Pradhan Mantri Surakshit Matritva Abhiyaan (PMSMA)

Why in News?

The Pradhan Mantri Surakshit Matritva Abhiyaan completed ten years of implementation. More than 7.50 crore pregnant women have received antenatal services under the programme, in addition to routine antenatal care.

The initiative provides free and comprehensive antenatal care at designated government health facilities on the 9th of every month.

Why Maternal Health Matters

Maternal health is an important indicator of the accessibility and quality of a country’s healthcare system.

Pregnancy-related complications can threaten the lives of both the mother and the child if risks such as severe anaemia, hypertension and gestational diabetes are not detected and treated early.

India’s Maternal Mortality Ratio declined from:

• 556 deaths per lakh live births in 1990
• 130 during 2014–16
• 87 during 2022–24

India aims to achieve the Sustainable Development Goal of reducing MMR to below 70 per lakh live births by 2030.

What is Maternal Mortality Ratio?

The Maternal Mortality Ratio is the number of maternal deaths per one lakh live births during a given period.

A maternal death refers to the death of a woman during pregnancy or within 42 days of the termination of pregnancy due to causes related to or aggravated by pregnancy or its management. Accidental and incidental causes are excluded.

What is Pradhan Mantri Surakshit Matritva Abhiyaan (PMSMA)?

The Pradhan Mantri Surakshit Matritva Abhiyaan was launched by the Ministry of Health and Family Welfare in 2016.

It provides:

• Free antenatal care
• Comprehensive medical examinations
• Diagnostic services
• Medicines
• Counselling
• Identification and follow-up of high-risk pregnancies

The programme primarily serves pregnant women in their:

• Second trimester: 13–27 weeks
• Third trimester: 28 weeks until delivery

Services are provided at designated public health facilities in rural and urban areas on the 9th of every month.

Goal of PMSMA

PMSMA seeks to improve the quality and coverage of antenatal care, diagnostics and counselling under the Reproductive, Maternal, Newborn, Child and Adolescent Health strategy.

It is based on the principle that every pregnant woman should receive at least one comprehensive examination by a physician or specialist during the second or third trimester.

Major Objectives

• Ensure at least one specialist antenatal examination for every pregnant woman.
• Improve the quality of antenatal services.
• Provide applicable diagnostic tests and medicines.
• Detect and manage existing medical and obstetric conditions.
• Identify and line-list high-risk pregnancies.
• Prepare individual birth and complication-readiness plans.
• Reach women who missed or discontinued routine antenatal care.
• Address malnutrition during pregnancy.
• Provide special attention to adolescent, early and high-risk pregnancies.
• Link high-risk cases with appropriate referral facilities.

Services Provided

The minimum service package includes:

• Clinical examination
• Blood and urine tests
• Ultrasonography
• Screening for high-risk factors
• Iron and folic acid supplements
• Calcium supplements
• Treatment of identified conditions
• Nutrition counselling
• Birth planning
• Complication-readiness counselling
• Safe-pregnancy guidance
• Mother and Child Protection Card
• Safe motherhood booklet

The programme follows a single-window approach so that pregnant women can receive essential investigations, medicines and counselling at one facility.

High-Risk Pregnancy Identification

PMSMA screens pregnant women for 25 high-risk factors, including:

• HIV and syphilis
• Severe anaemia
• Pregnancy-induced hypertension
• Gestational diabetes
• Hypothyroidism
• Tuberculosis and malaria
• Previous caesarean section
• Multiple pregnancy
• Hepatitis B
• Abnormal fetal heart rate
• Teenage pregnancy
• High fever
• Reproductive tract and sexually transmitted infections
• Previous stillbirth
• Congenital malformation
• Negative blood group
• Early or elderly first pregnancy
• Grand multiparity
• Short stature
• Other medical or obstetric complications

Women identified as high-risk are linked to the nearest First Referral Unit for appropriate management and safe delivery.

Colour-Coded Risk Identification

A sticker is placed on the Mother and Child Protection Card:

• Green sticker: No risk factor detected
• Red sticker: High-risk pregnancy identified

This enables health workers to identify cases requiring priority care and follow-up.

Extended PMSMA

The Extended PMSMA, or e-PMSMA, was introduced in 2022 to strengthen the management of high-risk pregnancies.

Key Features

• Name-based line-listing of high-risk pregnancies
• Up to four additional PMSMA sessions in a month
• Individual tracking until a healthy outcome
• Follow-up until the 45th day after delivery
• SMS alerts to the beneficiary and ASHA worker
• Additional check-ups and continuous monitoring
• Financial support for follow-up visits

The initiative ensures that high-risk identification is followed by sustained care rather than remaining a one-time diagnosis.

Financial Incentives under e-PMSMA

Incentives for ASHA Workers

• ₹100 per high-risk pregnancy for mobilisation for each of up to three follow-up visits
• ₹500 per high-risk pregnancy after a healthy outcome for both mother and child is verified on the 45th day after delivery

Assistance to Beneficiaries

A woman identified with a high-risk pregnancy may receive:

• ₹100 per follow-up visit
• Support for a maximum of three visits
• Assistance towards transportation to the PMSMA clinic or nearest appropriate facility

Private-Sector Participation

PMSMA systematically involves private medical practitioners.

Private-sector:

• Obstetricians and gynaecologists
• Radiologists
• Physicians

are encouraged to volunteer at government facilities where public-sector specialists are unavailable or inadequate.

Doctors were encouraged to contribute one day every month, amounting to 12 days annually.

The national PMSMA portal and mobile application facilitate private and voluntary-sector participation.

The IPledgeFor9 Achievers Awards recognise individuals and teams contributing voluntarily to the programme.

Who Can Access PMSMA?

PMSMA services are available to:

• Pregnant women in their second or third trimester
• Indian citizens residing in India
• Women attending designated facilities on the 9th of every month
• Women who missed or dropped out of routine antenatal care
• Women identified with high-risk pregnancies

High-risk and missed-ANC cases receive special attention.

Major Achievements

• More than 7.50 crore pregnant women received antenatal services.
•  India’s MMR declined by 43 points, from 130 to 87 per lakh live births between 2014–16 and 2022–24.
• High-risk pregnancy screening and specialist care became more systematic.
• e-PMSMA strengthened individual tracking and follow-up.
• Private doctors were mobilised to supplement government health services.
• Antenatal services became more accessible at designated facilities across the country.

The decline in MMR cannot be attributed to one scheme alone, but PMSMA forms an important part of India’s broader maternal-health framework.

PMSMA and Other Maternal-Health Initiatives

Janani Suraksha Yojana

Promotes institutional deliveries.

• More than 11.96 crore women benefited since 2014–15.

Janani Shishu Suraksha Karyakram

Provides free healthcare services to pregnant women and newborns.

• More than 18.05 crore beneficiaries received support.

SUMAN

 The Surakshit Matritva Aashwasan initiative strengthens respectful and quality maternal healthcare through more than 99,290 facilities.

Other Supporting Programmes

• POSHAN Abhiyaan: Maternal and child nutrition
• PM Matru Vandana Yojana: Maternity benefits
• LaQshya: Quality improvement in labour rooms
• National Health Mission: Financial and institutional support
• Ayushman Arogya Mandirs: Primary healthcare and antenatal services

Together, these initiatives create an integrated maternal and newborn healthcare ecosystem.

Commemoration of Ten Years

The ten-year milestone is being observed through:

• Ayushman Arogya Shivirs at 1.8 lakh Ayushman Arogya Mandirs
• Special PMSMA sessions at district hospitals, sub-district hospitals and First Referral Units
• Community awareness programmes through:
  • Village Health, Sanitation and Nutrition Days
  • Jan Arogya Samitis
  • Self-Help Groups

Significance

1. Early Risk Detection

Screening identifies high-risk conditions before they become life-threatening.

2. Universal and Free Care

The programme provides quality antenatal services irrespective of income or location.

3. Specialist Access

Pregnant women receive at least one examination by a physician or trained specialist.

4. Reduction in Maternal and Neonatal Risks

Timely treatment of anaemia, hypertension, diabetes and other conditions improves pregnancy outcomes.

5. Continuity of Care

e-PMSMA tracks high-risk pregnancies until after delivery.

6. Public–Private Partnership

Volunteer doctors supplement specialist shortages in government facilities.

7. Last-Mile Inclusion

Special efforts target women who missed or dropped out of routine antenatal care.

Challenges

• Shortage of obstetricians, radiologists and trained doctors
• Uneven quality of services across districts
• Limited access in remote and difficult areas
• Delays in diagnostic reports and referrals
• Weak follow-up of high-risk pregnancies
• Inadequate awareness among vulnerable women
• Transportation barriers
• Digital and documentation gaps
• Need for stronger coordination between facilities, ASHAs and referral units

Way Forward

• Ensure specialist availability at every designated PMSMA facility.
• Strengthen referral transport and First Referral Units.
• Improve the tracking of high-risk pregnancies through e-PMSMA.
• Expand ultrasound and diagnostic facilities in underserved areas.
• Increase awareness through ASHAs, SHGs and community institutions.
• Improve coordination between antenatal, delivery and postnatal services.
• Conduct regular audits of maternal deaths and near-miss cases.
• Strengthen nutrition, anaemia and adolescent-pregnancy interventions.
• Encourage greater private-sector volunteering.
• Monitor outcomes rather than only the number of check-ups conducted.

Conclusion

PMSMA has institutionalised free, specialist antenatal care on a fixed day every month and strengthened the early detection of high-risk pregnancies.

Its integration with e-PMSMA, referral services, ASHA follow-up and other maternal-health programmes has contributed to a more systematic and inclusive healthcare framework. Continued investment in specialists, diagnostics, transport and post-diagnosis follow-up is essential to ensure that no woman loses her life while giving life.