Pradhan Mantri Surakshit Matritva Abhiyan

The Ministry of Health and Family Welfare (MoHFW) launched the Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA). This programme aims to provide comprehensive, free-of-cost, assured and quality antenatal care to all pregnant women on the ninth of every month.

The PMSMA guarantees minimum antenatal care services to women in their second or third trimester of pregnancy at the designated government health facilities. This programme follows a systematic approach for engagement with the private sector, which includes developing strategies for generating awareness, motivating private practitioners to volunteer for the programme campaign, and appealing to the private sector to participate in the PMSMA at government health facilities.

Objectives of PMSMA

The Pradhan Mantri Surakshit Matritva Abhiyan aims to improve the coverage and quality of Antenatal Care (ANC), including counselling and diagnostics services, as a part of the Reproductive Maternal Neonatal Child and Adolescent Health (RMNCH+A) strategy. Following are the objectives of the PMSMA:

• Ensure at least one antenatal care checkup for all pregnant women in their third or second trimester by a specialist or physician.
• Improve the quality of care during ANC visits, including the following services:
  • Every applicable diagnostic service.
  • Screening for the relevant clinical conditions.
  • Appropriate management of an existing clinical condition such as pregnancy-induced hypertension, anaemia, gestational diabetes, etc.
  • Proper documentation of services rendered and appropriate counselling services.
  • Additional service opportunities for pregnant women who have missed ANC visits.
• Identifying and line-listing high-risk pregnancies based on existing clinical conditions and obstetric or medical history.
• Appropriate birth complication readiness and planning for each pregnant woman, especially those identified with any comorbid or risk factor condition.
• Special emphasis on appropriate and adequate management of women with malnutrition and early diagnosis.
• Special focus on early and adolescent pregnancies as these pregnancies require specialised and extra care.

Features of PMSMA

• PMSMA is based on the premise that when each pregnant woman is appropriately investigated and examined by a physician at least once during the PMSMA and adequately followed up, it can result in a reduction of neonatal and maternal deaths in India.
• OBGY specialists, physicians or radiologists provide antenatal checkup services with support from private sector doctors to supplement the government sector efforts.
• The beneficiaries will receive a minimum package of antenatal care services (including drugs and investigations on the ninth day of each month at identified public health facilities, such as CHCs, PHCs, urban health facilities, DHs, etc.) in urban and rural areas in addition to the routine ANC at a health outreach or facility.
• Pregnant women attending the PMSMA clinics will receive a minimum package of investigations, including one ultrasound during the second trimester of pregnancy, and medicines such as calcium supplements, IFA supplements, etc., using the principles of a single window system.
• The programme targets to reach out to all pregnant women. Special efforts are made to reach out to women not registered for ANC, those registered but not availed of the ANC services and high-risk pregnant women.
• OBGY specialists, physicians or radiologists from the private sector will be encouraged to give voluntary services at the public health facilities where the government sector practitioners are inadequate or unavailable.
• Pregnant women will be given safe motherhood booklets and ‘Mother and Child Protection Cards’ (MCP).
• Identifying and following up on high-risk pregnancies. A sticker indicating the risk factor and condition of the pregnant women will be added to the MCP card for each visit, which is as follows:
  • Red sticker – for women with a high-risk pregnancy.
  • Green sticker – for women with no risk factor detected.
• A mobile application and a national portal for PMSMA are developed to facilitate the engagement of voluntary or private practitioners.
• The ‘IPledgeFor9’ achievers awards are devised to celebrate team and individual achievements and acknowledge voluntary contributions in districts and states across India.

Beneficiaries of PMSMA

All pregnant women are the beneficiaries of this programme. The PMSMA aims to reach out to every pregnant woman in the second and third trimesters of pregnancy. A mobile or web-based application is designed to help pregnant women find the nearest PMSMA facility and avail of services provided under this programme. 

The PMSMA website also provides the facility for all pregnant women to find their nearest facility to avail of ANC checkups and other services. The beneficiaries can click on the ‘Reach to Your Nearest Facility’ option on the website, select the state and district, and click on the ‘Search’ button. The designated government health facilities will be displayed on the screen. 

Services Provided Under PMSMA

The beneficiaries visiting the health care facility for the first time are registered in a separate PMSMA register. After that, they need not register or apply again to avail of the ANC checkup every month.

The following services are provided under the PMSMA to all pregnant women in India after registration:

• Auxiliary Nurse Midwifery (ANM) and Student Nurse (SN) ensure that all basic laboratory investigations are done before the OBGY or medical officer examines the beneficiary.
• The investigations report by the ANM and SN are generally handed over within an hour or before the beneficiaries meet the doctors for further checkups. This will ensure the identification of any high-risk status, like gestational diabetes, anaemia, infection, hypertension, etc., during the examination and further advice. 
• In certain cases, beneficiaries are advised to get ANM and SN investigations done where additional investigations are required and share the report during the next PMSMA or routine ANC checkup visit.
• The following lab investigations are provided under the PMSMA:
  • Ultrasound Sonography Test (USG).
  • Haemoglobin (Hb) level.
  • Urine albumin.
  • Random Blood Sugar (Dip stick). 
  • Rapid malaria test.
  • Rapid Venereal Disease Research Laboratory (VDRL) test.
  • Blood grouping.
  • Complete Blood Count (CBC).
  • Erythrocyte Sedimentation Rate (ESR).

Following are the specific services provided under PMSMA:

• A detailed history of all the beneficiaries is taken, examined and assessed for any complications, danger signs or a high-risk status.
• Examining foetal heart sounds and blood pressure per abdominal examination is done for all beneficiaries coming for the ANC checkup.
• When a pregnant woman visiting a public health facility needs a specific investigation, the sample is collected at the facility and transported for testing to the appropriate centre. The ANM or Multi Purpose Workers (MPW) are responsible for conveying the investigation results and following up with the pregnant women.
• A medical officer will examine and attend to a beneficiary after examination by ANM or staff nurse.
• All identified high-risk pregnancies should be referred to Janani Shishu Suraksha Karyakaram (JSSK) help desks or higher facilities for guiding pregnant women. 
• All identified high-risk women, including those with complications to be treated and managed by OBGY, CEmOC or BEmOC specialists. 
• One ultrasound is done for all pregnant women during the second or third trimester of pregnancy. 
• Before leaving the PMSMA facility, every pregnant woman is counselled on rest, nutrition, safety, safe sex, identification of danger signs, birth preparedness, institutional delivery and Postpartum Family Planning (PPFP).
• The MCP cards are filled out at the clinics, and a sticker indicating the risk factor and conditions of the pregnant women is added to the MCP card for each visit. The stickers are as follows:
  • Red sticker – for women with a high-risk pregnancy.
  • Blue sticker – for women with pregnancy-induced hypertension.
  • Yellow sticker – for pregnancy with comorbid conditions such as hypertension, diabetes and STIs.
  • Green sticker – for women with no risk factor detected.
• Counselling sessions for women focus on the following topics:
  • Care during pregnancy.
  • Birth preparedness, complication readiness, and contact details to be used in case of need.
  • Danger signs during pregnancy.
  • Family planning.
  • Importance of nutrition, including calcium supplementation and iron-folic acid consumption.
  • Identification of referral transport.
  • Institutional delivery.
  • Entitlements and service guarantee under JSSK.
  • Entitlements under Janani Suraksha Yojana (JSY).
  • Post-natal care.
  • Breastfeeding and complementary feeding.

Implementation of Services under PMSMA

The government health care centres are authorised to partner and implement the PMSMA in rural and urban areas, which are as follows:

• In rural areas – Rural hospitals, primary health centres, district hospitals, sub-district hospitals, medical college hospitals and community health centres.
• In urban areas – Urban health posts, urban dispensaries and maternity homes.

The Pradhan Mantri Surakshit Matritva Abhiyan is a programme which provides health care facilities to all pregnant women in India. It also provides counselling to all pregnant women regarding the safety and risks associated with pregnancies. Thus, it helps pregnant women have safe deliveries and access to health care facilities easily.

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