Cats and pregnancy in India: what actually transmits toxoplasmosis, and what the obstetric bodies say about giving the cat away

Does a pregnant woman in India have to give up her cat?

No. The American College of Obstetricians and Gynecologists answers this question in four words, and the answer is that you can keep your cat. No obstetric body, no public health agency and no veterinary school we could find recommends rehoming a cat because somebody in the household is pregnant.

ACOG publishes the answer as a standing patient question. Its text reads: "Yes, you can keep your cat." It then sets out the only real precaution, which is that somebody else takes over daily cleaning of the litter tray, and adds that for an indoor cat who only eats cat food and has no contact with outside animals, "your risk of toxoplasmosis is very low";.

The United States public health agency goes further by implication. Its list of precautions for pregnant and immunocompromised people includes "Keep cats indoors to prevent them from hunting other animals" and "Feed cats commercially prepared dry or canned food";. Both instructions presuppose that the cat is still in the house. Nowhere on that page, or on the agency's prevention page, is rehoming mentioned.

Cornell University's Feline Health Center records the history of the advice and where it ended up. "Immunodeficient people and pregnant women were advised to avoid cats in the past; however, the CDC now advises that this is not necessary";. The same page states that "Owning a cat does not mean you will be infected with Toxoplasma" and that in the United States "people are much more likely to become infected by eating raw meat and unwashed fruits and vegetables than by handling cat feces";.

Humane World for Animals, formerly the Humane Society of the United States, names the practice directly. "Since toxoplasmosis can be transmitted via contact with cat feces, cat owners are told to lower their risk by putting their cats outside or even giving their cats away. But neither is necessary, as this is a myth";. Its closing line is the one worth carrying into a family argument: "Sensible precautions will protect you from toxoplasmosis during your pregnancy and getting rid of your cat would be an unnecessary cruelty to both of you";.

What the two Indian studies actually found about cat contact

Two Indian datasets bear on this and they do not say the same thing, which is worth knowing before anyone quotes either one at you.

A prospective study at the Postgraduate Institute of Medical Education and Research in Chandigarh followed 340 antenatal women between November 2021 and November 2023. Six of them had congenital toxoplasmosis confirmed by PCR on amniotic fluid. The authors record that "None of the pregnant women with congenital toxoplasmosis had a history of cat exposure, and among the remaining study participants, only 2.9% reported such exposure";. They read that as a change in the epidemiology, "with environmental contamination of soil, water, and sand by Toxoplasma oocysts emerging as the primary source of human infection";.

The pan-India seroprevalence study points the other way, slightly. Across 1,464 women of childbearing age in four regions, the authors list the possible risk factors they found as "lower socioeconomic status, residing in mud plastered houses, consumption of raw salad, drinking untreated water, owning pets and advanced age";. Pet ownership is on that list. But the mechanism the same authors offer for the regional pattern is entirely environmental: they attribute the South Indian excess to mud-plastered houses, tube well and hand pump water used "without using any disinfectant or filter", a climate that "favour[s] sustenance and proliferation of Toxoplasma oocysts", and the fact that "South Indians do not wear shoes and most often are barefoot", which "might increase chances of transferring T. gondii oocysts from soil and water to their food";.

We are publishing both rather than picking one. The honest reading is that pet ownership in that study travels with mud floors, untreated water and bare feet in the same households, and a cross-sectional survey cannot separate them. It is not evidence that the cat in a Chennai flat with tiled floors, filtered water and a bag of commercial kibble carries the same risk.

How people actually catch Toxoplasma, ranked

People catch Toxoplasma gondii mainly by swallowing it in food. The largest study to rank the routes put undercooked and cured meat first in every one of its six centres, soil contact a distant second, and direct contact with cats nowhere at all.

The study is a European multicentre case-control study published in the BMJ in 2000. It compared 252 pregnant women with acute infection against 858 pregnant women who tested seronegative, across Naples, Lausanne, Copenhagen, Oslo, Brussels and Milan. Its summary is unambiguous: "Risk factors most strongly predictive of acute infection in pregnant women were eating undercooked lamb, beef, or game, contact with soil, and travel outside Europe and the United States and Canada. Contact with cats was not a risk factor. Between 30% and 63% of infections in different centres were attributed to consumption of undercooked or cured meat products and 6% to 17% to soil contact";.

Population attributable fraction is the measure that makes those numbers worth reading. The authors explain that it "indicates the proportionate reduction in infection that would be achieved if pregnant women were entirely unexposed to a factor";. It is not a measure of how dangerous one exposure is. It is a measure of how much of the real disease burden you would remove by eliminating it, which is the number a person deciding what to change in their own life actually needs.

Note the last four rows before you use them. Not significant does not mean proven safe. These are confidence intervals that include 1, on a sample of 252 cases, and the authors are careful to say that their results "may not be generalisable to countries with different climates, farming, or culinary practices, particularly outside Europe" and that local case-control studies are needed. No such study has been done in India. That is the single biggest gap in this page and we are not going to paper over it.

The mechanism explains the pattern. Cats "excrete oocysts (up to 10 million oocysts per day) for only two weeks of their life, when they first acquire infection", and those oocysts "become infective one to five days after excretion, are spread by surface water, and can survive for more than a year";. The authors draw the conclusion themselves: "Thus contact with soil and water, rather than direct contact with cats, is a risk factor for infection";.

The belief that is exactly backwards

The same study asked every woman, before anything else, how she thought toxoplasmosis could be avoided. Across the five centres where the question was put, 49 percent named contact with cats and 6 percent named contact with soil. Raw meat was named by 58 percent, raw or unwashed fruit and vegetables by 38 percent, and 29 percent could name no risk factor at all, rising to 51 percent in Naples.

So the route responsible for at most 17 percent of infections was in the minds of 6 percent of women, and the one responsible for none of them was in the minds of half. That inversion is the thing this page exists to correct, and it is the reason a pregnant woman in India gets told to rehome a cat while nobody in the room mentions the salad.

India's own National Centre for Disease Control lists the routes without ranking them. Its 2025 zoonoses manual records "4 established routes of transmission of Toxoplasma gondii (a) by ingesting uncooked meat containing tissue cysts, (b) by ingesting the food and water contaminated with oocysts from infected cat faeces, (c) congenitally from mother-to-fetus where transplacental infection occurs when an uninfected mother acquires infection during pregnancy (d) through organ transplantation including the whole blood transfusion from a latently infection donor to seronegative recipient". Route (b) is the cat's contribution, and the vehicle is food and water, not the animal.

What has to be true before a cat can pass this on

Five things have to line up before your cat can give anybody toxoplasmosis, and a daily scoop breaks the chain at the third one. The parasite's full life cycle is set out in our guide to raw meat, offal and bones at home over Eid, which carries the shedding window and the sporulation arithmetic in detail; what follows is only the part that bears on the human question.

Cats are the only definitive host. The Merck Veterinary Manual states it flatly: "Felids are the only definitive hosts of T gondii, which contaminates the environment with oocysts eliminated in feces";. Cornell says the same, "Wild and domestic cats are the only definitive hosts for T. gondii";. No other animal on earth sheds the infective stage.

The third link is the one the whole precaution rests on. The CDC's wording is the clearest: "Change the cat litter box daily. The Toxoplasma parasite does not become infectious until 1 to 5 days after a cat shed it in its feces. By cleaning the litter box every day, you remove the feces before they become infectious";. India's own zoonoses manual agrees: "Freshly passed oocysts in cat's faeces are non-sporulated and therefore non-infective";.

The fourth link is why cuddling is not the problem. Oocysts are swallowed, not absorbed and not inhaled. Humane World for Animals spells out what would have to happen: "in order to contract toxoplasmosis, the person would have to make contact with contaminated feces in the litter box and then, without washing their hands, touch their mouth or otherwise transmit the contaminated fecal matter to their digestive system";.

Cornell adds the part about the coat, which settles several of the questions people actually ask. "It is unlikely that you would be exposed to the parasite by touching an infected cat, because they usually do not carry the parasite on their fur. It is also unlikely that you would become infected through cat bites or scratches";.

Which cats pose any risk, and where ACOG gets it slightly wrong

A cat poses a risk only if it has eaten an infected animal or raw meat, which means an indoor cat fed commercial food is in a different position from a cat that hunts. ACOG's phrasing of that point overstates it in a way that matters acutely in India.

ACOG writes that toxoplasmosis "is only found in cats who go outdoors and hunt prey, such as mice and other rodents";. The word "only" is doing more work than the parasite literature supports. A cat does not have to go outdoors to eat infected meat. It has to eat infected meat.

Humane World for Animals states the same rule with the second half included: "Only cats who ingest tissue cysts get infected. Within the feline population, this would be limited to outdoor cats who hunt and eat rodents, as well as cats who are fed raw meat by their owners";. The CDC's instruction to pregnant and immunocompromised people is to "Feed cats commercially prepared dry or canned food; do not feed cats raw or undercooked meats to prevent them from becoming infected with Toxoplasma";. That instruction would be pointless if going outdoors were the only route in.

This is not a quibble in an Indian household. Raw mutton trimmings, chicken offcuts from the butcher and leftover kheema all reach cats in Indian homes, and a cat that never leaves the flat can be eating uncooked tissue every week. Our guide to homemade cat food in India covers what raw feeding does and does not achieve; for this question, raw meat is the one feeding decision that changes a pregnant woman's exposure, and it does not depend on the cat going outside at all.

The honest caveat nobody states

A 2022 peer-reviewed review of toxoplasmosis in pregnancy puts the limit on all of this in one sentence: "As cats primarily become infected by hunting or eating raw meat, they can be kept indoors to decrease infection risk. However, the correlation between indoor cats and infection risk has not been directly studied";. The same review adds, "Interestingly, cat ownership is not highly associated with infection" while still advising that somebody else cleans the tray.

So the indoor-cat reassurance is mechanistically sound and has not been tested head to head. That is a reason to take the cheap precautions, not a reason to rehome an animal. It is also why this page does not tell you the risk is zero. Nobody can tell you that, and the review records that "up to 50% of people diagnosed with a T. gondii infection could not identify a known risk factor";.

The one cat the agencies do say to avoid

Street kittens. The CDC's list for pregnant and immunocompromised people includes a flat instruction: "Do not adopt or handle stray cats, especially kittens. Do not get a new cat while you are pregnant or immunocompromised";. A kitten is the life stage at which a cat is most likely to be shedding, because shedding happens on first infection.

That is a real constraint in Indian cities, where a litter turning up under the stairwell is an ordinary event rather than a crisis. It does not mean the kittens must be abandoned. It means somebody else in the household does the handling, the feeding and the trip to the vet, and that adopting one waits until after the birth. Our guide to street cats in India covers what the law expects of a feeder and how a colony is usually managed.

The litter tray: who empties it, and why daily is the whole instruction

Hand the tray to somebody else for the pregnancy, and have it scooped every single day whoever does it. Daily scooping is not hygiene theatre; it is the specific interval that keeps the oocyst below the age at which it can infect anyone.

The CDC's instruction for pregnant and immunocompromised people has two halves and most pages drop the second. "If possible, have someone else change cat litter. If no one else can, wear disposable gloves and wash your hands with soap and water afterwards";. ACOG's version is the same handover. Nobody says the tray should stop existing.

1. Name the person. Not "someone else", but a named adult who is not pregnant and not immunocompromised, agreed before the second trimester and written on the fridge if the household is large.
2. Scoop daily, at a fixed time. Tie it to something that already happens every day, because the interval is the protection and a skipped Sunday is the failure mode.
3. Wear gloves if you have to do it yourself, then finish with handwashing in soap and water. Cornell's list puts the glove and the handwashing together, not as alternatives.
4. Keep the tray out of the kitchen and away from where food is prepared or dried.
5. Wash the tray itself with very hot water periodically. Cornell recommends removing faeces daily and washing the box frequently with boiling water.

Two things people worry about that the evidence does not support. Smell is not a route, because oocysts have to be swallowed rather than breathed. And handling a bag of fresh clumping litter is not the exposure; the exposure, if there is one, is faeces that have been sitting. Our guide to litter training a cat in India covers the tray setup itself, which does not change during a pregnancy.

The last thing worth saying about the tray is that it is not the biggest item on the list. Cornell publishes its prevention steps "in order of importance", and the order is instructive. The first four are do not eat raw or undercooked meat, do not eat unwashed fruits and vegetables, do not drink unpasteurised milk, and do not drink environmental water that has not been filtered or boiled. "Remove feces from the litter box daily" sits eleventh of thirteen, and "Do not allow pregnant women or immunosuppressed people to clean the litter box" twelfth. A veterinary school ranked the cat below the kitchen.

India is not Europe, and the routes may not rank the same way here

The 30 to 63 percent meat figure is European, and India's own government manual argues the meat route is rare here. Nobody has run the study that would settle it, so this section sets out what each side claims and where they collide.

The NCDC manual makes a specific Indian claim: "Though in India and other countries in the continent mutton is the commonest meat consumed, the chances of toxoplasmosis through this route are rare, because the meat is cooked adequately";. It gives no citation for that sentence and no measurement behind "adequately". It is plausible. Indian mutton is usually pressure-cooked or slow-cooked well past the 67 degrees Celsius at which tissue cysts die, and there is no Indian equivalent of steak tartare or a rare lamb chop in everyday home cooking.

It is also incomplete, in two directions. The same manual notes that "Those who are involved in skinning and handling meat scraps, are also at risk of getting infected";, which is a description of a great many Indian kitchens at Bakrid and of anyone who buys and portions meat at home. And the European study's single strongest meat finding was not eating rare meat at all; it was tasting meat while cooking, at an odds ratio of 4.7 for weekly or more. Checking the seasoning on raw kheema is the behaviour, and it is universal.

If the NCDC is right that the meat route is small in India, the arithmetic does not transfer the risk to cats. It transfers it to soil and water, which is exactly where the Indian data point.

What the pan-India seroprevalence study shows, and what it does not

The only pan-India study tested 1,464 women of reproductive age across four regions with one central laboratory in New Delhi. Overall anti-Toxoplasma IgG prevalence was 22.4 percent. Region by region, South India was 37.3 percent, East India 21.2 percent, North India 19.7 percent and West India 8.8 percent, a difference the authors call highly significant at p<0.001. Among women living in mud houses, prevalence was 66 percent.

One note on how that table is built. The paper names its four recruiting institutions and its four regions but does not pair them off in the text, so the pairing above is ours, read off the institutions' locations. There is only one way to assign Manipal, Surendra Nagar, Gauhati and New Delhi to south, west, east and north, which is why we are comfortable printing it, but it is an inference rather than a line in the paper.

The table is the caveat nobody prints. A fourfold spread across four single centres is not a map of India, and a woman in Maharashtra reading "West India 8.8 percent" is reading a number from one district of Gujarat. Treat the regional figures as evidence that exposure varies enormously with living conditions, which is what the authors themselves argue, rather than as a risk score for your city.

The living conditions they name are the useful part. The majority of women in the South and East samples "resided in mud-plastered houses and consumed tube well/hand pump water without using any disinfectant or filter", and the authors add that climatic conditions in South India "favour sustenance and proliferation of Toxoplasma oocysts";. A humid monsoon climate keeps oocysts viable in soil; the NCDC manual puts that survival at "about a year in moist soil";.

Which turns the practical question away from the cat and towards three things in an Indian home. Where does your drinking water come from and is it filtered or boiled. How is your salad washed, and in what water. And who handles soil, including the balcony pots and the terrace garden that a community cat can reach in Mumbai or Chennai as easily as a field can in a village.

Freezing meat: three good sources, two answers

This one matters because freezing is the cheapest intervention available and the sources disagree about whether it works. The CDC says "Freeze meat for several days at sub-zero (0 degrees Fahrenheit) temperatures before cooking to greatly reduce chance of infection";. The Merck Veterinary Manual is more precise: "Tissue cysts are killed by heating throughout to 67 degrees Celsius or by cooling to minus 13 degrees Celsius";. A 2022 review agrees that freezing to minus 12 degrees Celsius or less kills tissue cysts.

India's NCDC manual says the opposite: "Heating meat to 66 degrees Celsius kills the organisms. Freezing causes reduction of organisms but is not adequate";.

We cannot resolve that and we are not going to average it. The reconciliation that is defensible is about equipment rather than biology. Minus 13 degrees Celsius throughout a joint of meat is a specification, not a setting, and a domestic Indian freezer compartment holding a large piece of mutton through a power cut is not reliably reaching it. Cook the meat through. Treat freezing as a bonus you cannot verify.

Does Indian antenatal care test for this?

Not routinely. Toxoplasmosis does not appear in the Government of India's minimum antenatal package, and the Indian literature records that universal antenatal screening "is not uniformly implemented". India's own zoonoses manual recommends it anyway, which is a disagreement inside the government's own documents.

The Pradhan Mantri Surakshit Matritva Abhiyan operational framework sets out the essential lab investigations a facility must provide for the guaranteed antenatal package. The list is haemoglobin, urine albumin and sugar, malaria, VDRL, HIV, blood sugar, blood grouping, and screening for gestational diabetes using an oral glucose tolerance test. Toxoplasmosis is not among them. The only occurrence of the letters "toxo" anywhere in that 48-page framework is tetanus toxoid.

The 2025 PGIMER Chandigarh study states the position plainly: "In India, routine universal antenatal screening for congenital toxoplasmosis is not uniformly implemented";. The same paper records that reported seropositivity in Indian antenatal women "varies from 15 to 49.5%";, which is a range wide enough to tell you that different laboratories are measuring different populations with different assays.

Now the disagreement. The NCDC zoonoses manual's own prevention section ends with: "Routine serological check-up in antenatal clinics and treatment of infected mothers would be a valuable step in protecting the foetus";. So one arm of the Ministry of Health and Family Welfare recommends routine antenatal serology, and the Ministry's flagship antenatal programme does not fund or require it. Both documents are current. We are publishing the contradiction rather than choosing the one that reads better.

One fact from the international literature is worth taking into that conversation, because it is widely misunderstood and is a frequent source of unnecessary fear. A 2022 review records that most infections in pregnancy produce nothing you would notice: "Most infected women do not show symptoms", and in a study of 76 women who gave birth to congenitally infected children, 52 percent were asymptomatic. Looking for symptoms is not a screening method.

Does the dog have to go too?

A dog never sheds Toxoplasma, because only cats do. The honest complication is that a dog can carry a cat's oocysts into your hands on its coat, and in the one long prospective study that measured both, contact with dogs carried higher relative risks than contact with cats.

Start with the part that is settled. "Felids are the only definitive hosts" of Toxoplasma gondii. A dog is an intermediate host, exactly like a human, a goat or a pigeon. It can be infected, it can carry tissue cysts, and it cannot produce the environmental stage. So no dog in any household has ever given anyone toxoplasmosis through its own faeces.

The complication is mechanical, and it is the single most counterintuitive finding in this literature. In a five-year prospective study of seroconversion in children in Panama, the strongest relative risks were for contact with nursing dogs at 5.8, weaned dogs at 4.7 and twelve-month-old dogs at 3.4. Cats came lower: weaned cats at 3.0, six to twelve month old cats at 2.7 and nursing cats at 2.5. Flies scored 3.6, garbage 2.4 and cockroaches 2.2.

The proposed mechanism is not that dogs carry the parasite. It is that "children could become infected by ingesting oocysts transferred to their hands from petting oocyst-contaminated dogs", that "Dogs could be contaminated externally by rolling in cat feces", and that dogs can pass oocysts in their own faeces after eating cat faeces. The parasite is still the cat's. The dog is the delivery vehicle.

The counter-evidence is in the same passage and we are publishing it alongside. In controlled experiments, when unsporulated oocysts were placed on dog hair and skin, mice inoculated with that fur and those skin scrapings did not become infected, which suggested the oocysts did not sporulate on the coat, although the researchers still concluded dogs may be involved in mechanical transmission.

Two Indian details follow from that. Flies and cockroaches appear in the same risk list, and the review notes that oocysts "may be spread through the environment by flies, cockroaches, earthworms, dung beetles, and other coprophagous invertebrates";, which is an argument for covering food rather than for removing animals. And a dog that comes home muddy through a Pune or Kolkata monsoon has had its paws and belly in exactly the moist soil the NCDC manual says holds oocysts for about a year. Wipe the dog down, then wash your own hands. Our guide to introducing a dog to a new baby carries the rest of the hygiene plan for the months after the birth.

What to say when the family insists

Answer the demand with the one sentence from the obstetric body and the one offer that ends the argument, which is to take over the litter tray yourself. Most of these conversations are not really about evidence, and winning them on evidence alone rarely works.

The demand usually arrives in one of four forms, and each has a short, true answer.

Give the objector a job. The pattern that works in a joint household is the same one that works for every other pet argument: the person most worried becomes the person responsible for the precaution. Hand the litter tray to the father-in-law who raised the concern, with the daily instruction attached, and the conversation changes from whether the cat stays to who is scooping on Thursday.

• Lead with the source, not the argument. One printed page from the obstetric body beats forty minutes of your own reasoning.
• Concede something real. Say yes to no raw meat, yes to the tray handover, yes to the cat staying off the kitchen counter. A plan with concessions in it reads as caution rather than defiance.
• Route the disagreement to your obstetrician rather than to the internet, and say so out loud. It is the answer everyone in the room has agreed in advance to accept.
• Do not argue the science of litter boxes with someone who is frightened. Agree the precaution first, explain the mechanism later, if at all.
• Write the plan down and stick it inside a cupboard door, so the instruction survives the week your mother-in-law visits and the routine changes.

Our guide to pet allergy in children in India sets out the same structure for the other common reason an Indian family demands an animal leaves, which is a child's asthma or rash. The order of operations there is the order here. Confirm what is actually true, try the management, and let the clinician who examined the person decide.

The precautions that actually carry the weight, in order

Rank the precautions by how much infection each one removes, and the kitchen comes before the cat. This list follows Cornell's published order of importance, with the Indian additions the foreign lists leave out.

1. Cook all meat through, to 67 degrees Celsius internally, and never taste raw kheema or mince while seasoning it. Tasting meat while cooking carried an odds ratio of 4.7 at weekly frequency in the European study Merck Veterinary Manual.
2. Wash all fruit, salad and vegetables under running water before eating them raw. This is the route the BMJ commentary suspects explains part of the unexplained half.
3. Drink only filtered or boiled water, and treat untreated tube well or hand pump water as a real exposure. It was a named risk factor in the pan-India study and carried an odds ratio of 1.7 in Europe.
4. Avoid unpasteurised milk, which carried an odds ratio of 1.8 and is on the CDC's list.
5. Wear gloves for any gardening, potting or soil contact, including balcony pots and terrace beds, and wash afterwards.
6. Wash hands and all boards, knives and surfaces with hot soapy water after handling raw meat.
7. Feed the cat only commercial dry or canned food, with no raw meat, for the duration.
8. Keep the cat indoors and off hunting.
9. Hand the litter tray to somebody else, and have it scooped every single day Centers for Disease Control and Prevention.
10. Do not handle or adopt stray kittens while pregnant.
11. Wash your hands after handling the dog, particularly a dog that goes out on the street.

Notice what is not on that list. Rehoming the cat is not on it. Testing the cat is not on it either, and the reason is covered in our guide to Eid pet safety and raw meat at home: a faecal test or a blood test on the cat does not reliably tell you whether it is shedding right now, so the daily scoop replaces the test rather than following it.

Also notice the shape. Six of the first six items are about the kitchen, the tap and the soil. Three are about the cat, and all three are cheap, reversible and leave the animal exactly where it is.

What this page can prove, and what it cannot

This page can prove what the named bodies say and what the published studies measured. It cannot give you a number for your own risk in your own city, because the study that would produce one has not been done in India.

• Established: the American College of Obstetricians and Gynecologists says "Yes, you can keep your cat";, and the CDC's precautions for pregnant households assume the cat stays.
• Established: in 252 infected and 858 uninfected pregnant women across six European cities, contact with cats, kittens, cat faeces and hunting cats was not a risk factor, and 30 to 63 percent of infections were attributable to undercooked or cured meat.
• Established: a shed oocyst needs 1 to 5 days to become infective, which is why a daily scoop works National Centre for Disease Control.
• Established: cats are the only definitive host, so no dog sheds this parasite.
• Established: toxoplasmosis is not in India's minimum antenatal investigation package.
• Not established: any Indian case-control study ranking the routes of infection in Indian pregnant women. The European authors explicitly say their results may not generalise outside Europe and ask for local studies.
• Not established: whether an indoor cat lowers a household's risk, which a 2022 review states "has not been directly studied";.
• Not established: whether the NCDC manual is right that the meat route is rare in India, since it offers no measurement.
• Disputed: whether domestic freezing kills tissue cysts. Merck and the CDC say yes at a stated temperature; India's NCDC manual says freezing "is not adequate"; Centers for Disease Control and Prevention National Centre for Disease Control.
• Disputed: whether Indian antenatal clinics should screen routinely. The NCDC manual says they should; the government's own antenatal package does not include it Ministry of Health and Family Welfare.

Nothing on this page is a substitute for your obstetrician. What it is for is the conversation that happens before you get to the appointment, usually in a crowded room, usually with somebody who has already decided. For that conversation you need one sourced sentence and one reasonable offer, and both are above.