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By avoiding fragmented interventions and pursuing a comprehensive care economy, India can ensure maternal well-being and promote greater economic involvement for women
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This essay is part of the series: World Health Day 2025: Healthy Beginnings, Hopeful Futures
The World Health Organization (WHO), in line with the Sustainable Development Goals (SDGs), has acknowledged that the health of mothers and children is a crucial indicator of the overall efficacy of a country's healthcare institution. Wealth and economy, a key component of inequality that encompasses social standing and financial stability, influence family formation patterns, making it more than just a medical or reproductive rights issue.
A complicated interaction between poverty, financial dependence, and gendered norms that place an undue weight on unpaid care duties on women shapes the everyday lives of millions of Indian women and their maternal health. Thus, investments in maternal and child health by public, commercial, and charitable sectors are crucial for preserving and improving lives. As countries leverage the demographic dividend to drive growth, they also unlock significant economic benefits for the continent.
India is one of the nations with the largest gap between the number of men and women performing unpaid care duties, with the overall value of unpaid care work done by Indian women amounting to a staggering 15 percent of GDP.
In India, women perform the majority of unpaid caregiving and household duties, which restricts their economic options and increases their health risks. India is one of the nations with the largest gap between the number of men and women performing unpaid care duties, with the overall value of unpaid care work done by Indian women amounting to a staggering 15 percent of GDP.
By outsourcing more demanding home chores through domestic help and care services, high-earning mothers worldwide can spend more time and attention with their children. In contrast, repetitive, time-consuming, and physically taxing household chores frequently fall on women who lack the financial resources, leading to significant exhaustion and stress in mothers. Economic strain further impacts maternal health by limiting access to safe housing, nutritious food, and quality medical care—all essential for positive outcomes for both mothers and children.
Traditional gender roles create higher emotional and physical burdens on women. Under this dynamic, in many cultures, men control family financial resources and decision-making, in turn limiting women's ability to seek healthcare. Support from male partners has been found to lower maternal difficulties and enhance birth outcomes, especially in situations with limited resources, and is crucial for women to move through critical phases of pregnancy and childbirth and may help with postpartum symptoms of depression.
Households with higher levels of financial insecurity can result in issues including anaemia and low birth weight, which raise infant mortality rates.
Poverty restricts women from engaging in paid work and hinders their access to necessary prenatal and postnatal care. According to a study, in India, antenatal care (ANC) service coverage increased by only 1.05 percent and postnatal care by 3.4 percent from 2005 to 2021 among the poorest. Households with higher levels of financial insecurity can result in issues including anaemia and low birth weight, which raise infant mortality rates.
There is still a huge socioeconomic divide even though the use of maternal healthcare services has increased dramatically. Women from disadvantaged backgrounds had worse perinatal outcomes, most likely as a result of lower healthcare utilisation and obstacles such as lack of transportation and pregnancy-related shame.
Parliament passed the Maternity Benefits Act of 1961 to govern maternity benefits and women's employment during pregnancy by the Directive Principles of State Policy. This law, among other things, guarantees a woman's right to maternity and pregnancy leave, safeguards her income during that time, and mandates that employers give female employees access to on-site childcare and nursing breaks.
Without enough social protection, social hierarchies and restrictions frequently push women into informal labour.
However, because of the prevalence of informal jobs and the unrecognised nature of their work, women are especially vulnerable to job loss. Without enough social protection, social hierarchies and restrictions frequently push women into informal labour. More than half of these women lack contracts, which prevents them from receiving social benefits like maternity leave, healthcare, and childcare.
The term “motherhood penalty” describes the drop in women's labour force participation rates (LFPR) during the years while they are pregnant. According to research, mothers' employment is severely impacted by having young children, and this inverse link gets worse over time. Urban women's employment has remained below 25 percent since the 1990s despite economic growth, indicating enduring obstacles associated with caring duties and cultural norms around motherhood.
According to the Economic Survey 2023–2024, India needs to implement strategic reforms to develop a strong care economy. Public spending equal to 2 percent of GDP could generate almost 11 million jobs, most of which would benefit women. With improved support networks for working women, such policies could lessen the financial effects of parenting.
A centrally sponsored flagship programme of the Indian government's Ministry of Women and Child Development, the Pradhan Mantri Matru Vandana Yojana (PMMVY) is intended to assist pregnant and nursing mothers. The goal is to give maternity benefits to mothers from economically and socially underprivileged backgrounds and encourage maternal nutrition and institutional births by providing a financial incentive of INR 5,000 for the first child and INR 6,000 for the second child (if it is a girl).
A stronger emphasis on dietary diversity is required, including the inclusion of nutrient-dense foods that are readily available locally.
According to a study, the programme has improved the use of critical maternal and child health services like immunizations and prenatal care. However, some studies show no appreciable benefits on overall maternal health outcomes. The number of women who received some PMMVY benefits fell by about 40 percent in just two years, from 96 lahks in 2019–20 to 61 lakh in 2021–22. Bureaucratic obstacles and strict eligibility requirements, like the need for biometric identification, also prevent over half of the eligible women from receiving the payments.
Furthermore, addressing the contextual factors impacting maternal and child health is necessary for PMMVY to facilitate improvements in nutritional outcomes and maternal and child health. A stronger emphasis on dietary diversity is required, including the inclusion of nutrient-dense foods that are readily available locally.
Comprehensive policy changes that acknowledge and address these systemic injustices are necessary to address the economic determinants of maternal health. Provide parental leave that is safeguarded by employment and sufficiently financed by public funds or social insurance with highly accessible, high-quality childcare options and flexible work schedules for all employees. This leave should be available to both mothers and fathers, promoting shared caregiving responsibilities and maternal health during and after pregnancy.
As suggested by the Community Preventive Services Task Force, funding the local implementation of evidence-based programmes, including home visits, treatment for substance use disorders, quitting smoking, mental health services, and others, will prove helpful. Inform the public on risk-reducing practices, pregnancy-related warning signs, and the significance of prenatal and postpartum care.
Pregnant women with low incomes should receive specific measures to lessen the negative effects of poverty on maternal and child health outcomes.
To give the woman the much-needed money during her pregnancy, payments shouldn't be postponed. Additionally, beneficiaries should have access to the PMMVY portal (ideally using their beneficiary login ID) so they can periodically monitor the status of their payments. Tamil Nadu and Odisha state-level schemes teach us that better mother and child health outcomes can result from a greater benefit level combined with streamlined procedures.
Pregnant women with low incomes should receive specific measures to lessen the negative effects of poverty on maternal and child health outcomes. This includes having access to mental health resources, dietary assistance, and medical care during pregnancy. Increasing women's economic stability breaks the intergenerational cycle of poverty by improving their immediate living situations as well as the long-term health of their children.
To guarantee fair access to maternal and child healthcare throughout India, it is essential to scale up best practices from states with robust maternal health facilities, like Kerala. By avoiding fragmented interventions and pursuing a comprehensive care economy, India can ensure maternal well-being and promote greater economic involvement for women.
Madhavi Jha is a Research Intern at the Observer Research Foundation.
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