Janani Suraksha Yojana (2005): Promoting Institutional Deliveries and Maternal Health in India

Policy Update
Sneha Kohli

Background 

Maternal health remains an important indicator of a country’s healthcare accessibility, quality of medical services, and broader socioeconomic development. In India, barriers such as poverty, geographical isolation, limited awareness, and the cost of childbirth have historically affected pregnant women’s access to institutional delivery and skilled maternal care. Encouraging childbirth in health facilities is important because it enables timely medical assistance, referral, and management of complications during pregnancy, delivery, and the postnatal period.

Against this backdrop, the Government of India launched the Janani Suraksha Yojana (JSY) on 12 April 2005 as a safe motherhood intervention under the National Rural Health Mission, now implemented under the National Health Mission (NHM). The scheme aims to reduce maternal and neonatal mortality by promoting institutional deliveries among pregnant women, particularly those from economically disadvantaged backgrounds. It combines conditional cash assistance with community-level outreach, identifying Accredited Social Health Activists (ASHAs) as a crucial link between pregnant women and healthcare facilities (National Health Mission [NHM]).

The scheme has continued to operate across all States and Union Territories, with special provisions for states identified as having lower institutional delivery rates. Its significance can be understood alongside India’s broader maternal health progress: the national Maternal Mortality Ratio (MMR) declined to 88 maternal deaths per 100,000 live births during 2021–23, according to the Sample Registration System (SRS) data released by the Registrar General of India. However, maternal health outcomes continue to vary substantially across states, highlighting the need to strengthen both access to institutional delivery and the quality of care available to women (Ministry of Health and Family Welfare [MoHFW], 2026).

Functioning

JSY operates as a centrally sponsored scheme under the National Health Mission. Its principal mechanism is conditional cash assistance intended to encourage eligible pregnant women to deliver in public health facilities or accredited private institutions. The scheme places particular emphasis on states with historically lower institutional delivery rates, while applying different eligibility provisions to low-performing and high-performing states (NHM, n.d.).

The scheme provides different cash entitlements, as a one time benefit, depending on the state category and whether the beneficiary resides in a rural or urban area. According to the NHM’s published guidelines, the assistance structure is as follows:

Source: Ministry of Health and Family Welfare, Government of India, parliamentary annexure. 

The JSY classifies states and Union Territories into Low-Performing States (LPS) and High-Performing States (HPS), based on institutional delivery performance. According to the Ministry of Health and Family Welfare’s Annual Report 2023–24, the LPS category comprises Assam, Bihar, Chhattisgarh, Jharkhand, Jammu and Kashmir, Ladakh, Madhya Pradesh, Odisha, Rajasthan, Uttar Pradesh, and Uttarakhand; the remaining states and Union Territories fall under HPS (Ministry of Health and Family Welfare [MoHFW], 2024).

Eligibility conditions differ by category. In LPS, all pregnant women delivering at eligible health facilities can receive assistance, irrespective of age or number of children. In HPS, assistance is restricted to women belonging to Below Poverty Line (BPL) households and Scheduled Caste/Scheduled Tribe (SC/ST) communities. Separate provisions apply to deliveries at accredited private institutions; therefore, eligibility should be checked against the applicable facility and state provisions (National Health Mission [NHM], n.d.; MoHFW, 2024).

The scheme also provides for ASHA incentives for facilitating antenatal care and institutional delivery. The mother’s assistance and the ASHA’s incentive are separate components and should not be conflated (NHM, n.d.; MoHFW, 2025a).

Accredited Social Health Activists (ASHAs) are community-based health workers who act as a link between rural communities and the public healthcare system, helping women access maternal and child health services. ASHA workers are central to the scheme’s implementation at the community level. Their responsibilities include identifying and supporting pregnant women, encouraging antenatal care, facilitating registration and institutional delivery, and helping beneficiaries access maternal healthcare services.

This community-based approach is particularly relevant in rural and underserved areas, where distance, limited information, and social barriers can delay access to healthcare. Despite their important role, ASHA workers may face practical challenges, including delays in receiving incentives, heavy workloads, and difficulties reaching pregnant women in remote or underserved areas. These barriers can affect follow-ups, timely referrals, and the facilitation of institutional deliveries, highlighting the need for timely payments, adequate support, and stronger coordination with healthcare facilities.

JSY also operates alongside other maternal health programmes. The Janani Shishu Suraksha Karyakram (JSSK) provides eligible women delivering in public health institutions with free delivery services, including caesarean sections, as well as entitlements such as medicines, diagnostics, diet, transport, and blood transfusion when required. Other initiatives, including the Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA) and LaQshya, complement these efforts through antenatal care and improvements in labour-room and maternity services (MoHFW, 2026).

Performance

Official data indicate that JSY continues to reach a substantial number of pregnant women across India. However, the number of beneficiaries and the quality of maternal health outcomes should be assessed separately: the former measures programme reach, while the latter depends on multiple factors, including service availability, timely referral, and the quality of care.

The Ministry of Health and Family Welfare reported the following number of JSY beneficiaries for the two most recent financial years covered by the parliamentary response:

Source: Ministry of Health and Family Welfare (2025a). Figures are based on state and Union Territory reports.

JSY recorded approximately 1.03 crore beneficiaries in 2023–24 and 96.15 lakh in 2024–25, a decline of around 6.2%. Uttar Pradesh accounted for the largest number of beneficiaries in both years, followed by Bihar. The decline in JSY beneficiaries may reflect several factors, including changes in the number of eligible births, variations in scheme eligibility, and differences in state-level reporting. However, the available data do not establish the relative contribution of these factors. Notably, national institutional births reached 90.6% in 2023–24, according to the Ministry of Health and Family Welfare, suggesting that the decline in JSY beneficiaries should not automatically be interpreted as a fall in institutional deliveries (MoHFW, 2026). Further analysis of state-wise birth figures, beneficiary eligibility, and reporting completeness is needed to explain the decline.

Parliamentary data provide state-wise figures for State Programme Implementation Plan (SPIP) approvals and reported expenditure under JSY. In 2024–25, Uttar Pradesh had an SPIP-approved amount of ₹54,897.23 lakh and reported expenditure of ₹28,175.14 lakh, while Bihar had an approval of ₹32,930 lakh and expenditure of ₹17,949.41 lakh (Ministry of Health and Family Welfare [MoHFW], 2025). These approvals represent planned allocations under the SPIP, not necessarily funds actually released. The Ministry clarifies that expenditure figures are provisional, based on State and Union Territory Financial Monitoring Reports, and include expenditure against Central releases, State releases, and opening unspent balances. Therefore, the difference between approval and expenditure should not be interpreted as the amount of funds pending release or as a direct measure of implementation performance.

National health indicators show substantial progress in institutional delivery and maternal survival. The National Family Health Survey (NFHS-5), covering 2019–21, reported that institutional births increased from 79% in NFHS-4 (2015–16) to 89% in NFHS-5. The proportion of pregnant women receiving at least four antenatal care visits also increased from 51% to 58% during the same period (MoHFW, 2022). More recent administrative data reported by the Ministry show that India recorded approximately 2.02 crore institutional deliveries in 2022–23, 1.98 crore in 2023–24, and 1.94 crore in 2024–25. The national MMR was 88 per 100,000 live births during 2021–23, compared with 93 during 2019–21 (MoHFW, 2026).

These trends indicate that improvements in institutional delivery have coincided with a decline in maternal mortality in India. However, increased access to health facilities does not necessarily guarantee timely or quality care. The decline in the national MMR from 93 per 100,000 live births in 2019–21 to 88 in 2021–23 must therefore be considered alongside the availability of skilled personnel, emergency obstetric services, and timely referrals. While JSY helps reduce financial barriers and encourages institutional delivery, its contribution to maternal survival depends partly on the quality and responsiveness of the healthcare system. These improvements cannot be attributed to JSY alone, as other maternal health programmes and broader health-system developments also contribute to outcomes (MoHFW, 2026).

Impact

JSY has helped institutionalise financial incentives as a mechanism for encouraging pregnant women to seek facility-based delivery. By reducing some of the immediate financial barriers associated with childbirth and linking women to ASHA workers, the scheme creates a pathway between household-level awareness and formal healthcare services. This is particularly relevant for women from economically disadvantaged communities and those living in areas with historically low institutional delivery rates (NHM, n.d.).

The expansion of institutional births from 79% in 2015–16 to 89% in 2019–21 reflects a broader improvement in access to facility-based childbirth. The decline in national MMR to 88 per 100,000 live births during 2021–23 is also an important maternal health milestone (MoHFW, 2022, 2026). However, these changes should be understood as outcomes of the wider maternal healthcare system rather than as effects attributable exclusively to JSY.

The scheme’s impact also depends on what happens after a woman reaches a health facility. Institutional delivery can improve access to skilled birth attendance and emergency obstetric care, but the benefits depend on adequate staffing, functioning equipment, respectful treatment, timely referrals, and the availability of medicines and blood. JSY therefore works most effectively when financial assistance is accompanied by accessible and reliable healthcare services.

Emerging Issues

Despite the expansion of institutional delivery, several challenges remain relevant to JSY’s implementation.

1. Uneven state-level outcomes: Maternal health indicators continue to differ across states. These variations underline the need for state-specific approaches to maternal health, rather than relying on beneficiary coverage alone.

2. Financial and administrative implementation: State-wise expenditure data show differences between approved amounts and reported spending. Although these figures are provisional and do not independently establish underperformance, they highlight the importance of timely fund utilisation, accurate reporting, and transparent monitoring (MoHFW, 2025b).

3. Quality of institutional care: Increasing facility-based deliveries does not automatically guarantee safe or respectful care. Gaps in routine maternity services, such as antenatal check-ups, skilled attendance during normal delivery, and postnatal follow-up, differ from gaps in emergency obstetric care, including timely Caesarean sections, blood transfusions, and the management of severe complications. Addressing both requires trained personnel, adequately equipped facilities, reliable referral transport, and round-the-clock emergency services, particularly in underserved districts (National Health Mission [NHM], n.d.).

4. Monitoring outcomes beyond beneficiary numbers: The number of women receiving cash assistance is an important indicator of programme reach, but it does not independently measure the timeliness of payments, quality of care, maternal complications, or beneficiary satisfaction. 

Way Forward

Strengthening JSY requires moving beyond the promotion of institutional deliveries towards a more comprehensive approach to maternal health.

First, implementation should be tailored to state-level needs. States with persistently high MMR should receive focused attention through stronger referral systems, improved emergency obstetric care, and better coordination between community health workers and health facilities.

Second, timely disbursement of cash assistance should remain a priority. Clear beneficiary communication, reliable administrative processes, and accessible grievance-redressal mechanisms can help ensure that eligible women receive the assistance intended for them.

Third, the role of ASHA workers should be strengthened through adequate training, timely payment of incentives, and effective coordination with health facilities. Since ASHAs connect communities with the formal health system, their ability to support antenatal care, institutional delivery, and referrals is important to the scheme’s functioning.

Fourth, performance monitoring should combine beneficiary coverage and expenditure with indicators of service quality and maternal outcomes. State-level reporting should make it possible to assess not only how many women receive assistance, but also whether they obtain timely care and experience safe, respectful treatment.

Finally, JSY should be integrated with complementary programmes such as JSSK, PMSMA, and LaQshya to support mothers and newborns beyond delivery. JSSK provides free maternity services, medicines, diagnostics, transport, and treatment for sick newborns and infants in public health facilities, while PMSMA strengthens antenatal care and the identification of high-risk pregnancies. Alongside these initiatives, timely postnatal follow-ups can help monitor maternal recovery, identify complications, support newborn care and immunisation, and facilitate referrals when necessary. This continuity of care can help ensure that the benefits of institutional delivery extend into the postnatal period for both mothers and newborns (National Health Mission [NHM], n.d.).

Conclusion

The Janani Suraksha Yojana remains an important component of India’s maternal healthcare framework. By combining conditional cash assistance with community outreach through ASHA workers, the scheme seeks to reduce financial barriers and encourage institutional delivery among pregnant women, particularly those from disadvantaged backgrounds. National indicators show substantial improvements in institutional births and a decline in maternal mortality, although outcomes vary across states and cannot be attributed to JSY alone.

The central challenge is to ensure that increased access to institutional delivery is matched by reliable, timely, and high-quality maternal care. Strengthening state-level implementation, fund utilisation, community outreach, and outcome-based monitoring can help ensure that the scheme contributes more consistently to safer childbirth and improved maternal health.

References

Ministry of Health and Family Welfare. (2022, July 22). Update on NFHS-5 & Rural Health Statistics. Press Information Bureau, Government of India. https://www.pib.gov.in/PressReleasePage.aspx?PRID=1843842&lang=2&reg=48

Ministry of Health and Family Welfare. (2025a, August 5). Financial assistance to pregnant women under JSY (Rajya Sabha Unstarred Question No. 1858). Parliament of India. https://sansad.in/getFile/annex/268/AU1858_tvQ7zU.pdf?source=pqars

Ministry of Health and Family Welfare. (2025b, March 25). Maternal healthcare in the country (Rajya Sabha Unstarred Question No. 2820). Parliament of India. https://sansad.in/getFile/annex/267/AU2820_FX9TVt.pdf?source=pqars

Ministry of Health and Family Welfare. (2026, March 13). Steps taken for reducing maternal mortality. Press Information Bureau, Government of India. https://www.pib.gov.in/PressReleasePage.aspx?PRID=2239637&lang=1&reg=+3

National Health Mission. (n.d.). Janani Suraksha Yojana. Ministry of Health and Family Welfare, Government of India. https://nhm.gov.in/nhm/index1.php?lang=1&level=3&lid=309&sublinkid=841

Office of the Registrar General & Census Commissioner, India. (2022). Special bulletin on maternal mortality in India 2018–20. Government of India. https://censusindia.gov.in/nada/index.php/catalog/44379/study-description

About the contributor
Sneha Kohli is a third-year B.A. (Hons.) Political Science student at Jesus and Mary College, University of Delhi. She has a keen interest in public policy, governance, and policy research, with prior experience in research projects, policy analysis, and academic writing. She values curiosity, critical thinking, and collaborative learning, and looks forward to contributing to and learning from IMPRI’s research ecosystem. 

Acknowledgements
The author extends sincere gratitude to the IMPRI team for their expert guidance and Khushi and Prisha Sachdeva for their valuable feedback and support. 

Disclaimer

All views expressed in the article belong solely to the author and not necessarily to the organisation. 

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