Kayalvizhi Sundar, 25, beams as she comes out of the Government Women and Children’s Hospital in Egmore in Chennai on a hot humid morning earlier this month.

She has just received a sum of Rs4,000 ($61.53) from the Tamil Nadu state government. “The nurse told me that this money was for me to eat healthy food,” said Sundar, who is seven months pregnant. “She advised me and my husband that I should not spend it on anything else.”

Sundar will receive another Rs8,000 from the state in two instalments—once when she delivers her baby and another when the child is four-and-a-half months old. But before collecting her last instalment, however, she will have to get her baby immunised with the pentavalent vaccine, which combines different vaccines in one injection and protects infants against whooping cough, tetanus, hepatitis B, diphtheria, and a bacteria that causes meningitis and pneumonia.

Tamil Nadu, with a clutch of such well-planned and well-implemented healthcare and monetary programmes, is arguably one of the best states in India for expecting moms. And this month, the government rolled out another landmark initiative for mothers.

On Aug. 3—to commemorate International Breastfeeding Week—state chief minister J. Jayalalithaa inaugurated more than 350 breastfeeding rooms at bus terminals across the state, where mothers can feed their children. This is the first time any state in the country has made such arrangements. On the same day, breast milk banks were launched in seven government hospitals across the state. Each hospital would be given equipment worth up to Rs10 lakh to store milk donated by mothers. According to reports, milk in these banks can be preserved for up to three months.

Nurturing state

For decades, successive governments in this southern Indian state have focused on improving healthcare access for pregnant women.

In 1987, the All India Anna Dravida Munnetra Kazhagam (AIADMK) government, under former chief minister MG Ramachandran, launched the state’s flagship programme for pregnant women—the Dr. Muthulakshmi Reddy Maternity Benefit Scheme, named after the prominent women’s rights activist.

“Not a single state has implemented this important benefit till date. Tamil Nadu is the only state doing this.”

The first-of-its-kind scheme in the country initially provided an amount of Rs300 to every woman below the poverty line to help cover the expenses incurred during childbirth. In 1995, the sum was increased to Rs500. A little over a decade later, the amount was raised more than tenfold to Rs6,000. Then, in 2011, the current state government doubled this sum to Rs12,000.

“In 2012, the National Food Security Act was passed by the government of India and this Act has a clause in it that provides maternity benefit of Rs6,000 ($92.30) for every pregnant mother in the country,” said Job Zachariah, who heads the field office of United Nations International Children’s Emergency Fund (UNICEF), in Chennai. “Not a single state has implemented this important benefit till date. Tamil Nadu is the only state doing this.”

Experts Quartz spoke to say that the AIADMK government under Jayalalithaa—who has spent 13 of the last 24 years as the state’s chief minister, stepping down twice over corruption charges—is more proactive than others in implementing initiatives for the benefit of pregnant women and new mothers. Consider, for instance, the Amma baby care kit launched in 2014 for a sum of Rs67 crore. The scheme provides new mothers in government hospitals with baby powder, towel, dress, mosquito net, oil, shampoo, soap and even a toy for the baby.

In 1992, during her first stint as chief minister, Jayalalithaa’s pioneering programmes for unwed pregnant mothers—the cradle baby scheme—was aimed at reducing infanticide, specifically female infanticide. Women could leave unwanted infants, mostly infants born out of wedlock, in cradles set up in government shelters rather than killing them. Over 4,000 children have been left to the care of the state government under this scheme from 1992 to 2012, as per official records.

In the last decade alone, the state has managed to bring down infant mortality rate from 24 per 1,000 births in 2005 to 21 in 2013. This figure is almost half of the national average of 40 infants dying out of every 1,000 births. The maternal mortality rate of 90 deaths per 100,000 live deliveries is also well below the national average of 178.

Tamil Nadu ranks high in terms of institutional deliveries, too. Almost 99.3% of pregnant women deliver at hospitals, rather than at home. Compare this with 87.9% of institutional deliveries in Gujarat, 76.3% in West Bengal and 90.3% in Maharashtra, according to data from the latest report on the Rapid Survey on Children conducted by the union ministry of women and child development.

Borne by state

“As far as Tamil Nadu is concerned, everything is free for a pregnant woman until the child is six months old,” said S. Srinivasan, state coordinator for the National Rural Health Mission in Chennai.

Once a woman registers her pregnancy with the state, she has access to free health check-ups, including five ultrasound scans. If required, the government also covers the cost of caesarean births and anaesthetists.

“If specific medicines are not available at the hospital, the government allows hospitals to buy them from outside and reimburses the cost. We practically have unlimited funds as far as pregnant mothers are concerned,” Srinivasan said.

Ambulance services for pregnant women—both pick-up and drop facilities post delivery—are also free.

Malnutrition

The state government may be proactive in delivering healthcare to pregnant mothers but the system isn’t entirely flawless. Doctors admit that corruption is a problem—and mothers in remote areas of the state often do not get the full sum of Rs12,000, as government workers take their cut. Experts also say that giving money to pregnant women won’t do much unless the larger issue of malnutrition is sufficiently addressed.

“Tamil Nadu’s women suffer from chronic malnutrition and anaemia.”

“Giving money for nutritious food only once a woman is six-seven months pregnant makes no sense,” said Poongothai Aladi Aruna, a gynaecologist and former minister in the rival Dravida Munnetra Kazhagam government. “Tamil Nadu’s women suffer from chronic malnutrition and anaemia. Many women are in such poor health that they do not have breast milk to feed the child. We need to address the larger issue of malnutrition first and we need to do it urgently.”

Only 18.8% women in Tamil Nadu breastfeed, according to UNICEF. Singari Velmurugan, a 26-year-old resident of a remote village called Kuzhipatti, isn’t one of them.

From her village, the closest primary health centre is about 5 km away, and the closest district hospital is at a distance of 35 km in Dharmapuri town. She says a nurse visits her tiny hamlet twice a month to attend to pregnant women in the area. “The nurse gives us smelly tablets and does tests when we get pregnant,” she said. “We go once a week to the anganwadi and take the maavu (Tamil for flour), which we make kanji (Tamil for gruel or porridge) with, and have it. Sometimes they give us an egg, too.”

But despite this diet, Velmurugan could not feed her son.

“When my son was born, I did not have any breast milk,” she said. “I took the powders properly as instructed but food is scarce here. My husband earns only Rs1,000 a month and it is barely enough to feed him, myself, my mother-in-law and my father-in-law,” she said.

The problem of malnutrition became central to healthcare debate last November after the death of 13 newborns at a government hospital in Dharmapuri. Most of the infants who died had malformed lungs, according to hospital reports, indicating that mothers suffered acute malnutrition.

Nonetheless, Tamil Nadu is far ahead of several other Indian states when it comes to taking care of mothers-to-be.

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