Skip to main content

Gujarat govt's programme to reduce maternal deaths, infant mortality failed to deliver, says WHO study

Counterview Desk
A high-profile study, carried out by half-a-dozen scholars associated with the Duke University, Rand Corporation, World Bank, Stanford University and Stanford Medical School (all from US), and Sambodhi Research and Communications Pvt Ltd (New Delhi), has come to the drastic conclusion that the Chiranjeevi yojna of the Gujarat government, launched to reduce infant and maternal deaths in rural areas, has been largely unsuccessful. Published in the Bulletin of the World Health Organization (WHO), it suggests that the samples collected by the scholars have put a question mark on the project’s aim of encouraging mothers to deliver in private hospitals, with the government subsidizing the costs.
“The project”, the study says, “aimed to provide free childbirth care at participating private-sector hospitals to women who are below the poverty line. The hospitals are paid 1600 Indian rupees per delivery, approximately $30 to $40. The hospitals may offer additional services to patients and charge separate fees for them. By 2012, approximately 800 private-sector hospitals were participating and the program had helped pay for more than 800,000 deliveries”.
Titled “Effect of Chiranjeevi Yojana on institutional deliveries and neonatal and maternal outcomes in Gujarat, India: a difference-in-differences analysis”, its authors, Manoj Mohanan, Sebastian Bauhoff, Gerard La Forgia, Kimberly Singer Babiarz, Kultar Singh and Grant Miller, say, there was an “increase in institutional delivery rates over time across Gujarat”, but this was “unrelated to the Chiranjeevi yojana.”
The study says, “The data collected through our study indicated that implementation of the programme was not associated with a statistically significant change in the probability of institutional delivery (2.42 percentage points).” In fact, it underlines, “The programme was also not associated with changes in the incidence of birth-related maternal complications, the use of antenatal and postnatal services or the use of neonatal intensive care.”
It underlines, “Our survey data suggests that 54% of the mothers in our sample suffered complications, including premature delivery, prolonged and obstructed labour, excessive bleeding, breech presentation, convulsions, hypertension, fever, incontinence or other birth-related problems after the programme had been implemented – and that the probability of these complications did not significantly change under the Chiranjeevi yojana.”
“Even if the programme has not increased institutional delivery rates, we would expect to see lower mean household expenditures on deliveries, given that the programme had paid providers over US$ 32 million as of 2012. However, analysis of our survey data indicated that implementation of the programme had no significant relationship either with the probability that households reported any delivery-related spending, or with mean hospital spending for delivery conditional on any spending”, it says.
The study underlines, “Our findings indicate that the Chiranjeevi yojana was not associated with changes in the probability of institutional delivery (including delivery at private institutions), maternal morbidity or delivery-related household expenditure. These findings differ from those reported by previous evaluations suggesting substantial benefits of the Chiranjeevi yojana, including a 27 per cent increase in institutional deliveries, a 90 per cent reduction in maternal deaths and a 60 per cent reduction in neonatal deaths.”
It insists, “These earlier studies did not address self-selection of women into institutional delivery, reporting inaccuracies by hospitals, or any increases in institutional deliveries over time that were unrelated to the programme. The programme was rolled out in a period when the economy of Gujarat was growing by over 10 per cent per year.”
Claiming that the results of the study are “robust to the inclusion of a wide variety of control variables”, and that “the staggered introduction of the Chiranjeevi yojana does not appear correlated with pre-existing trend differences in institutional delivery rates”, it notes, “There are several possible explanations for observing no increase in the probability of institutional delivery associated with the Chiranjeevi yojana. One is that the quality of services provided by private maternity hospitals is poor or, at least, is perceived to be poor by the local population. As a result, demand for institutional delivery may be low even if such delivery is provided free of charge.”
The study also points out that – despite the support of the programme – “institutional deliveries in Gujarat remain associated with large transportation costs, informal payments or other expenses that make programme benefits small relative to the full cost of institutional delivery.” The study emphasizes, “The finding of little or no association between the Chiranjeevi yojana and the out-of-pocket costs of deliveries is more puzzling. Even if the programme failed to make institutional delivery more attractive for any women, it should have reduced the household expenses for the many poor women who still chose institutional delivery.”
In fact, the poor women were found to be “asked to pay fees for deliveries in health facilities that were participating in the programme… It seems possible that some providers are providing extra, chargeable services – or simply increasing side charges. If charges are being made for extra services, those services do not appear to have any discernible health benefits.”

Interestingly, the study comes against the backdrop of the fact that the Chiranjeevi yojana received Wall Street Journal Asian Innovation Award in 2006 and has been hailed by some as a model for wide adoption throughout India. It was launched to help address the shortage of obstetricians at public hospitals accessible to low-income women in rural areas.

Comments

TRENDING

Wave of disappearances sparks human rights fears for activists in Delhi

By Harsh Thakor*  A philosophy student from Zakir Hussain College, Delhi University, and an activist associated with Nazariya magazine, Rudra, has been reported missing since the morning of July 19, 2025. This disappearance adds to a growing concern among human rights advocates regarding the escalating number of detentions and disappearances of activists in Delhi.

How community leaders overcome obstacles to protect forests and pastures in remote villages

By Bharat Dogra  Dheera Ram Kapaya grew up in such poverty that, unable to attend school himself, he would carry another boy’s heavy school bag for five kilometers just to get a scoop of daliya (porridge). When he was finally able to attend school, he had to leave after class five to join other adolescent workers. However, as soon as opportunities arose, he involved himself in community efforts—promoting forest protection, adult literacy, and other constructive initiatives. His hidden talent for writing emerged during this time, and he became known for the songs and street play scripts he created to promote forest conservation, discourage child marriages, and support other social reforms.

‘Act of war on agriculture’: Aruna Rodrigues slams GM crop expansion and regulatory apathy

By Rosamma Thomas*  Expressing appreciation to the Union Agriculture Minister for inviting suggestions from farmers and concerned citizens on the sharp decline in cotton crop productivity, Aruna Rodrigues—lead petitioner in the Supreme Court case ongoing since 2005 that seeks a moratorium on genetically modified (GM) crops—wrote to Union Minister Shivraj Singh Chouhan on July 14, 2025, stating that conflicts of interest have infiltrated India’s regulatory system like a spreading cancer, including within the Indian Council for Agricultural Research (ICAR).

The GMO illusion: Three decades of hype, harm, and false hope

By Sridhar Radhakrishnan  Three decades of hype, billions of dollars spent, and still no miracle crop. It's time to abandon the GMO biotech fairy tale and return to the soil, the seed, and the farmer. “Trust us,” they said. “GMOs will feed the world.” Picture a world where there is plenty of food, no hunger, fields grow without chemical pesticides, children are saved from malnutrition, and people live healthily.

Sandra Gonzalez Sanabria: An inspiring life from Colombia’s Amazonian valley

By Vidya Bhushan Rawat*  In the village of Héctor Ramírez, known as Agua Bonita, in La Montañita, Caquetá, Colombia, a vision of peace and renewal is unfolding. In the pre-2016 period, this would have been nearly impossible for outsiders to visit, as it was the epicenter of violent resistance against state oppression. However, after the Peace Accord was signed between the Colombian government and former revolutionaries—marking the end of a 70-year insurgency that claimed over 400,000 lives until 2025, including civilians, rebel fighters, and security personnel—things began to change. Visiting Agua Bonita during the Global Land Forum in Bogotá revealed a village of hope and resilience. Former FARC revolutionaries have settled here and transformed the village into a center of peace and aspiration.

Indigenous Karen activist calls for global solidarity amid continued struggles in Burma

By A Representative   At the International Festival for People’s Rights and Struggles (IFPRS), Naw Paw Pree, an Indigenous Karen activist from the Karen Human Rights Group (KHRG), shared her experiences of oppression, resilience, and hope. Organized with the support of the International Indigenous Peoples Movement for Self-Determination and Liberation (IPMSDL), the event brought together Indigenous and marginalized communities from across the globe, offering a rare safe space for shared learning, solidarity, and expression.

Activists allege abduction and torture by Delhi Police Special Cell in missing person probe

By A Representative   A press statement released today by the Campaign Against State Repression (CASR) alleges that several student and social activists have been abducted, illegally detained, and subjected to torture by the Delhi Police Special Cell. The CASR claims these actions are linked to an investigation into the disappearance of Vallika Varshri, an editorial team member of 'Nazariya' magazine.

India’s zero-emission, eco-friendly energy strategies have a long way to go, despite impressive progress

By N.S. Venkataraman*   The recent report released by OPEC’s World Oil Outlook 2025 has predicted that by the year 2050, crude oil would replace coal as India’s key energy source. Clearly, OPEC expects that India’s dependence on fossil fuels for energy will continue to remain high in one form or another.

Gender violence defies stringent laws: The need for robust social capital

By Dr. Manoj Kumar Mishra*  The tragic death of Miss Soumyashree Bisi, a 20-year-old student from Fakir Mohan College, Balasore, who reportedly self-immolated due to harassment, shocked the conscience of Odisha. Even before the public could process this horrifying event, another harrowing case emerged—a 15-year-old girl from Balanga, Puri, was allegedly set ablaze by miscreants. These incidents are not isolated; they highlight a disturbing pattern of rising gender-based violence across the state and the country.