Due to India’s three-tier public health system, there are different levels of trained medical personnel [Auxiliary Nurse Midwife (ANM), Medical Officer (MO), and Specialist] present at various health facilities. A pregnant woman within the public health system avails prescribed care during pregnancy at different facilities (sub-centers, primary health centers, community health centers, rural/sub-district hospitals, and district hospitals) by different personnel.

There is a lack of training modules to help the ANMs and MOs in the early identification of antenatal women with high-risk conditions and there are currently no standardized protocols across the country clearly outlining the responsibility of an ANM, MO, and Specialist for the management of women with high-risk pregnancies.