron and Folic Acid (IFA) tablets would be given to every pregnant woman at the AWC or Health centre or during ANC during this period, along with tetanus vaccination due. Nutrition and health education would also be carried out by the AWW and the health functionary who would also facilitate the above services to the beneficiary. The details of the services availed would be duly recorded in the Individual Mother and Child Protection Card common to ICDS and NRHM.
c) Institutional Delivery: One of the accepted strategies for reducing maternal mortality is to promote deliveries at health institutions by skilled personnel like doctors and nurses. The Janani Suraksha Yojana (JSY) provides cash assistance for Institutional Delivery. The benefits under JSY are linked to pregnant women getting the delivery conducted in health centres / hospitals. [Early initiation of breast feeding and colostrum feeding may also be ensured]. No cash transfer has been envisaged under IGMSY at the time of delivery since it is covered under JSY.
B. Infant Care
d) Immunization: Immunization of pregnant women and infants protects children from six vaccine preventable diseases - poliomyelitis, diphtheria, pertussis, tetanus, tuberculosis and measles. These are major preventable causes of child mortality, disability, morbidity and related malnutrition. Immunization of pregnant women against tetanus also reduces maternal and neonatal mortality. This service is delivered by the Ministry of Health and Family Welfare under its Reproductive Child Health (RCH) programme. In addition, the Iron and Vitamin "A" Supplementation to children and pregnant women is done under the RCH Programme of the Ministry of Health and Family Welfare. Recognizing the fact that malnutrition and the cycle of illhealth often starts with the mother, IGMSY would strive to ensure the optimal immunization of every pregnant woman in close collaboration with the health workers. The scheme would also ensure accessing provisions for counseling, iron and folic-acid supplements that are vital for the health of both the mother and the child.
e) Growth Monitoring: Growth monitoring consists of routine weighments & watching developmental milestone to observe pattern of growth, combined with preventive action when deviations are detected. Under the ICDS Scheme, growth monitoring of children is one of the important activities. Children under three are weighed once a month and children 3-6 years of age are weighed quarterly. Mother and Child Protection Cards are provided to mothers to track the nutritional status, immunization schedule and developmental milestones for both the child and the pregnant and lactating mothers. Through discussion and counseling, growth monitoring also increases the participation and capabilities of families to understand and improve childcare and feeding practices.
It helps families understand the linkage between child growth and the dietary intake, health care, safe drinking water and environmental sanitation etc. Keeping the importance of the growth monitoring in view, it would be mandatory for all the IGMSY beneficiaries to regularly attend the growth monitoring sessions at the AWCs. The AWWs would be responsible for maintaining the weight-for-age growth charts for all infants and young children as per WHO Child Growth Standards included in the Mother and Child Protection Card. This condition would contribute towards improving health and nutrition seeking behaviour.
f) Infant and Young Child Feeding (IYCF): IYCF is a critical care practice that can accelerate child survival and development. Research studies (LANCET, 2004) around the world highlight that globally, the universal practice of exclusive breastfeeding for the first six months of life reduces young child mortality by 13 %. Together, universal optimal IYCF practices can prevent around one-fifth of young child mortality in India. The promotion of colostrum feeding is critical because it is the baby’s first immunization, ideal nutrition for the newborn that builds resistance to infection, aids recovery from infection and accelerates growth. This would ensure and encourage: a) Colostrum feeding; b) Initiation of breastfeeding within one hour of birth; c) Exclusive breastfeeding for the first six months; d) Introduction of appropriate complementary feeding at six months along with continued breast feeding for two years.
C. Registration of birth of the child, immunization (as per details given in above para 3.2), attending at least 2 growth monitoring and IYCF counseling sessions within 3 months of delivery would be the second milestone for receiving cash benefits of Rs.1500/- under the scheme after three months of delivery.
D. The milestone under IGMSY for receiving cash benefit of Rs. 1000/- after six months of birth of the child by ensuring exclusive breastfeeding for six months and introduction of complimentary feeding as certified by the mother and the child receiving OPV and DPT at 14 weeks along with attending at least 2 growth monitoring session of the child and IYCF counseling sessions by the mother between 3rd and 6th months of delivery.
Incentives to Anganwadi Workers (AWWs) and Helpers (AWHs):
AWW would receive a cash incentive of Rs.200/- per pregnant and lactating woman after all the due cash transfers to the beneficiary is complete. Similarly, a cash incentive of Rs.100/- would be provided to AWH per beneficiary. This would ensure effective implementation of the scheme, since the cash incentives would act as a catalyst to motivate the AWW and AWH to service the beneficiaries efficiently and also encourage more women to participate in the scheme.
Funding pattern and Functional Responsibilities
- IGMSY is a centrally sponsored scheme which would be implemented through the State ICDS Cells with 100 % financial assistance from the Ministry of Women and Child Development. The day to day implementation and administrative matters would be the responsibility of the State Government.
- All financial powers at the State level would be vested in the concerned State Secretary responsible for ICDS implementation who would be assisted by the State ICDS Cell. Every State and District ICDS Cell would open and maintain a separate special bank account for IGMSY transactions. Every ICDS Project also
- would open such a special bank account in a nationalized bank and maintain separate accounts.
