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High-Risk Pregnancies in Zari Jamni, Yavatmal: The Missing Trail Between ANC Identification and Delivery
In a tribal block of Yavatmal district, a pregnant woman can walk into a health centre, get checked, and be told her pregnancy needs extra care. What happens after that moment is much harder to find in any public record.
This is the story of Zari Jamni, a block in Vidarbha where government documents openly admit to gaps in tracking risky pregnancies, but never quite explain what happened between the first warning sign and the birth itself.
To understand why this gap matters, it helps to first understand what antenatal care actually involves and why doctors flag some pregnancies as high risk in the first place.
What Antenatal Care Means and Why Timing Matters
Antenatal care, often shortened to ANC, simply means the medical check-ups a woman receives during pregnancy, before the baby is born.
These visits usually include blood pressure checks, blood and urine tests, ultrasound scans, weight monitoring, and advice on diet and medicines.
The idea is straightforward. The earlier a pregnancy is registered with the health system, the more chances doctors and health workers get to catch a problem early and treat it in time.
Some pregnancies carry extra risk. A woman might have severe anaemia, high blood pressure caused by pregnancy, diabetes that develops during pregnancy, a thyroid condition, tuberculosis, or she may be carrying twins. She might be a teenager, or having her first baby at an older age, or she might have had a stillbirth or a difficult delivery before. All these situations fall under what doctors call a high-risk pregnancy, and they need closer monitoring than a normal pregnancy would.
This is exactly where Zari Jamni ran into trouble. A 2025 government record pointed out three connected problems in the block. Pregnancy registration was happening late, not enough women were delivering in hospitals or health centres, and high-risk pregnancies were not being tracked properly.
Underneath these three problems sat a simpler one. Health workers on the ground did not have an easy way to sort out which pregnant women needed routine care and which ones needed close, priority attention. This meant some women who badly needed extra monitoring may not have received it in time.
Timing plays a big role here. If a woman registers late in her pregnancy, there is less time left to run tests, spot a risk factor, write it down properly, refer her to a bigger hospital if needed, and keep checking on her before she delivers. The national maternal health scheme, called Pradhan Mantri Surakshit Matritva Abhiyan or PMSMA, is built around this idea.
It offers a fixed package of care, especially in the second and third trimesters, covering physical examination, blood and urine tests, ultrasound, free medicines, counselling, a proper birth plan, and identification of high-risk cases so they can be referred onward.
For Zari Jamni, though, the available figures do not tell us how many women registered in their first three months of pregnancy, which is considered the ideal window. Nobody has published how late the delayed registrations actually were, whether most women showed up in their second trimester or third, or how this varied from one village to another.
Even more basic than that, there is no published number for how many pregnant women in the block were actually classified as high risk in the first place. Without that starting figure, it becomes impossible to say what share of pregnancies in Zari Jamni genuinely needed the kind of close monitoring that was found to be lacking.
This missing starting point becomes more noticeable when later numbers from the same block are placed next to it. A separate government record, this one about coordination between different types of health workers, states that four antenatal check-ups were completed for 100 per cent of women covered, and that 100 per cent of deliveries happened in institutions rather than at home, across more than 100 villages.
These sound like strong numbers. But they measure something quite different from tracking a high-risk pregnancy individually. Completing four check-ups tells us a woman turned up four times. It does not tell us whether the specific problem she was flagged for, say high blood pressure or anaemia, was watched closely, whether she got the extra visit her condition called for, or whether a referral to a bigger hospital was actually completed.
The same applies to delivering in a hospital. It tells us where the baby was born. It does not tell us whether the mother reached the hospital she was originally referred to because of her risk, whether a specialist saw her beforehand, or whether the pathway leading up to that delivery matched what her risk category demanded.
This distinction became formally more important after January 2022, when the government rolled out what is called Extended PMSMA. Under this expanded version, spotting a risk is only the first step.
Every woman identified as high risk is supposed to be added to a specific list and followed individually through the rest of her pregnancy, with extra check-ups built in.
According to the latest description of the programme, this tracking is meant to continue for 45 days after the baby is born. For Zari Jamni, the public record tells us where the problem started and gives us some broad numbers from later on, but the detailed trail connecting the two, for individual women, simply is not there.
What the National Programme Promises Every High-Risk Mother
The term high-risk pregnancy is not a vague label. Under PMSMA, it refers to a specific list of 25 medical and obstetric conditions.
These include HIV, syphilis, severe anaemia, pregnancy-induced high blood pressure, gestational diabetes, an underactive thyroid, tuberculosis, malaria, a previous caesarean delivery, a narrow pelvis that could complicate birth, and a history of difficult past pregnancies.
The list also covers twin or multiple pregnancies, Hepatitis B, an abnormal foetal heartbeat, teenage pregnancy, high fever, infections passed through sexual contact, a previous stillbirth, birth defects in an earlier child, and a negative blood group.
A few more conditions round off the list, including a first pregnancy happening very early or very late in life, having had many previous pregnancies, being unusually short in height, and a few other specific medical conditions.
Because this list is so detailed, spotting a risk is really just the opening step of a much longer process. PMSMA requires every high-risk case to be connected with the nearest well-equipped hospital, known as a first referral unit, so that a safe delivery can be arranged in advance.
These cases are meant to get priority attention. Women who stop coming for check-ups partway through are supposed to be actively brought back into the system rather than simply left off the list.
Extended PMSMA goes a step further by making individual tracking compulsory. Every high-risk pregnancy is meant to be followed personally, not just counted in a total. Up to three additional check-up visits are arranged for the mother, along with support from a community health worker known as an ASHA. The system also sends SMS alerts to remind both the health worker and the family about registration and upcoming visits.
A government update from June 2026 confirms that high-risk women across the country are meant to be listed individually, tracked through their pregnancy, and monitored for 45 days after the baby arrives.
What this means in practice is that one woman's full record should contain far more than just a registration entry. First, she registers for antenatal care. During a check-up, a doctor or health worker spots a risk factor through examination or test results. That risk factor needs to stay attached to her file every single time she is seen again. She might need extra check-ups. She might be referred to another hospital. She actually has to reach that hospital.
Her delivery needs to be planned around her specific risk. And once she delivers, the outcome needs to be recorded back into the same file, with monitoring continuing for weeks afterwards.
The problem in Zari Jamni sits precisely inside this chain. It was never simply about women skipping check-ups. The block's official problem statement specifically mentioned poor tracking of high-risk cases and inconsistent prioritising of who needed urgent attention.
These are continuity problems. A woman can be correctly flagged during one visit, but if that information does not travel with her to the next worker or the next facility, the flagging achieves very little.
A referral written on paper is only useful if there is a way to confirm, later, that she actually reached the place she was sent to. This is the layer of information that appears to have been missing.
Why Frontline Workers Struggled to Keep Track
A separate government record from Zari Jamni gives a closer look at how the system worked, or did not work, on the ground.
Three types of frontline workers operate in most villages here. ASHAs, who are community health volunteers. Auxiliary nurse midwives, commonly called ANMs, provide clinical support at the village level. And Anganwadi workers, who focus on nutrition and childcare. Each of these three was doing their job, but they were not coordinating well with each other.
This lack of coordination led to real problems. Some services were being duplicated because workers were not talking to each other. Follow-up visits were being missed. Records were incomplete, meaning the full history of a pregnant woman was not always available to whoever saw her next. Outreach to pregnant women, new mothers, and children under five was inconsistent across villages.
For high-risk pregnancy tracking specifically, missed follow-ups and incomplete records are the two most damaging problems. A missed follow-up means a woman who was already in the system simply did not turn up for her next scheduled visit, or nobody chased her when she did not.
An incomplete record means that even when she did show up somewhere else, the worker seeing her did not have her full history, including whatever risk had been flagged earlier. The available material does not tell us how many high-risk women specifically were affected by either of these two problems. So it is not possible to say how many women carrying a genuine medical risk fell through these particular cracks.
What the record does show clearly is that the block changed its approach later on. Starting in 2024, a coordination effort brought ASHAs, ANMs and Anganwadi workers together for structured monthly meetings at sub-centres and Anganwadi centres, where they would plan their work jointly rather than separately.
The three groups began conducting home visits together instead of separately, and started holding shared Village Health and Nutrition Days. Booklets were handed out clarifying exactly who was responsible for what, to reduce overlap and confusion.
One particularly useful change involved the paperwork itself. Common registers were introduced for antenatal care and other services, replacing whatever separate systems existed before, along with one unified format for reporting performance at the block level. Information collected during home visits and nutrition days started being cross-checked between the different departments.
In total, 248 frontline workers were trained under this new approach, and the effort eventually covered more than 100 villages, forming a notable example of coordinated health work within the wider region of Vidarbha.
These details tell us something important about how bad the earlier information gap must have been. Shared registers were introduced because separate ones clearly were not working. Cross-verification of beneficiary data was introduced because different departments were apparently holding different pieces of the same woman's story.
After this coordination model kicked in, the block reported that all women covered had completed four antenatal check-ups, and all deliveries happened in institutions rather than at home.
These are strong figures on paper. But once again, they measure overall coverage, not individual high-risk tracking. There is still no published figure anywhere for how many pregnant women in these villages were actually high risk during this period.
There is no breakdown by specific condition, whether that is severe anaemia, high blood pressure, diabetes, a previous caesarean, or a past stillbirth. There is no village-level figure for how many referrals were made for high-risk cases, and no figure for how many of those referrals were actually completed.
Nobody has published how many women needed a repeat specialist visit, and no interval is recorded anywhere between the day a risk was first spotted and the day of the next check-up.
There is no number for how many identified high-risk women missed one of the extra visits they were entitled to under the national scheme.
And there is no figure at all for how many women in the block were formally added to the individual tracking list under Extended PMSMA, tracked through SMS alerts, or monitored through the 45 days after delivery.
A Document Titled Colour Coding That Never Explains the Colours
The most specific government document on this subject has a very precise title. It is called "Colour Coding of ANC Mothers: Risk Stratification for Improved Maternal Health." It names Yavatmal as the district and Zari Jamni as the block, and it repeats the same problem statement seen elsewhere. Delayed registration, low institutional deliveries, poor tracking of high-risk pregnancies, no simple tool for health workers to categorise mothers, and inconsistent prioritising of urgent cases.
Given the title, this looked like exactly the document that would explain how the colour-coding system actually worked in practice. It does not. Right after the maternal health problem statement, the section meant to describe the interventions switches, without warning, to an entirely different subject, a tuberculosis elimination programme.
It describes how 46 village councils were selected based on TB case numbers, how door-to-door screening was carried out for TB symptoms, how sputum samples were collected through mobile vans and health facilities, how patients were supported to complete their treatment, how nutritional help was given to TB patients, and how villages were certified as TB-free.
The section that follows, meant to show the impact of the intervention, continues along the same lines, giving figures for TB-free villages, sputum samples collected, treatment completion, and TB deaths. None of this has anything to do with the maternal colour-coding system named at the very top of the document.
This means the only publicly available version of this particular document contains the maternal health problem, but not a single detail about the maternal solution. It does not say what colours were actually used to sort mothers by risk, or which colour meant routine care and which meant high risk. It gives no clinical rule for how a woman would be placed into one colour category or another.
It does not explain whether a woman's colour could change partway through her pregnancy if a new problem was found, or how often her category was supposed to be reviewed. There is no date given for when this colour-coding system started, and no figures for how many women were colour-coded in total, how many fell into the highest-risk colour, or how many moved from one colour to another as their pregnancy progressed.
Most importantly, for the stretch of time between a risk being spotted and a baby being born, there is no outcome data attached to this document at all. No figures exist for how many high-risk referrals were made from smaller centres to bigger hospitals, and no referral completion numbers are given.
There is nothing showing how many high-risk women received the additional check-ups they were meant to get after being flagged, and nothing breaking down which hospital or centre each risk category of women actually delivered in. There is no figure for women who ended up delivering before they could reach the facility chosen for them during their check-ups, and no number for how many high-risk pregnancies simply could not be tracked all the way through to childbirth.
This gap in the published document does not prove that colour coding never happened on the ground in Zari Jamni. What it proves is narrower and more specific. The document meant to explain how colour coding worked, and whether it actually helped high-risk mothers, does not contain that information in its publicly available form, a gap that stands out sharply given how much detail exists elsewhere for the same corner of Vidarbha.
The separate coordination document fills in part of the picture, describing shared registers, joint meetings, joint home visits, cross-checked data, trained workers, and the broad coverage figures mentioned earlier. But even this fuller document stops at overall numbers. It does not follow a single high-risk pregnancy, whether named or not, through every step, from the date she was flagged, to her risk category, to her next scheduled check-up, to whether that check-up actually happened, to which hospital she was referred to, to whether that referral was completed, to any further assessment she received, and finally to where she delivered.
These are exactly the steps that individual tracking under the national scheme is designed to capture, treating each high-risk case as something to be followed all the way through rather than noted once and forgotten.
A woman in Zari Jamni might show up once in a registration list, again somewhere inside a four-check coverage percentage, and a third time inside a delivery count.
None of these three appearances, on their own, confirms that the same risk flag stayed attached to her file through every single handover along the way. What would actually answer that question is not another broad percentage, but the complete, connected story of one flagged pregnancy followed from the first warning sign through to delivery, and that particular story is not something the published Zari Jamni records currently offer.
FAQs
What is antenatal care and why does it matter for high-risk pregnancies in Zari Jamni?
A: Antenatal care refers to the regular medical check-ups a pregnant woman receives before delivery, including blood pressure checks, blood and urine tests, ultrasound scans and health advice. These visits allow health workers to spot problems such as anaemia or high blood pressure early. In Zari Jamni, official records point to delayed registration for these check-ups alongside poor tracking of women flagged as high risk.
How does the government track a high-risk pregnancy after it is identified?
A: Under Extended PMSMA, a high-risk pregnancy is meant to be listed individually and followed through extra check-ups, referral to a well-equipped hospital, and monitoring for 45 days after delivery, supported by SMS alerts. For Zari Jamni, published records confirm the problem of poor tracking existed but do not show the specific referral, follow-up or delivery details for individual high-risk women.
What health coverage figures are publicly available for Zari Jamni in Yavatmal?
A: Government records state that four antenatal check-ups were completed for all women covered under a later coordination programme, and that all deliveries happened in hospitals or health centres, across more than 100 villages. These figures do not include any breakdown of how many women were high risk, what their specific conditions were, or whether their individual referrals and extra check-ups were completed.
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References
NITI Aayog. (2025). Stories of change: Aspirational districts and blocks. Government of India. https://www.niti.gov.in/sites/default/files/2025-08/stories-of-chnage-aspirational-districts-and-blocks.pdf
NITI Aayog. (2025, August 11). Stories of change: Aspirational districts and blocks. Government of India. https://www.niti.gov.in/node/1789
Press Information Bureau. (2026, June 8). Pradhan Mantri Surakshit Matritva Abhiyaan: A decade of inclusive maternal healthcare delivery. Government of India. https://www.pib.gov.in/PressReleasePage.aspx?PRID=2270486
Press Information Bureau. (2026, June 9). Institutional deliveries rise to 90.6%, antenatal care coverage reaches 95.9%. Government of India. https://www.pib.gov.in/PressReleasePage.aspx?PRID=2270828
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