Universalize central scheme for maternity entitlement, free it of all conditionalities

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Forty gynaecologists and paediatricians write to Prime Minister Narendra Modi for the implementation of maternity entitlements as per the National Food Security Act norms:

We, the undersigned are a group of concerned Gynaecologists and Paediatricians writing to you to draw your attention on the status of pregnant and lactating women in our country. We write to you during the time when the world celebrates Women’s Day. As you may agree, we will not be able to make progress if half of our population is left behind anaemic and undernourished.

We appreciate your earlier efforts to promote the importance of food and health security of pregnant women but much remains to be done. As per a recent announcement, the National Nutrition Mission aims to reduce stunting, under-nutrition, and low birth weight by 2 per cent and anaemia (among young children, women and adolescent girls) by 3 per cent annually over the three-year mission period (2017-18 to 2019-20). This goal will remain unrealised if women continue to remain undernourished and anaemic during pregnancy. It will contribute to intergenerational cycle of malnutrition by passing the burden of malnutrition to the new born child.

The World Health Organisation (WHO) website states “Breastfeeding is an unequalled way of providing ideal food for the healthy growth and development of infants; it is also an integral part of the reproductive process with important implications for the health of mothers. Review of evidence has shown that, on a population basis, exclusive breastfeeding for six months is the optimal way of feeding infants.”

To enable mothers to establish and sustain exclusive breastfeeding for six months, WHO and UNICEF recommend:

  • Initiation of breastfeeding within the first hour of life
  • Exclusive breastfeeding – that is the infant only receives breast milk without any additional food or drink, not even water
  • Breastfeeding on demand – that is as often as the child wants, day and night
  • No use of bottles, teats or pacifiers

The implementation of the above, which are so critical for the health, nutrition and care of women and children, is not possible, unless women can withdraw from her regular responsibilities of work to be with the child in the first six months. The recent amendment in National Maternity Benefit Act does acknowledge this fact by providing six months of paid leave to women in the organised sector. In India 95 per cent women workers are in the informal and unorganized sector and do not receive any wage compensation during pregnancy and after childbirth, although we expect them to rest, gain weight, improve their own health and then provide the baby with exclusive breastfeeding for six months.

The Economic Survey of India 2016 (Ministry of Finance, Government of India) points out that “42.2 95 per cent Indian women begin pregnancy too thin and do not gain enough weight during pregnancy’ and recommends that ‘some of the highest economic returns to public investment in human capital in India lie in maternal and early life health and nutrition interventions.”

Sir, to address this crisis, as Doctors, we would earnestly request you to implement the National Food Security Act 2013, within which:

  • Pradhan Mantri Matru Vandana Yojana (PMMVY), the Central Scheme for maternity entitlements should immediately be made universal and free of conditionalities and not linked to the number of children or age of the woman, as that is fundamentally discriminatory to both women and children as citizens.
  • The amount of maternity entitlement given under this scheme should be increased from Rs. 5000 to at least Rs 6000 (as per the National Food Security norms) and be increased progressively to achieve coherence with wage compensation.
  • Supplementary nutrition through locally prepared foods – preferably hot cooked meals to be supplied to all pregnant and lactating women at the local Anganwadi centre.

We do hope you will appreciate our concern and respond.

Signatories:

Dr Abha Govind (consultant, obstetrics and gynaecology, London)
Dr Abha Kullar Sabhikhi (Delhi)
Dr Amit (Nav Jyoti Hospital, Delhi)
Dr Anshu Sharma (National Centre for Disease Control, Delhi)
Dr Anita Verma (private practice, Delhi)
Dr Antima (private practice, Nainital)
Dr Asha Sharma (private practice, Delhi)
Dr Arun Gupta (BPNI and IBFAN)
Dr Binayak Sen (Medico Friends Circle, West Bengal)
Dr Chanda Khanna (private practice, Delhi)
Dr Charulatha Bannerjee (Kolkata)
Dr Deepika Gulati (Delhi)
Dr Gopal Dabade (Drug Action Forum, Karnataka)
Dr Hema Sharma (Central Government Health Scheme, Bengaluru)
Dr. Kalpana Srivastava (private practice, Delhi)
Dr. Keya Gupta (Kolkata)
Dr. Kumkum Srivastava (MBBS, D Ped, Jaipur)
Dr J P Dadhich (BPNI and IBFAN)
Dr Jyotsana Aggarwal (private practice, Delhi)
Dr Jyothsna Madan (Cloudnine Hospital, Bangalore)
Dr Manisha (Lifeline Hospital, Delhi)
Dr Mira Shiva (Initiative for Health and Equity in Society)
Dr Monika Bajaj (Portland Hospital for Women and Children, London)
Dr. Nandini Athavale (private practice, Jalgaon)
Dr Neera Sharma (Delhi)
Dr Neeta Lal (retired paediatrician, Gurugram)
Dr Nitin Dunveer (Delhi)
Dr Rahul Bhardwaj (private practice, Delhi)
Dr Rahul Behl (Delhi)
Dr Satish Babu (Bangalore)
Dr Sharda Jain (East Delhi Gynaecology Forum and Life Care Centre)
Dr Siddhartha Sen (Royal Gwent Hospital, Newport)
Dr Subhasri B. (Chennai)
Dr Suranjeen Pallipamula Prasad (Jhpiego, Ranchi)
Dr Sylivia Karpagam (public health doctor and researcher, Karnataka)
Dr Tina George (Christian Medical College, Vellore)
Dr Vandana Prasad (Public Health Resource Network)
Dr Varsha Shridhar (private practice and NGO)
Dr Vineet Khanna (private practice, Delhi)
Dr Yogesh Jain (AIIMS and Jan Swasthya Sayog, Bilaspur)


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