Our Government since India gained independence, has given special attention to the health needs of rural people specially women and children. Janani Suraksha Yojana is one of the latest mechanisms formed under National Rural Health Mission (NRHM) on April 2005. The action plan integrates the cash assistance with antenatal care during the pregnancy period, institutional care during delivery and immediate post-partum period in a health centre by establishing a system of coordinated care by field level health worker known as ASHA [Accredited Social Health Activist]. The objective of the Yojana is to reduce overall maternal mortality ratio and infant mortality rate and to increase institutional deliveries in BPL [Below Poverty Level] families. Also, the benefits would be available to such pregnant women falling in the above category even though not registered under JSY previously during pregnancy period. The JSY is a 100% centrally sponsored scheme. This paper intends to highlight the positive and the negative outcome of the JSY programme with regards to the women’s rights as mothers and children’s rights as future responsible citizens of the nation.

The study area and methods:

Nazratilla village under Longaighat GP in the district of Karimganj is selected as it suits our research design which seeks to study women beneficiaries under JSY belonging to different layers of rural demographic pattern below the poverty level. The selection of the village is purposive. Karimganj College has adapted Karnamadhu for community development purpose in order to make it a model village in the future. We, as members of Karimganj College fraternity, participated in an awareness campaign on JSY organised jointly by Karimganj College Women Cell and Community Orientation Cell, Karimganj College. Later, we surveyed the field for collection of data through Questionnaire and interviews.

Longaighat lies on the south western part of Karimganj Town and is situated by the bank of river Longai. It is one of the oldest geographical locations with 16.00 sq. km. area and a population of 9031 as per 2001 census. Nazratilla is one of the truncated villages of Katakhal Ward [Ward No. 8]. The total population of the village is 1003. The people are mostly agriculturists and their rate of literacy is downward. Demographic pattern of Longaighat G P as well as Nazratilla village are represented graphically in Table-1 and Table-2.

The Yojana covers the entire country with special focus on 18 (eighteen) states where the challenge of strengthening Public Health System and improving key health indicators is the highest. Assam being one of the 18 (eighteen states aims at provision of integrated comprehensive and effective primary health care to the poor and marginalized sections of the society specially women and children by improving access, availability, quality and accountability of public health services under NRHM. The duration of the mission is 7 (seven) years from 2005 to 2012. A leading Indian magazine reveals the fact that Assam is one amongst the 6 (six) states where the maternal mortality rate and infant mortality ratio is higher than the national standard. The statistics show that the rate is higher than Bihar (India Today - 27th September ‘07). World Health Report 2005 says maternal mortality rate in Assam exceeds 400 per 100000 live births. In order to reduce this upward trend of infant and maternal mortality ratio, Government. of Assam had taken ‘continuum of care’ approach for mother and child beginning before pregnancy. JSY should no doubt be commended for a bottom up approach to development of the basic health needs for under privileged rural women and their off spring. Notwithstanding, the survey reveals some gaps between policy commitments and their implementations. While interacting with sample respondents at Nazratilla and its periphery, we have had the feeling that most of the beneficiaries were not aware of the legal framework of the action plan. The rules and the responsibilities within the mission need to be understood by them. Also, those who came under its preview had grievances against the reluctant and apathetic attitudes of the health authority to furnish available information. Most surprising fact that came out from this field survey was the official level misappropriation of cash assistance meant for the mother after delivery from health institutions. Official report shows that between June ’07 to August ‘07, out of 7 (seven) antenatal mothers, benefits were extended to 4 (four) for institutional delivery (South Karimganj PHC). This is no doubt a positive response towards the implementation of the Yojana. 3 (three) did not avail the benefits reasons best known to them. To our great surprise, we noticed that traditional birth practices including the work of untrained traditional birth attendants (Dhai) coupled with social prejudices such as nutritional taboos and differential feeding patterns still persisted which act as a hindrance to implement the programme.

The most striking fact revealed by this survey is the non-existence of PHC at the periphery of the Longaighat GP having population of 10,000. The pie-chart represents the distance of the nearest PHC at Nilambazar from the villagers living in 6 (six) of the villages under the Longaighat GP.

This is the picture of one of India’s poorest remote villages 3 kms away from the district head quarters, Karimganj where minimum amenities for health care are not available. The nearest sub centre is at Ambarkhana which is in a bad shape. Doctors are hardly found. Most of the pregnant mothers avail the benefit during antenatal period at this sub centre which is run by paramedic ANM. Last, but not the least, the Mission envisages key role of Panchayat Raj Institution (PRI) to plan, control and monitor the health programme as envisaged in the 73rd Amendment Act. To our great surprise, we noticed the aloofness of the Panchayat members.

The woman is a mother who as a mother is ‘supreme being and Guru’. We envision human rights for women as the corrective rights of a woman to be seen and accepted as a person in the capacity to decide or act on her own behalf and to have equal access to resources an equitable social, economic and political support to develop her full potential. In a democratic state structure, it should be the main concern of the Government to provide equal opportunity to all. It is the question of obligation, not of whims. Women’s rights are Human rights and Human rights are women’s right. If this goal is to be attained, collective efforts both at Governmental and Non-Governmental level supported by awareness generation programmes are needed. Mere passing of Act and Plan will be of no use unless accompanied by necessary social education an awareness about women’s potential capabilities and possible contributions to the development of the country. Nonetheless, the issue of women’s rights as mothers must be approached in a way that is meaningful and relevant in our diverse cultural context.

Janani Suraksha Yojana is a statement of hope and conviction. The Government. of Assam is committed to achieving the goals laid down in national health policy. For the undeserved poor in the village level, the Mission spells hope in the form of a voluntary trained health activist (ASHA), improved hospital facility at PHC, access to universal immunization, escort services for institutional delivery, nutrition and medical care. We need dynamic political leadership, administrative commitment and buoyant community participation to fulfill the ambitious agenda of the Mission.

Dr. Monolina Nandy Roy