Pradhan Mantri Surakshit Matritva Abhiyan

 As India strives towards achieving the Sustainable Development Goals (SDGs) and looks ahead to the post - 2015 era, progress in reducing maternal mortality becomes an important frontier. Every pregnancy is special and every pregnant woman must receive special care. Any pregnant woman can develop life-threatening complications with little or no advance warning, so all pregnant women need access to quality antenatal services to detect and prevent life- threatening complications during childbirth.

With the implementation of several schemes, significant progress was observed in the maternal health care service indicators like institutional deliveries and Ante Natal Care (ANC) coverage. As per latest data of the Rapid Survey on Children (2013 - 14), the institutional deliveries in India are 78.7%. Inspite of this massive increase in the number of pregnant women coming to institutions for delivery, till date only 61.8% women receive first ANC in first trimester (RSOC) and the coverage of full ANC (provision of 100 IFA tablets, 2 tetanus toxoid injections and minimum 3 ANC visits) is as low as 19.7 % ( RSOC ).

Despite availability of treatment guidelines, mechanisms for monitoring and supportive supervision, regular training of health care providers at different levels across the country and the existence of outreach platforms like Village Health and Nutrition Day (VHND), the desired coverage and quality of maternal health services is still a matter of concern. Maternal mortality with MMR of 167 per 1,00,000 live births still remains high even with improved access to maternal health care services. Timely detection of risk factor during pregnancy and childbirth can prevent deaths due to 5 preventable causes. This can only be possible if the complete range of the required services is accessed by the pregnant women.

With the objective to provide quality ANC to every pregnant woman the Government of India has launched the Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA), a fixed day ANCs given every month across the country. This is to be given in addition of the routine ANC at the health facilit.

About the campaign

Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA) is a fixed day strategy, every month across the country during which a range of quality maternal health services are envisaged to be provided as part of Antenatal Care.

Under the campaign, a minimum package of antenatal care services is to be provided to the beneficiaries on the 9th day of every month at the Pradhan Mantri Surakshit Matritva Clinics to ensure that every pregnant woman receives at least one checkup in the 2nd/ 3rd trimester of pregnancy. If the 9th day of the month is a Sunday / a holiday, then the Clinic should be organized on the next working day.

Target beneficiaries

The programme aims to reach out to all Pregnant Women who are in the 2nd & 3rd Trimesters of pregnancy.

Public Health Facilities to access services under PMSMA

• Rural Areas - Primary Health Centers, Community Health Centers, Rural Hospitals, Sub - District Hospital - District Hospital - Medical College Hospital
• Urban Areas - Urban Dispensaries, Urban Health Posts, Maternity Homes

Provision of services during PMSMA

• All the beneficiaries visiting the Facility are first registered in a separate register for Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA).
• After registration, ANM & SN ensures that all basic laboratory investigations are done before the beneficiary is examined by the OBGY /Medical Officer. The report of the investigations should ideally be handed over within an hour and before the beneficiaries are meeting the doctors for further checkups. This will ensure identification of High Risk status (like anemia, gestational diabetes, hypertension, infection etc.) at the time of examination and further advice. In certain cases, where additional investigations are required, beneficiaries are to be advised to get those investigations done and share the report during next PMSMA or during her routine ANC check - up visit.
• Lab Investigations - USG, & all basic investigations – Hb , Urine Albumin, RBS (Dip stick), Rapid Malaria test, Rapid VDRL test, Blood Grouping, CBC ESR, USG

Following are details of specific services which will be provided during Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA) :

• A detailed history of all the beneficiaries needs to be taken and then examined and assessed for any danger signs, complications or any high risk status.
• Blood Pressure, per abdominal examination and examination for fetal heart sounds should be done for all the beneficiaries coming for ANC check - up.
• If a woman visiting a public health facility requires a specific investigation, sample should be collected at the facility itself and transported to the appropriate centre for testing. ANM/ MPW should be responsible for transporting the collected sample, conveying the results to the pregnant women and appropriate follow up
• After examination by ANM/Staff Nurse, Medical Officer to also examine and attend to every beneficiary attending PMSMA .
• All identified high risk pregnancies should be referred to higher facilities and JSSK help desks that have been set up at these facilities should be responsible for guiding the referred women once they reach the facilities. MCP cards to be issued to all beneficiaries.
• All identified High Risk women including those with complications to be managed and treated by OBGY/CEmOC/BEmOC Specialist). If needed, such cases should be referred to higher level facilities and a referral slip with probable diagnosis and treatment given should be mentioned on the slip.
• One ultrasound is recommended for all pregnant women during the 2nd/ 3rd trimester of pregnancy. If required, USG services may be made available in a PPP mode and expenditure booked under JSSK.
• Before leaving the facility every pregnant women to be counselled, may be individually or in groups, on nutrition, rest, safe sex, safety, birth preparedness, identification of danger signs, institutional delivery and Post - partum Family Planning ( PPFP ) .
• Filling out the MCP cards at these clinics should be mandatory and a sticker indicating the condition and risk factor of the pregnant women should be added onto MCP card for each visit:
  • Green Sticker - for women with no risk factor detected
  • Red Sticker – for women with high risk pregnancy
  • Blue – for women with Pregnancy Induced Hypertension
  • Yellow – pregnancy with co-morbid conditions such as diabetes, hypothyroidism, STIs
• Counselling session to focus on the following topics:
  • Care during pregnancy.
  • Danger signs during pregnancy.
  • Birth preparedness & Complication readiness, contact details to be used in case of need
  • Family Planning
  • Importance of nutrition including iron - folic acid consumption and calcium supplementation.
  • Rest
  • Safe sex
  • Institutional delivery.
  • Identification of referral transport.
  • Entitlements under Janani Suraksha Yojana (JSY)
  • Entitlements and service guarantee under Janani Shishu Suraksha Karyakram (JSSK)
  • Post - natal care.
  • Breastfeeding and complementary feeding.

Those pregnant women with unwanted pregnancies need to be provided with safe abortion care services after proper counselling.

Referral Transport Mechanism for High risk women: During PMSMA, 108 /102 /State owned ambulances/Private empanelled ambulances can also be used for referring those cases identified as high risk.

By: Abhishek pratap Singh