Indira Gandhi Matritava Sahyog Yojna

Indira   Gandhi  Matritava  Sahyog Yojna : Conditional  Maternity  Benefit  Scheme  (CMB)  

Objectives 

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 six months 
• Contributing to better enabling environment by providing cash incentives for improved health and nutrition to pregnant and nursing mothers  

Target Group 

Pregnant Women of 19 years of age and above for first two live births (benefit for still births will be as per the norms of scheme)

All government employees will be excluded  from  the scheme as  they are entitled  for paid maternity leave.

Geographical Coverage

The  scheme  will  be  implemented  as  a  pilot  project.  In  order  to  ensure  national coverage, IGMSY will be piloted in 95 identified districts from all the States/UTs across the  country.  Of  these  95  districts,  62  districts  will  be  selected  from  the  15  bigger states, 26 districts each from the 13 other states and 1 district each from all the UTs.

Cash Transfer	Conditions	Amount (In Rs.)	Means of Verification
First (at the  end of second trimester)	-- Registration of Pregnancy at AWC/ health  centres  within 4 months of pregnancy -- At least one ANC with IFA tablets and TT -- Attended at least one  counselling session at AWC/ VHND	1500	Mother & Child Protection Card reflecting registration of pregnancy by relevant AWC/ Health Centres and counter signed by AWW
Incentive under JSY	-- JSY package for institutional delivery including early initiation of breastfeeding and ensure colostrum feed.	As per JSY norms
Second (3 Months after delivery)	-- The birth of the child is registered. -- The child has received:    - OPV and BCG at birth    - OPV and DPT at 6 weeks    - OPV and DPT at 10 weeks -- Attended at least 2 growth monitoring and IYCF counselling sessions within 3 months of delivery.	1500	Mother & Child Protection Card, Growth Monitoring Chart and Immunization Register *will also be available for still births and infant mortality.
Third (6 months after delivery)	--Exclusive breastfeeding for six months and introduction of complimentary feeding as certified by the mother -- The child has received OPV and DPT -- Attended at least 2 growth monitoring and IYCF counselling sessions between 3rd and 6th months of delivery.	1000	Self  certification, Mother  &  Child Protection  Card, Growth  Monitoring Chart  and Immunization Register

Incentives to Anganwadi Workers (AWWs) and Helpers (AWHs):

AWW will 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/ will be approved to AWH per beneficiary.

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.

• 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 will 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 will be the first milestone for receiving cash benefits of Rs.1500/- at the end of second trimester. Every  registered mother under  the  IGMSY will have a Mother and Child Protection Card.  Early  registration  at  the AWC will also  ensure  that  the woman gets the benefit of 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. 
• 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 will  have  to mandatorily attend at least one ANC. Monthly supply of Iron and Folic Acid (IFA) tablets will 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 will also be carried out by  the AWW and  the health  functionary who will also  facilitate the  above  services  to  the  beneficiary. The  details  of  the  services availed will  be duly recorded in the Individual Mother and Child Protection Card common to ICDS and NRHM. 
• 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

• 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 ill-health often starts with the mother,  IGMSY will  strive  to  ensure  the  optimal  immunization  of  every  pregnant woman in close collaboration with the health workers. The scheme will also ensure accessing provisions  for counseling,  iron and  folic-acid supplements  that are vital for the health of both the mother and the child.
• Growth  Monitoring:  Growth  monitoring  consists  of  routine  measurements  to detect abnormal growth, combined with some action when  this  is 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 will be mandatory for all the  IGMSY beneficiaries  to  regularly attend  the growth monitoring sessions at  the Anganwadi Centres. The AWWs will be responsible for maintaining the weight-forage  growth  charts  for  all  infants  and  young  children  as  per WHO  Child Growth Standards included in the Mother and Child Protection Card. 
• 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 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.

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  will  be  the  second milestone  for  receiving  cash  benefits  of  Rs.1500/- under the scheme after three months of delivery.

The  third 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  &  the  child  has 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.