Pradhan Mantri Surakshit Matritva Abhiyan (2016): Assessing a Decade of Safer Motherhood

Policy Update

Shruti Sethi

Background 

On 9 June 2016, the Government of India launched the Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA), a scheme built on a deceptively simple premise: that if every pregnant woman in the country were examined by a qualified physician and appropriately investigated at least once during her second or third trimester, a measurable share of preventable maternal and neonatal deaths could be averted.

Announced by Prime Minister Narendra Modi and detailed in his Mann Ki Baat address on 31 July 2016, PMSMA became the Ministry of Health and Family Welfare’s (MoHFW) instrument for delivering free, assured and quality antenatal care (ANC) on a  fixed day i.e., on the 9th of every month, at designated government health facilities across the country (Prime Minister’s Office, 31 July 2016).

The scheme emerged against a specific policy backdrop. During 2014–16, India’s Maternal Mortality Ratio (MMR) stood at 130. MMR counts deaths per one lakh live births during pregnancy or within 42 days of its termination, from causes related to the pregnancy. This was well above the Sustainable Development Goal target 3.1 of bringing MMR below 70 by 2030 (World Health Organization, n.d.), and maternal health had been flagged as a priority area under the National Health Policy, 2017, which set a target of reducing MMR to below 100 per lakh live births (Ministry of Health and Family Welfare, 2017).

Many of the underlying causes of maternal death, such as severe anaemia, pregnancy-induced hypertension and undiagnosed high-risk conditions, are preventable when detected early and managed through timely specialist care. Routine antenatal care already existed within the public health system, but consistent access to specialist-led examination, particularly in underserved and rural areas, did not. PMSMA was designed to close precisely this gap.

The scheme completed a decade of implementation on 9 June 2026, an occasion the Ministry marked with nationwide events, a special ₹75 Commemorative Coin and a ₹5 Postal Stamp, and a formal accounting of outcomes.

Source: PIB, Ministry of Health and Family Welfare (9 June 2026) 

Functioning

PMSMA guarantees a minimum package of antenatal care to women in their second or third trimester (13 weeks to delivery) at public health facilities (Primary and Community Health Centres, District and Sub-District Hospitals, and urban health facilities) on the 9th of every month, in addition to routine ANC available through the year. 

The core objectives are to:

• Ensure at least one comprehensive antenatal check-up by a physician or specialist for every pregnant woman in her second or third trimester;
• Improve the quality of ANC through diagnostics, screening, appropriate management of clinical conditions, and structured counselling;
• Identify and line-list high-risk pregnancies (HRPs) based on obstetric and medical history;
• Support birth planning and complication readiness, particularly for women with identified risk factors; 
• Extend additional outreach to women who have missed or dropped out of routine ANC.

The service package includes clinical examination, laboratory investigations (blood and urine tests), one ultrasonography during the second trimester, essential medicines such as Iron and Folic Acid (IFA) and calcium supplements, and nutrition and birth-preparedness counselling, delivered through a single-window model so that women are not required to make repeat visits for different services (Ministry of Health and Family Welfare, n.d.).

A distinctive design feature is the scheme’s engagement of private-sector doctors as volunteers. The Prime Minister’s original appeal asked obstetricians, gynaecologists, radiologists and physicians in private practice to dedicate roughly twelve days a year, one clinic day a month, to PMSMA sessions at government facilities, particularly where government-sector specialists are unavailable (Prime Minister’s Office, 31 July 2016). Volunteer contributions are recognised annually through the ‘IPledgeFor9’ Achievers Awards (Ministry of Health and Family Welfare, n.d.).

High-risk pregnancies are identified through screening for 25 specified conditions, including HIV, syphilis, severe anaemia, pregnancy-induced hypertension, gestational diabetes, hypothyroidism, tuberculosis, previous caesarean section, twin or multiple pregnancy, teenage pregnancy and bad obstetric history, among others (Ministry of Health and Family Welfare, 2 August 2024). Each woman’s Mother and Child Protection (MCP) Card carries a colour-coded sticker at every visit: green for no risk factor detected and red for a high-risk pregnancy, creating a portable, visible record that follows her across visits and facilities (Ministry of Health and Family Welfare, n.d.).

Extended PMSMA: From Identification to Follow-Up

Identifying a high-risk pregnancy is only the first step; the harder task is ensuring that identification translates into a safe outcome. This is the gap that Extended PMSMA (e-PMSMA), launched in January 2022, was designed to close (National Health Mission, 2022). Under e-PMSMA, every woman identified as high-risk is individually tracked by name, through to 45 days after delivery, rather than being logged only in aggregate. 

The strategy adds three features to the base scheme:

1. Name-based line-listing of HRPs, with provision for up to four additional PMSMA sessions in a month where needed;
2. SMS-based alerts to both the beneficiary and the attending Accredited Social Health Activist (ASHA) worker for registration and follow-up visits; and
3. Case-based financial incentives: ₹100 per follow-up visit to the beneficiary, for up to three visits, to offset transport costs; a separate ₹100 per visit to the ASHA worker for mobilising the beneficiary to attend, for the same three visits; and a further ₹500 to the ASHA on verified achievement of a healthy outcome for mother and child at the 45-day mark (National Health Mission, 2022).

These incentives are funded through the RCH (Reproductive and Child Health) flexible pool under the National Health Mission (NHM), alongside state-level and district-level allocations for sensitisation, IEC campaigns and free diagnostics under the Janani Shishu Suraksha Karyakram (JSSK) (National Health Mission, 2022).

Performance

The Ministry’s ten-year accounting, released in June 2026, offers the fullest picture of implementation scale. Since 2016, more than 7.5 crore antenatal check-ups have been conducted under PMSMA, in addition to routine ANC, and nearly 1.2 crore high-risk pregnancies have been identified and tracked. More than 9,000 private healthcare providers are registered as volunteers under the scheme across states and Union Territories and quality ANC services are now being extended through 1.8 lakh Ayushman Aarogya Mandirs as part of the tenth-anniversary rollout (Ministry of Health and Family Welfare, 8 June 2026).

Coverage indicators from National Family Health Survey (NFHS-6) point to broad-based gains in service uptake: antenatal care coverage has risen to 95.9 percent, institutional deliveries to 90.6 percent and the share of women receiving at least four ANC visits to 65.2 percent, though first-trimester registration, at 76.2 percent, still lags the other indicators (Ministry of Health and Family Welfare, 8 June 2026).

Institutional deliveries recorded under HMIS (Health Management Information Systems) have declined marginally in absolute numbers over the three most recent financial years  from 2.02 crore in 2022–23 to 1.94 crore in 2024–25 (Ministry of Health and Family Welfare, 13 March 2026). Reading alongside NFHS-6’s finding that the institutional delivery rate itself has risen, this decline in absolute numbers most plausibly reflects India’s falling birth rate rather than a coverage setback, but the Ministry’s public communication does not make this connection explicit.

Impact

According to the Sample Registration System (SRS), India’s MMR declined from 130 per lakh live births in 2014–16 to 87 in 2022–24, accounting for a fall of 43 points (Ministry of Health and Family Welfare, 8 June 2026). This is drawn from the most recent SRS bulletin (2022–24); the state-wise table below uses the preceding SRS window (2021–23), where the national figure is 88 — the one-point difference reflects the shift in reporting period, not a data inconsistency.

Citing the UN Maternal Mortality Estimation Inter-Agency Group, the Ministry has framed this as an 86 percent decline in maternal mortality since 1990, against a global average decline of 48 percent over the same period. The UN Inter-Agency Group for Child Mortality Estimation similarly reports a 70 percent decline in India’s neonatal mortality rate between 1990 and 2024, against a global decline of 54 percent, and a 79 percent decline in the under-five mortality rate against a global decline of 61 percent (Ministry of Health and Family Welfare, 9 June 2026).

PMSMA’s contribution to this decline should be read as one part of a wider maternal health architecture rather than in isolation. The Janani Suraksha Yojana (JSY), a conditional cash transfer promoting institutional delivery, has benefited more than 11.96 crore women since 2014–15.

The Janani Shishu Suraksha Karyakram (JSSK) entitles women delivering in public facilities to free drugs, diagnostics, diet, transport and blood transfusion, and has supported more than 18.05 crore beneficiaries in the same period. Surakshit Matritva Aashwasan Yojana (SUMAN) commits to zero denial of maternal health services across a network of over 99,290 facilities, while the Pradhan Mantri Matru Vandana Yojana (PMMVY), POSHAN Abhiyaan and LaQshya address maternity benefits, nutrition and labour-room quality respectively (Ministry of Health and Family Welfare, 8 June 2026).

Beyond the aggregate numbers, PMSMA’s design choices have produced identifiable qualitative gains. The red-sticker system and name-based line-listing of high-risk pregnancies gives frontline health workers a simple, portable way to prioritise the women who need closest attention, rather than treating all antenatal visits uniformly. The scheme’s engagement of private-sector OB-GYNs, radiologists and physicians at public facilities has extended specialist-led screening and risk assessment into government health centres that would otherwise rely solely on general-duty staff, particularly in areas with thin specialist coverage. And the PMSMA portal’s digital tracking, extended further under e-PMSMA’s SMS alerts and name-based follow-up, has strengthened the continuity between identification, referral and postpartum monitoring in a way that a purely paper-based system would struggle to sustain.

PMSMA’s specific contribution within this architecture is specialist-led screening and risk stratification during the antenatal period, feeding women identified as high-risk into referral pathways that these other schemes are designed to support through delivery and immediate postpartum care.

State-Wise Disparities Persist

The aggregate national decline conceals wide variation across states. The table below, drawn from the SRS 2021–23 bulletin, illustrates the spread:

Source: Registrar General of India, Sample Registration System bulletin, as tabulated in the Ministry of Health and Family Welfare’s reply to Lok Sabha Unstarred Question No. 3474 (13 March 2026).

Kerala, Andhra Pradesh, Maharashtra and Tamil Nadu report MMR already at or near the SDG target of 70, while Madhya Pradesh, Chhattisgarh and Odisha remain far above the national average. Odisha and Chhattisgarh are also the only states in the table whose MMR rose rather than fell across the three most recent SRS windows, while Madhya Pradesh, despite remaining the second-highest of the three, at least shows a declining trend over the same period.

This pattern is consistent with a broader trend in India’s health outcomes: national averages driven by strong performance in a subset of states, while others show slower or stalled improvement despite the same scheme architecture being nominally in place. It suggests that PMSMA’s impact is mediated heavily by state-level health system capacity i.e., availability of specialists, functioning First Referral Units (FRUs) and last-mile ASHA outreach, rather than by scheme design alone.

This pattern does not appear to be explained by underinvestment in the weaker-performing states. State-wise PMSMA fund approvals under the NHM/RCH flexible pool, reported as of early FY 2023–24, show Uttar Pradesh (₹3,211.34 lakh), Madhya Pradesh (₹1,737.26 lakh) and Odisha (₹1,670 lakh) among the highest-approved states, against a total approved outlay of ₹17,573.8 lakh nationally, while Maharashtra (₹57.23 lakh), Andhra Pradesh (₹31 lakh) and Kerala (₹11.97 lakh) — three of the four MMR front-runners — received a fraction of that allocation (Ministry of Health and Family Welfare, 1 August 2023).

While this is a limited cross-section rather than a rigorous correlation analysis, the absence of any visible positive relationship between fund approvals and outcomes suggests that state-level capacity may matter more than funding levels alone in shaping PMSMA’s effectiveness.

Emerging Issues

Three limitations stand out from a decade of implementation data.

First, private-sector participation, while significant in absolute terms, remains modest relative to India’s need: just over 9,000 registered providers nationally is a thin layer of specialist capacity to supplement a public system serving a birth cohort of roughly 2.5 crore deliveries a year (Registrar General of India, 2023).

Second, the scheme’s effectiveness is structurally dependent on ASHA workforce capacity for both mobilisation and the follow-up tracking that e-PMSMA requires a burden layered onto an already multi-tasked cadre, and one that scheme design alone does not resolve.

Third, and most significant, the state-wise MMR data suggest that a uniform national scheme is not, by itself, sufficient to close outcome gaps rooted in differences in state health infrastructure, workforce density, and referral-system functionality. PMSMA’s own reporting acknowledges linkage to First Referral Units as a design feature, but does not publicly report FRU functionality or referral-completion rates by state, a more direct measure of whether identification is translating into safe delivery in the weaker-performing states.

Audit evidence from multiple states reinforces these concerns. A Performance Audit by the Comptroller and Auditor General of India (CAG) in Delhi found significant gaps in PMSMA implementation. Although a State-level coordination committee had been constituted, only one meeting was held during 2017–18 to 2020–21, while no District-level PMSMA coordination meetings were conducted.

Of the 3.82 lakh pregnant women registered under PMSMA during 2016–17 to 2020–21, 16,557 (4.33 per cent) were identified as high-risk; however, details of only 7,164 (44.75 per cent) were shared with ANMs and ASHAs for follow-up. The audit also found that, across April 2016 to September 2022, only 47.16 per cent of women registered under PMSMA received antenatal care from either an OBGYN specialist or an MBBS doctor (Comptroller and Auditor General of India, 2024a).

In Nagaland, the CAG found even more limited programme reach: PMSMA was being implemented in only 36 of 615 health units across 11 districts, while achievement against targeted antenatal care coverage in the test-checked districts ranged from just 0.09 per cent to 6.26 per cent (Comptroller and Auditor General of India, 2020). These findings suggest that the effectiveness of PMSMA is shaped not only by the design of the scheme but also by the administrative capacity, facility availability and monitoring systems through which it is implemented.

The West Bengal CAG audit also highlights the importance of verifiable facility-level reporting: although the State reported that PMSMA clinics were being conducted across 440 rural and 172 urban facilities, with pregnant women examined by specialists on the 9th of every month, the Department did not furnish the list of facilities to Audit, limiting independent verification of the reported coverage. CAG further noted that this response did not address the underlying audit concern, since PMSMA covers antenatal care only and does not extend to the postnatal and intranatal care gaps under examination (Comptroller and Auditor General of India, 2024b).

Way Forward

Addressing these gaps points to a set of priorities for the next phase of implementation, building directly on what the scheme’s own data indicate:

1. Publish state-wise and district-wise data on FRU functionality and referral-completion rates for HRP cases, not only identification and tracking numbers, so that the gap between risk detection and safe outcome becomes visible and actionable rather than inferred.

2. Direct incremental private-sector volunteer recruitment and specialist deployment toward the states with the highest MMR namely Odisha, Chhattisgarh, Madhya Pradesh, Uttar Pradesh and Assam, rather than relying on uniform national targets that understate the concentration of need.

3. Review ASHA workload and incentive structures specifically for e-PMSMA follow-up, given that the strategy’s effectiveness depends on sustained, individual-level tracking of HRP cases through a cadre already carrying multiple national health programme responsibilities.

4. Strengthen convergence reporting across JSY, JSSK, SUMAN and PMSMA at the facility level, so that a woman flagged as high-risk under PMSMA can be tracked through the referral chain into these complementary schemes rather than each being measured independently.

5. Clarify, in official communication, the relationship between declining absolute institutional-delivery numbers and demographic trends such as falling birth rates, to avoid the figures being read as either a coverage decline or an unqualified success without the underlying context.

Conclusion

Over a decade, PMSMA has grown from a monthly antenatal clinic initiative into one of the more closely tracked components of India’s maternal health strategy, with over 7.5 crore check-ups and nearly 1.2 crore high-risk pregnancies identified and, since 2022, individually followed through to outcome. The accompanying decline in national MMR  from 130 to 87 per lakh live births between 2014–16 and 2022–24, is a genuine achievement, and one that places India ahead of the global average pace of maternal mortality reduction.

But the scheme’s own data point to where the next decade of work lies: in states where MMR remains two to five times the national figure, in strengthening the referral and follow-up systems that connect identification to safe delivery and in building specialist and frontline-worker capacity in the districts furthest from India’s better-performing states.

References

1. Comptroller and Auditor General of India (CAG). (2020). Performance Audit of Select District Hospitals in Nagaland. Report No. 3 of 2020. https://cag.gov.in/uploads/download_audit_report/2021/10%20Chapter%206-061a2456527abf0.08428898.pdf

2. Comptroller and Auditor General of India (CAG). (2024a). Performance Audit on Public Health Infrastructure and Management of Health Services. Government of NCT of Delhi. Report No. 3 of 2024, Section 7.5.4.3, pp. 138–140. https://cag.gov.in/uploads/download_audit_report/2024/Report-No.-3-of-2024_PA-on-PHIMHS_English-%2811-09-2024%29-067c186cc63bfb6.16059277.pdf
3. Comptroller and Auditor General of India (CAG). (2024b). Report of the Comptroller and Auditor General of India on Public Health Infrastructure and Management of Health Services in West Bengal. Government of West Bengal. Report No. 3 of 2024, Chapter 3 (Healthcare Services). https://cag.gov.in/uploads/download_audit_report/2022/4.-WB-PHIMHS-2021-22-%28Report-No.-3-of-2024%29-06a6899790a5672.94116531.pdf

4. Ministry of Health and Family Welfare, Government of India. (2017). National Health Policy 2017. https://nhsrcindia.org/sites/default/files/2021-07/National%20Health%20Policy%202017%20(English)%20.pdf
5. Ministry of Health and Family Welfare, Government of India. (2023, August 1). State/UT-wise approvals towards PMSMA activities under the RCH Flexible Pool [Reply to Rajya Sabha Unstarred Question No. 1403]. Open Government Data Platform India. https://www.data.gov.in/resource/stateut-wise-approvals-towards-pradhan-mantri-surakshit-matritva-abhiyan-pmsma-activities
6. Ministry of Health and Family Welfare, Government of India. (2024, August 2). Update on Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA) [Press release]. Press Information Bureau. https://www.pib.gov.in/PressReleaseIframePage.aspx?PRID=2040949
7. Ministry of Health and Family Welfare, Government of India. (2026, March 13). Steps taken for reducing maternal mortality [Press release; reply to Lok Sabha Unstarred Question No. 3474]. Press Information Bureau. https://www.pib.gov.in/PressReleasePage.aspx?PRID=2239637
8. Ministry of Health and Family Welfare, Government of India. (2026, June 8). Pradhan Mantri Surakshit Matritva Abhiyaan: A decade of inclusive maternal healthcare delivery [Press release]. Press Information Bureau. https://www.pib.gov.in/PressReleasePage.aspx?PRID=2270486
9. Ministry of Health and Family Welfare, Government of India. (2026, June 9). Union Health Minister Shri J.P. Nadda launches nationwide celebrations to mark “10 years of PMSMA – a decade of care” [Press release]. Press Information Bureau. https://www.pib.gov.in/PressReleasePage.aspx?PRID=2270828
10. Ministry of Health and Family Welfare, Government of India. (n.d.). About the scheme. Pradhan Mantri Surakshit Matritva Abhiyan.  https://pmsma.mohfw.gov.in/about-scheme/
11. National Health Mission. (2022). Guidance note for extended PMSMA for tracking high-risk pregnancies (e-PMSMA). Ministry of Health and Family Welfare, Government of India. https://www.nhm.gov.in/New_Update-2022-23/MH/GUIDELINES-%20MH/Guidance_Note-Extended_PMSMA_for_tracking_HRPs.pdf
12. National Health Mission. (n.d.). Pradhan Mantri Surakshit Matritva Abhiyan.  https://nhm.gov.in/index1.php?lang=1&level=3&sublinkid=1308&lid=689
13. Prime Minister’s Office. (2016, July 31). PM’s “Mann Ki Baat” programme on All India Radio. PM India. https://www.pmindia.gov.in/en/news_updates/pms-mann-ki-baat-programme-on-all-india-radio/
14. Registrar General of India. (2023). Sample Registration System (SRS) Statistical Report 2023. Office of the Registrar General & Census Commissioner, India. https://censusindia.gov.in/nada/index.php/catalog/46172/download/50420/SRS_STAT_2023.pdf
15. World Health Organization. (n.d.). SDG target 3.1: Maternal mortality. WHO Global Health Observatory data repository. https://www.who.int/data/gho/data/themes/topics/sdg-target-3-1-maternal-mortality

About The Contributor

Shruti Sethi is a Research & Editorial Intern at IMPRI. She holds a bachelor’s degree in Economics from St. Xavier’s University, Kolkata. Her research interests include Gender & Labour Economics.

Acknowledgement

The author extends her sincere gratitude to the IMPRI team for their expert guidance and constructive feedback throughout the process.

Reviewed by Rakhi Kumari and Shruti Chandra.

Disclaimer

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

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