Financing Her Health: How Maternity Wallets and Medical Loans Can Transform Maternal Care

In India’s urban slums, women face a dual crisis: steep out-of-pocket healthcare costs and limited access to financial tools that could help manage these expenses. While microfinance has empowered women by helping them to build businesses and improve livelihoods, in most cases one of the most devastating financial shocks for low-income families - health emergencies - is overlooked. In fact, worldwide, health shocks push over a billion people deeper into poverty each year.

Take Manisha, for example. She lives in a densely populated slum in Mumbai with her husband and two children. During her second pregnancy, the cost of antenatal care and hospital delivery reached nearly $570, far beyond her family’s savings. Traditional microfinance institutions wouldn’t offer a loan for health-related needs. But through an affordable Emergency Medical Loan from Opportunity International’s local partner, Uplift Mutuals, Manisha was able to travel to her home village of Parbhani, Maharashtra, where she had family support and access to quality care. 

“The loan gave me peace of mind during my delivery,” Manisha shared. “I could spend my pregnancy in the village and deliver at the hospital of my choice. Otherwise, I would have had to stay in Mumbai’s overcrowded slum in unhygienic conditions."

For Manisha, access to a small, affordable loan meant she didn’t have to choose between safety and financial stability. But for many women in urban poverty, such options are out of reach. 

The urgent need for health finance for women and children

In Mumbai’s slum communities, hospitalization rates are nearly double the national average for urban residents, according to a survey conducted by Uplift Mutuals of nearly 39,000 low income households in urban Maharashtra. The survey also found that health expenses can exceed three times a family’s monthly income, with women bearing the brunt: delaying care, lacking autonomy in health decisions, and often excluded from borrowing due to pregnancy. Even supposedly “free” public services come with hidden costs that deter women from seeking care. In urban Maharashtra, nearly 30% of women miss the four antenatal check-ups recommended by the World Health Organization. In inner-city slums, the numbers are even more alarming. 

Traditional banks consider women living in informal settlements as uncreditworthy, and microfinance institutions typically avoid lending for health, viewing it as non-productive and high-risk. Pregnant women are frequently denied loans altogether, as lenders fear funds may be diverted to medical costs. The only alternative? Informal lenders charging exorbitant interest rates of 60 to 200%, trapping families in long-term debt from a single medical event. 

Health Finance Hubs: A holistic, community-led solution

To bridge this gap, Opportunity International and Uplift Mutuals – a pioneer of mutuals insurance in India – have launched a gender-responsive Health Finance Hub model in Pune and Mumbai. Using a human-centered design approach, products are co-created with the community, including women’s groups and organizations for people with disabilities, to ensure they meet real needs for low-income families. Three financial tools have emerged, all provided by Uplift: 

1. Emergency Medical Loans: Low-interest loans offer immediate liquidity during health emergencies. In the pilot, 72% of loans supported women’s health, with 40% used for institutional deliveries. Interest income from the loans subsidizes primary care services and currently offsets costs for the other two products. Interest rates are lower for women taking a loan for childbirth who have saved for three months with Uplift. Loan approvals typically take one to two days, and loans are promoted through local clinics, hospitals, at Uplift Health Finance Hubs, by Health Loan Officers and by word of mouth. The aim over time is to shift more people to savings and insurance, reducing an overreliance on emergency loans for medical expenses.
2. Maternity Wallets (health savings accounts): This commitment savings product helps women plan and save for childbirth and early childhood care. Paired with financial counseling and health education by Uplift Health Program Officers who go door to door, maternity wallets have significantly increased safe deliveries and antenatal care completion. Women save a minimum of $5.70 a month, earning interest on their savings, and then draw on the funds for costs related to childbirth, child health or education. Savings are collected primarily through UPI payments (India's real-time payment system), and rarely in cash. Pregnant mothers with maternity wallets have a monthly health check-in with a medical doctor. Withdrawals are typically via bank transfer within one day of a withdrawal request.
3. Health Mutual Insurance: Uplift’s mutual insurance is a unique women-led model where claims decisions sit with the members. The Claims/Management Committee consists entirely of women from the target community; these women also decide on the appropriate usage of the surplus generated by the mutuals. This community-governed insurance offers affordable coverage - around $8 a year - and can be purchased separately or bundled with the other health finance products.

Each Health Finance Hub also provides:

• Primary Care Services: On-site clinics offer free and subsidized care to all clients and the broader community, ensuring financial tools are backed by accessible services. Primary care services are subsidized by the interest charged for Emergency Medical Loans and partially funded with grant funding for now.
• Care Navigation: A 24/7 helpline and in-person support help families navigate the public health system, access entitlements and avoid unnecessary expenses. 

A compelling blueprint for scaling up health coverage

Early results from the pilot are promising. In the first year, 300 emergency medical loans were provided, 54 maternity wallets issued and 810 people insured (including 200 people with disability). All clients were low-income households living in slums or rehabilitated housing. The project made real impact on maternal and child health, as: 

• Out-of-pocket health spending dropped by 50%.
• 100% of women experienced safe institutional deliveries.
• 80% completed the recommended four antenatal visits. 

The pilot also demonstrated financial sustainability. In its first year, repayment rates for medical loans reached 100%, a powerful indicator of both demand and viability. Demand was high, with 3,000 loan applications, and the project is poised to scale quite quickly.

As the financial inclusion and development sectors seek scalable solutions for universal health coverage, this inclusive health finance model offers a compelling blueprint. By equipping women with tools to plan, save and protect themselves from health shocks, we can build more resilient communities and close the equity gap in maternal and child health. 

Financing women’s health isn’t just a health issue; it’s a financial inclusion imperative.