Strengthening equitable maternal health systems using the PRECEDE framework with lessons from Cuba and India

Abstract Problem Despite flagship programs like Janani Suraksha Yojana (JSY) and Pradhan Mantri Matru Vandana Yojana (PMMVY), India faces persistent maternal health inequities driven by fragmented legal frameworks, workforce deficiencies reflected by the 88% shortage of health workers in Primary Healthcare Centers, and weak community reinforcement mechanisms. Comparison Cuba achieves near-universal maternal health outcomes through constitutional health guarantees, integrated three-tier service delivery, residential maternity homes, and intensive community-based follow-up—all despite economic constraints. Key insight Using the PRECEDE model reveals that Cuba’s success stems from synergistic enabling factors—rights-based legal framework, reinforcing factors—maternity homes, postnatal surveillance, social accountability, and predisposing factors—health literacy, cultural norms. Recommendation India should adopt a rights-based constitutional amendment, establish residential maternity support centers for high-risk pregnancies, implement systematic postnatal home visits, and transition from conditional schemes to universal public provisioning to achieve equitable maternal health outcomes.