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Motherhood is often described as a fulfilling experience, yet for many women it still brings risk, ill health, and even death. How a society cares for women during pregnancy and childbirth is a true test of its public health system. It shows whether the system can reach a woman when she is at her most vulnerable.
On this front, Jammu and Kashmir has made considerable progress. According to the Economic Survey 2025-26, institutional deliveries in J&K have reached 99.7 percent as per HMIS data. To understand what this means, we need to look back. In NFHS-4 (2015-16), the figure was 85.6 percent. By NFHS-5 (2019-21), it had moved to 92.4 percent.
Now we are almost at universal coverage. The Survey also reports full immunisation coverage of 100 percent (HMIS), while the Infant Mortality Rate stands at 14 per 1,000 live births (SRS 2022) and the Neonatal Mortality Rate at 9.8 (NFHS-5). The national average for institutional delivery is still around 88-89 percent. J&K is now ahead of many larger states.
These are not just statistics on a chart. In a region where villages in Kishtwar or Gurez can remain cut off by snow for weeks, reaching the nearest district hospital from some remote areas may involve hours of walking followed by a difficult road journey. Institutional delivery becoming the norm marks a major social shift. For many families in remote areas, home births attended by traditional birth attendants known as dais were once the more accessible option.
What drove this change? It was not one single scheme, but layers of small improvements adding up. Road connectivity under PMGSY made referrals possible. The growth of First Referral Units (FRUs) and Sub-District Hospitals meant a woman did not have to reach Jammu or Srinagar for a complicated delivery. The 108-ambulance service, free transport under JSSK and, above all, the ASHA worker in the village have all contributed to this progress. Often trusted by families, ASHA workers track pregnancies and help ensure timely referrals.
The question now is how to sustain this 99.7 percent and make sure it actually means safe delivery. For families with limited incomes, the cost of reaching a health facility can remain a concern even when delivery itself is free. The family may still have to consider auto fare, medicines, blood tests, food during the hospital stay, and lost wages for the husband accompanying her. These perceived costs can delay care by crucial hours.
This is where entitlements already exist, but often do not reach. Janani Suraksha Yojana (JSY) provides cash assistance to promote institutional delivery, especially for BPL and SC/ST women. Janani Shishu Suraksha Karyakram (JSSK) goes a step further and guarantees completely free delivery, including Caesarean sections, medicines, diagnostics, blood, diet, and drop-back transport in public facilities. On paper, no woman should pay a rupee in a government hospital.
The challenge is not simply the availability of schemes, but whether women know about them and can access their benefits. Studies and field observations from within Jammu and Kashmir suggest that some women continue to perceive institutional delivery as expensive, highlighting a gap between the availability of government support and awareness of the entitlements.
Bridging this gap is not about printing more posters. It is about conversation. Regular home visits by ASHAs and ANMs, early registration of pregnancy in the first trimester, and clear, non-technical counselling in local language can ensure no pregnancy goes unnoticed and no woman remains unaware of her rights. What is needed is a basic birth preparedness plan, coupled with better coordination between peripheral staff and referral hospitals. Timely tracking of high-risk conditions like anaemia, hypertension or breech can prevent them from turning into midnight emergencies.
Education matters here too. Women who have had access to education may be better placed to understand health advice, recognise risks and make informed decisions about their care. Keeping girls in school, particularly in border districts, can also help improve maternal health over time.
The 99.7 percent figure marks a major achievement in institutional delivery coverage. The next challenge is to ensure that women receive quality care once they reach a health facility. When numbers go up, we need to strengthen our FRUs, ensure specialist presence, and support our staff nurses who manage heavy workloads in peripheral hospitals.
There is also the next layer of support. Pradhan Mantri Matru Vandana Yojana (PMMVY) for wage compensation, and the AB-PMJAY-SEHAT scheme, which now covers families in J&K, provide a safety net beyond delivery. Together, these schemes can help reduce the financial burden on families, although awareness of their benefits and access to those benefits remain important.
This matters beyond childbirth. When a woman can access care without financial or geographical barriers, trust in the public health system can grow. She is more likely to return for postnatal care and bring her child for immunisation. Together, these factors can help sustain progress in institutional deliveries and strengthen continuity of care for mothers and newborns.
J&K’s progress reflects years of effort by health workers and public health services, including those operating in difficult terrain. Maintaining these gains will require continued investment in accessible and reliable care.
That will require three things working together: greater awareness of entitlements at the household level in the local language, stronger and better supported outreach by peripheral health workers, and facilities that are not just present on paper, but accessible, staffed and responsive at midnight.
Ultimately, progress will mean that every woman in J&K, whether she lives in a remote village or a town, can reach a health facility when she needs it and receive care without worrying about the cost.
Author can be reached at Email id: bintez566@gmail.com
