Every year, the State government will spend ₹755.83 crore on gifting one-gram gold rings to roughly 4.42 lakh babies born in government hospitals under its new scheme, Thaimaaman Thanga Mothiram Thittam. The gold ring may be intended as a celebration of birth, but for many within the public health sector, the more pressing need is investment in the workforce and infrastructure that makes safe deliveries possible.

Already, the Dr. Muthulakshmi Reddy Maternity Benefit Scheme provides maternal assistance of ₹14,000 in cash support and two nutritional kits valued at ₹4,000. With this in place, the questions raised are plenty - Can the State government sustain a recurring cost of ₹755.83 crore a year, or ₹17,000 per ring (today’s gold rate) for 4,41,667 deliveries along with administration cost? Whether symbolic incentives such as gold rings are the best use of public resources when basic gaps in the health system remain unresolved? Does this self-defeat the State’s family welfare measures by incentivising higher order births?

A head of a government institution found it bizarre that the Tamil Nadu Medical Services Corporation (TNMSC) is tasked with the job of procuring and supplying the rings based on the yearly indent given by the Director of Public Health and Preventive Medicine. TNMSC will handle the sourcing transparently via an open competitive bidding process as per the Tamil Nadu Transparency in Tenders Act and Rules.

“TNMSC was set up in the 1990s with the objective of procuring quality medicines for government hospitals. But now, it is tasked with purchasing the yellow metal. How far this is ethical is a question to be asked,” he said.

A health officer pointed that from a policy perspective, the scheme has no connection with the Sustainable Development Goal 3 (reducing global Maternal Mortality Ratio to less than 70 deaths per 1,00,000 live births and to end preventable deaths of newborns and children under five years of age by 2030).

Another public health officer said that TN has already achieved near-universal institutional delivery coverage, with institutional deliveries exceeding 99%, leaving limited scope for further improvement on this indicator. “A government’s legitimacy comes from good governance, not symbolic kinship. Public resources should be directed towards strengthening systems and services that create lasting benefits rather than initiatives that primarily serve symbolic or emotional purposes,” he said.

While additional incentives are being introduced, many frontline healthcare personnel continue to face inadequate remuneration, he said, adding that Reproductive and Child Health contract staff receive approximately ₹4,500 per month.

“There is an acute shortage of obstetricians and gynaecologists. The government should announce funds to hire more OB-GYNs as and when they announce such schemes,” a doctor said.

There is a bigger issue of higher order births, a major challenge in maternal and child health care. “This scheme covers all newborns, irrespective of the third or fourth child. Isn’t this defeating the government’s own family welfare programme? On one hand, we are motivating mothers to undergo sterilisation after two babies, and on the other hand, the government is giving incentives to have any number of babies,” she asked.

The doctor said that certain conditions can be brought in for the scheme including two mandatory post-natal visits for mothers at the end of the first week and sixth week of delivery and complete immunisation till 1.5 years of age for the child.

Former Director of Public Health and Preventive Medicine K. Kolandasamy called this a good scheme as it would improve institutional deliveries. “Private hospitals are one of the important reasons for high caesarean rates. There is a big difference between the caesarean rates in the private and government sectors. This scheme could help in reducing caesarean sections,” he said.

The scheme could act as an incentive for families belonging to the lower middle income group to opt for government hospitals for childbirth, thereby reducing their maternal and childbirth-related health expenditure in private hospitals. “I would suggest granting two gram gold rings for girls and one gram gold rings for boys,” he said, calling for a robust monitoring mechanism at all levels.