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Introduction

The shift from PMSMA to Extended PMSMA (E-PMSMA) reflects India’s transition from episodic antenatal screening to continuous management of high-risk pregnancies, strengthening maternal healthcare delivery and advancing progress towards achieving SDG 3.1 on reducing maternal mortality.

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E-PMSMA: From Static Monitoring to Continuous Risk Management

• Longitudinal Care: E-PMSMA ensures that care extends beyond identifying risks to sustained follow-up throughout pregnancy until delivery.
  Eg: Every High-Risk Pregnancy (HRP) is individually tracked until a safe delivery is achieved.
• Additional Follow-ups: Unlike routine monthly check-ups, E-PMSMA mandates extra antenatal visits for high-risk women.
  Eg: Financial incentives support beneficiaries and ASHAs for up to three additional ANC visits.
• Timely Intervention: The strategy focuses on preventing complications through prompt referral and treatment.
  Eg: Identified HRPs are linked to the nearest First Referral Unit (FRU) for safe delivery.
• Digital Tracking: Technology enables continuity of care and reduces the chances of women being lost to follow-up.
  Eg: SMS alerts are sent to both pregnant women and ASHA workers for HRP registration and follow-up visits.
• SDG Alignment: Risk-based maternal care contributes directly to achieving SDG targets on maternal mortality reduction.
  Eg: India’s MMR declined from 130 (2014–16) to 87 per lakh live births (2022–24), moving closer to the SDG target of below 70.

Limitations and Challenges

• Regional Disparities: Maternal health outcomes remain uneven across States due to varying health capacities.
  Eg: According to SRS (2022–24), Assam (167) has MMR much higher than the national average of 87.
• Specialist Deficit: Shortage of obstetricians and specialists affects quality maternal care in rural areas.
  Eg: PMSMA depends partly on private specialists volunteering through the “I Pledge for 9” initiative.
• Weak Referral Systems: Timely access to higher facilities remains inadequate in many districts.
  Eg: Rural Health Statistics 2023–24 found that only about 55% of the required First Referral Units (FRUs) were functional.
• Digital Exclusion: Tracking mechanisms depend on mobile connectivity and accurate records.
  Eg: only 54% of women in rural India had ever used the internet (NFHS-5)
• Socio-cultural Barriers: Late registration, poor awareness and irregular ANC utilisation reduce programme effectiveness.
  Eg: NFHS-5 showed that only 58.1% of pregnant women received ANC in the first trimester.

Way Forward

• Strengthen FRUs: Enhance emergency obstetric infrastructure and specialist availability.
  Eg: Expand CEmONC services across underserved districts.
• Build Workforce: Improve deployment and incentives for maternal healthcare providers.
• Integrate Digital Systems: Develop seamless maternal tracking across the continuum of care.
  Eg: Link E-PMSMA monitoring with the Ayushman Bharat Digital Mission.
• Deepen Community Outreach: Promote early ANC registration and awareness at the grassroots.
  Eg: Use VHSNDs, SHGs and Jan Arogya Samitis for maternal health mobilisation.
• Enhance Convergence: Integrate maternal interventions with complementary schemes like Janani Suraksha Yojana (2005), Janani Shishu Suraksha Karyakram (2011) and Pradhan Mantri Matru Vandana Yojana (2017).

Conclusion

E-PMSMA signifies a paradigm shift from detecting risks to continuously managing them. By strengthening follow-up, referrals, digital tracking and convergence, India can accelerate progress towards SDG 3.1 and ensure safer motherhood for every woman.

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