{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T16:35:40Z","timestamp":1784133340403,"version":"3.55.0"},"reference-count":52,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,4,9]],"date-time":"2025-04-09T00:00:00Z","timestamp":1744156800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Glob. Women\u2019s Health"],"abstract":"<jats:p>Maternal morbidity and mortality in India continue to be high in populations and places with limited access to quality health services. Major barriers include out of pocket expenditure, lack of autonomy and information around maternal health services and weak implementation of pro-poor policies. Addressing demand-side barriers and enablers is critical to improving healthcare uptake and healthcare adherence along the pregnancy-postnatal continuum. This paper describes three well known operational spaces, maternal health financing, digital health, and self-care interventions within the Indian context including pro-poor maternal health policies, mobile health ecosystems and networks, and self-care opportunities that promote women's knowledge, choice, self-efficacy, and autonomy. These are expanded on to identify additional opportunities to improve access to MH services. Finally, the authors describe a new digital health intervention using a chat-based digital support system that has the potential to reduce barriers that women face in seeking and receiving quality MH services in Assam and elsewhere. Future work on how to implement such a combined approach need to account for multiple contextual factors, including understanding the nature and success of national pro-poor MH policies in each state, how the public and private health systems function and interact, social determinants of health as well as engaging women in the process to improve maternal and newborn health outcomes.<\/jats:p>","DOI":"10.3389\/fgwh.2025.1469328","type":"journal-article","created":{"date-parts":[[2025,4,9]],"date-time":"2025-04-09T05:20:04Z","timestamp":1744176004000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":4,"title":["Leveraging health financing, digital health and self-care approaches to strengthen maternal health journeys in India: perspectives from Assam"],"prefix":"10.3389","volume":"6","author":[{"given":"Sowmya","family":"Ramesh","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charlotte E.","family":"Warren","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ben","family":"Bellows","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Himanshi","family":"Dwivedi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Himani","family":"Gupta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashita","family":"Munjral","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Swapnil","family":"Rawat","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Tresner-Kirsch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jitender","family":"Nagpal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,4,9]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"550","DOI":"10.1111\/1471-0528.16888","article-title":"Trends in maternal mortality in India over two decades in nationally representative surveys","volume":"129","author":"Meh","year":"2022","journal-title":"BJOG"},{"key":"B2","doi-asserted-by":"publisher","first-page":"389","DOI":"10.1186\/s12884-021-03839-w","article-title":"Pro-poor policies and improvements in maternal health outcomes in India","volume":"21","author":"Bhatia","year":"2021","journal-title":"BMC Pregnancy Childbirth"},{"key":"B3","doi-asserted-by":"publisher","first-page":"e0285454","DOI":"10.1371\/journal.pone.0285454","article-title":"Factors associated with underutilization of antenatal care in India: results from 2019 to 2021 national family health survey","volume":"18","author":"Thakkar","year":"2023","journal-title":"PLoS One"},{"key":"B4","doi-asserted-by":"publisher","first-page":"957","DOI":"10.4081\/jphr.2018.957","article-title":"Has the janani suraksha yojana (a conditional maternity benefit transfer scheme) succeeded in reducing the economic burden of maternity in rural India? Evidence from the Varanasi district of Uttar pradesh","volume":"7","author":"Mukherjee","year":"2018","journal-title":"J Public Health Res"},{"key":"B5","doi-asserted-by":"publisher","first-page":"2227430","DOI":"10.1080\/23288604.2023.2227430","article-title":"Effects of the Indian national health insurance scheme (PM-JAY) on hospitalizations, out-of-pocket expenditures and catastrophic expenditures","volume":"9","author":"Parmar","year":"2023","journal-title":"Health Syst Reform"},{"key":"B6","doi-asserted-by":"publisher","first-page":"3553","DOI":"10.20546\/ijcmas.2020.912.422","article-title":"A review critical: impact assessment of janani surakshya yojana (JSY) in terms of, knowledge, attitude and service utilization pattern of women beneficiaries","volume":"9","author":"Bano","year":"2020","journal-title":"Int J Curr Microbiol App Sci"},{"key":"B7","doi-asserted-by":"publisher","first-page":"319","DOI":"10.1186\/1472-6963-12-319","article-title":"Addressing maternal healthcare through demand side financial incentives: experience of janani suraksha yojana program in India","volume":"12","author":"Gopalan","year":"2012","journal-title":"BMC Health Serv Res"},{"key":"B8","doi-asserted-by":"publisher","first-page":"394","DOI":"10.1186\/s12889-022-12563-9","article-title":"A decade of conditional cash transfer programs for reproductive health in India: how did equality fare?","volume":"22","author":"Godha","year":"2022","journal-title":"BMC Public Health"},{"key":"B9","doi-asserted-by":"publisher","first-page":"434","DOI":"10.1016\/j.worlddev.2014.06.004","article-title":"Does it pay to deliver? An evaluation of India\u2019s safe motherhood program","volume":"64","author":"Joshi","year":"2014","journal-title":"World Dev"},{"key":"B10","doi-asserted-by":"publisher","first-page":"289","DOI":"10.1177\/0972063414526116","article-title":"Tracking benefits of janani suraksha yojana\u2014a maternal cash transfer scheme: evidence from Rajasthan, India","volume":"16","author":"Purohit","year":"2014","journal-title":"J Health Manag"},{"key":"B11","doi-asserted-by":"publisher","first-page":"633","DOI":"10.1515\/bejeap-2022-0220","article-title":"Unpacking the financial incentives in health by revisiting India\u2019s \u201csafe motherhood program\u201d","volume":"23","author":"Baulia","year":"2023","journal-title":"BE J Econ Anal Policy"},{"key":"B12","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1007\/s40012-023-00375-0","article-title":"The ayushman bharat digital mission (ABDM): making of India\u2019s digital health story","volume":"11","author":"Sharma","year":"2023","journal-title":"CSIT"},{"key":"B13","doi-asserted-by":"publisher","first-page":"2423","DOI":"10.18203\/2394-6040.ijcmph20172835","article-title":"A study to assess awareness about janani suraksha yojana among beneficiaries of urban slums of Raipur city, chhattisgarh","volume":"4","author":"Khes","year":"2017","journal-title":"Int J Community Med Public Health"},{"key":"B14","doi-asserted-by":"publisher","first-page":"61","DOI":"10.4103\/WHO-SEAJPH.WHO-SEAJPH_15_21","article-title":"Women\u2019s experiences with maternity care in public health facilities of assam, India","volume":"11","author":"Rajbangshi","year":"2022","journal-title":"WHO South-East Asia J Public Health"},{"key":"B15","doi-asserted-by":"publisher","first-page":"327","DOI":"10.1177\/2516602620957781","article-title":"Issues and concerns of women\u2019s health in India: a case study of Cachar, Assam","volume":"2","author":"Dey","year":"2020","journal-title":"Int J Community Soc Dev"},{"key":"B16","doi-asserted-by":"publisher","first-page":"1876","DOI":"10.4103\/jfmpc.jfmpc_1636_21","article-title":"Prevalence of high-risk pregnancy among pregnant women enrolled under pradhan mantri surakshit matritva abhiyan in government health facilities of district Etawah, Uttar Pradesh: a cross-sectional study","volume":"11","author":"Prajapati","year":"2022","journal-title":"J Family Med Prim Care"},{"key":"B17","volume-title":"Towards a Holistic Digital Health Ecosystem in India","author":"Ranganathan","year":"2020"},{"key":"B18","volume-title":"myScheme\u2014One-Stop Search and Discovery Platform of the Government Schemes","year":"2022"},{"key":"B19","article-title":"Statistsa","year":"2024"},{"key":"B20","doi-asserted-by":"publisher","first-page":"598746","DOI":"10.3389\/fpsyt.2020.598746","article-title":"An integrated approach to improve maternal mental health and well-being during the COVID-19 crisis","volume":"11","author":"Shidhaye","year":"2020","journal-title":"Front Psychiatry"},{"key":"B21","doi-asserted-by":"publisher","first-page":"2467","DOI":"10.1093\/jamia\/ocab172","article-title":"Mobile health technology to improve maternal health awareness in tribal populations: mobile for mothers","volume":"28","author":"Choudhury","year":"2021","journal-title":"J Am Med Inform Assoc"},{"key":"B22","doi-asserted-by":"publisher","first-page":"e005489","DOI":"10.1136\/bmjgh-2021-005489","article-title":"Does exposure to health information through mobile phones increase immunisation knowledge, completeness, and timeliness in rural India","volume":"6","author":"Chakraborty","year":"2021","journal-title":"BMJ Glob Health"},{"key":"B23","doi-asserted-by":"publisher","first-page":"1287","DOI":"10.3390\/healthcare10071287","article-title":"Technology-Based (mhealth) and standard\/traditional maternal care for pregnant woman: a systematic literature review","volume":"10","author":"Kusyanti","year":"2022","journal-title":"Healthcare (Basel)"},{"key":"B24","doi-asserted-by":"publisher","first-page":"303","DOI":"10.1111\/jebm.12547","article-title":"Artificial intelligence, and digital health in improving primary health care service delivery in LMICs: a systematic review","volume":"16","author":"Saif-Ur-Rahman","year":"2023","journal-title":"J Evid Based Med"},{"key":"B25","doi-asserted-by":"publisher","first-page":"e23","DOI":"10.2196\/mhealth.8873","article-title":"The impact of mHealth interventions: systematic review of systematic reviews","volume":"6","author":"Marcolino","year":"2018","journal-title":"JMIR Mhealth Uhealth"},{"key":"B26","doi-asserted-by":"publisher","first-page":"e34061","DOI":"10.2196\/34061","article-title":"Effects of mHealth interventions on improving antenatal care visits and skilled delivery care in low- and middle-income countries: systematic review and meta-analysis","volume":"24","author":"Rahman","year":"2022","journal-title":"J Med Internet Res"},{"key":"B27","doi-asserted-by":"publisher","first-page":"1842","DOI":"10.3390\/ijerph20031842","article-title":"Reflections on digital maternal and child health support for mothers and community health workers in rural areas of Limpopo province, South Africa","volume":"20","author":"Muthelo","year":"2023","journal-title":"Int J Environ Res Public Health"},{"key":"B28","doi-asserted-by":"publisher","first-page":"196","DOI":"10.1186\/s12884-021-03684-x","article-title":"Explaining the impact of mHealth on maternal and child health care in low- and middle-income countries: a realist synthesis","volume":"21","author":"Kabongo","year":"2021","journal-title":"BMC Pregnancy Childbirth"},{"key":"B29","volume-title":"A Brief Guide on ABDM and its Various Building Blocks National Health Authority.","year":"2022"},{"key":"B30","doi-asserted-by":"publisher","first-page":"e005213","DOI":"10.1136\/bmjgh-2021-005213","article-title":"Assessing exposure to kilkari: a big data analysis of a large maternal mobile messaging service across 13 states in India","volume":"6","author":"Bashingwa","year":"2021","journal-title":"BMJ Glob Health"},{"key":"B31","doi-asserted-by":"publisher","first-page":"e009395","DOI":"10.1136\/bmjgh-2022-009395","article-title":"Optimising the reach of mobile health messaging programmes: an analysis of system generated data for the kilkari programme across 13 states in India","volume":"6","author":"Mohan","year":"2022","journal-title":"BMJ Glob Health"},{"key":"B32","doi-asserted-by":"publisher","first-page":"e005512","DOI":"10.1136\/bmjgh-2021-005512","article-title":"Can health information through mobile phones close the divide in health behaviours among the marginalised? An equity analysis of kilkari in madhya pradesh, India","volume":"6","author":"Mohan","year":"2021","journal-title":"BMJ Glob Health"},{"key":"B33","doi-asserted-by":"publisher","first-page":"e052336","DOI":"10.1136\/bmjopen-2021-052336","article-title":"Key learnings from an outcome and embedded process evaluation of a direct to beneficiary mobile health intervention among marginalised women in rural Bihar, India","volume":"12","author":"Irani","year":"2022","journal-title":"BMJ Open"},{"key":"B34","article-title":"Nivi Inc","year":"2023"},{"key":"B35","doi-asserted-by":"publisher","first-page":"356","DOI":"10.1186\/1472-6963-14-356","article-title":"Self-management support interventions to reduce health care utilisation without compromising outcomes: a systematic review and meta-analysis","volume":"14","author":"Panagioti","year":"2014","journal-title":"BMC Health Serv Res"},{"key":"B36","volume-title":"Sexual and Reproductive Health and Rights","year":"2022"},{"key":"B37","doi-asserted-by":"publisher","first-page":"l688","DOI":"10.1136\/bmj.l688","article-title":"Self-care interventions to advance health and well-being: a conceptual framework to inform normative guidance","volume":"365","author":"Narasimhan","year":"2019","journal-title":"Br Med J"},{"key":"B38","doi-asserted-by":"publisher","first-page":"e0202562","DOI":"10.1371\/journal.pone.0202562","article-title":"Effect of health intervention integration within women\u2019s self-help groups on collectivization and healthy practices around reproductive, maternal, neonatal and child health in rural India","volume":"13","author":"Saggurti","year":"2018","journal-title":"PLoS One"},{"key":"B39","doi-asserted-by":"publisher","first-page":"100198","DOI":"10.1016\/j.eclinm.2019.10.011","article-title":"Effects of health behaviour change intervention through women\u2019s self-help groups on maternal and newborn health practices and related inequalities in rural India: a quasi-experimental study","volume":"18","author":"Hazra","year":"2019","journal-title":"eClinicalMedicine."},{"key":"B40","doi-asserted-by":"publisher","first-page":"177","DOI":"10.1002\/ijgo.14792","article-title":"Effectiveness of mHealth-based educational interventions to improve self-care during pregnancy: a pragmatic randomized controlled trial from Northern India","volume":"163","author":"Persis","year":"2023","journal-title":"Int J Gynaecol Obstet"},{"key":"B41","doi-asserted-by":"crossref","first-page":"e003033","DOI":"10.1136\/bmjgh-2020-003033","article-title":"Not just money: what mothers value in conditional cash transfer programs in India","volume":"5","author":"Rao","year":"2020","journal-title":"BMJ Glob Health"},{"key":"B42","doi-asserted-by":"publisher","first-page":"154","DOI":"10.1016\/j.jhealeco.2015.07.001","article-title":"Financial incentives in health: new evidence from India\u2019s janani suraksha yojana","volume":"43","author":"Powell-Jackson","year":"2015","journal-title":"J Health Econ"},{"key":"B43","doi-asserted-by":"publisher","first-page":"1845","DOI":"10.2105\/AJPH.2009.179689","article-title":"Innovative approaches to reducing financial barriers to obstetric care in low-income countries","volume":"100","author":"Richard","year":"2010","journal-title":"Am J Public Health"},{"key":"B44","first-page":"8","article-title":"Financial incentives and maternal health: where do we go from here?","volume":"31","author":"Morgan","year":"2013","journal-title":"J Health Popul Nutr"},{"key":"B45","doi-asserted-by":"publisher","first-page":"e0173068","DOI":"10.1371\/journal.pone.0173068","article-title":"The effects of cash transfers and vouchers on the use and quality of maternity care services: a systematic review","volume":"12","author":"Hunter","year":"2017","journal-title":"PLoS One"},{"key":"B46","doi-asserted-by":"publisher","first-page":"262","DOI":"10.1186\/s12884-017-1445-y","article-title":"Demand-side financing for maternal and newborn health: what do we know about factors that affect implementation of cash transfers and voucher programmes?","volume":"17","author":"Hunter","year":"2017","journal-title":"BMC Pregnancy Childbirth"},{"key":"B47","doi-asserted-by":"publisher","first-page":"e0295295","DOI":"10.1371\/journal.pone.0295295","article-title":"The impact of maternal health on child\u2019s health outcomes during the first five years of child\u2019s life in countries with health systems similar to Australia: a systematic review","volume":"19","author":"Mudiyanselage","year":"2024","journal-title":"PLoS One"},{"key":"B48","doi-asserted-by":"publisher","first-page":"100619","DOI":"10.1016\/j.ssmph.2020.100619","article-title":"Unintended effects of janani suraksha yojana on maternal care in India","volume":"11","author":"Sen","year":"2020","journal-title":"SSM Popul Health"},{"key":"B49","doi-asserted-by":"publisher","first-page":"e67452","DOI":"10.1371\/journal.pone.0067452","article-title":"India\u2019s conditional cash transfer programme (the JSY) to promote institutional birth: is there an association between institutional birth proportion and maternal mortality?","volume":"8","author":"Randive","year":"2013","journal-title":"PLoS One"},{"key":"B50","first-page":"796","article-title":"Socio-demographic factors affecting the antenatal care service utilization in Assam","volume":"5","author":"Baruah","year":"2016","journal-title":"Indian J Basic Appl Med Res"},{"key":"B51","doi-asserted-by":"publisher","first-page":"155","DOI":"10.1186\/s12884-022-04441-4","article-title":"Public health insurance and maternal health care utilization in India: evidence from the 2005\u20132012 mothers\u2019 cohort data","volume":"22","author":"Gebremedhin","year":"2022","journal-title":"BMC Pregnancy Childbirth"},{"key":"B52","doi-asserted-by":"publisher","first-page":"20","DOI":"10.1186\/s12889-017-4575-2","article-title":"Putting women at the center: a review of Indian policy to address person-centered care in maternal and newborn health, family planning and abortion","volume":"18","author":"Srivastava","year":"2018","journal-title":"BMC Public Health"}],"container-title":["Frontiers in Global Women's Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fgwh.2025.1469328\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,9]],"date-time":"2025-04-09T05:20:06Z","timestamp":1744176006000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fgwh.2025.1469328\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,9]]},"references-count":52,"alternative-id":["10.3389\/fgwh.2025.1469328"],"URL":"https:\/\/doi.org\/10.3389\/fgwh.2025.1469328","relation":{},"ISSN":["2673-5059"],"issn-type":[{"value":"2673-5059","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4,9]]},"article-number":"1469328"}}