Ending preventable maternal deaths requires a collective effort
Bringing change in a large and diverse country such as India has not been easy. But India’s progress has been much higher than the global average, with the country registering a 77% decline in MMR from 1990 to 2015 compared to 44% worldwide.Updated: Jun 28, 2018 17:40 IST
“If you read the biography of any great man, you will always notice his mother’s contribution in his progress”, said Prime Minister Narendra Modi, who has been pushing us all to work for women, especially mothers, since forming the government in 2014. Implementing policies and programmes that benefit women and, most importantly, save their health and lives have yielded results and lowered Maternal Mortality Ratio (MMR) in the country. As per the latest SRS data released earlier this month, India’s MMR stands at 130/100,000 live births – a decline of massive 37 points from 167/1,000 live births in 2011-13.
In 2000, when countries across the world joined hands to commit towards achieving MDGs by 2015, India’s share of maternal deaths was nearly a quarter of the global burden. The narrative is fast changing, with India showing a 22% reduction in maternal deaths since 2013. This means 1,000 fewer pregnant women are dying each month during childbirth or from pregnancy-related complications, bringing India’s share of global maternal death burden to near 10% for the first time.
India’s progress has been much higher than the global average, with the country registering a 77% decline in MMR from 1990 to 2015 compared to 44% worldwide. In absolute numbers, there were 120,000 fewer maternal deaths in 2015 compared to 1990. At this rate of decline, India will achieve its Sustainable Development Goals (SDG) target by 2022, eight years ahead of the deadline.
Bringing change in a large and diverse country such as India has not been easy, more so as the acceleration of decline becomes increasingly difficult as we move down on the curve. Moving pregnant women from ‘Huts to Hospitals’ for delivery and ensuring skilled birth attendant deliver every child is imperative. The day of birth is the riskiest day for both the mother and the newborn, with nearly half of the maternal deaths and 40% of the neonatal deaths occurring within 24 hours of birth. A decade ago, a little more than half of all births were happening at home, but the introduction of conditional cash transfers for institutional deliveries has led to more than eight out of ten women delivering at a health centre.
With close to 21 million women now delivering in health facilities, it is critical for us to ensure that coverage is backed up by quality and respectful care. Sensitive to these challenges, the government recently launched LaQshya initiative for labour-room quality of care improvement. Advancing from the MMR of 130 per 100,000 in 2015 to the global SDG target of below 70 per 100,000, will require a strong focus on quality as envisioned under the LaQshya initiative.
Ensuring adequate and trained human resources is equally critical. The human resource packages are being made more attractive and flexible to get gynaecologists, anaesthetists and paediatricians to serve in the remotest districts. Many states, including Uttar Pradesh, have adopted schemes like “You Quote, We Pay”, where doctors propose the desired salary package to serve in underserved places.
Another challenge is to provide skilled birth attendance and a safe pair of hands for the 50 lakh pregnant women still delivering at home. Several training packages, such as Life Saving Anaesthesia Skills, Comprehensive and Basic Emergency Obstetric Care, Daksh and Dakshata trainings for quality intrapartum care, among others, have been implemented. The Janani Shishu Suraksha Karyakram (JSSK), which provides free transport and care to pregnant women during childbirth, and a cash support of Rs 5,000 to pregnant women for nutrition and partial wage compensation under the Pradhan Mantri Matru Vandana Yojana, are initiatives to encourage access to institutional delivery to women from the poorest quintile households.
Ending preventable maternal deaths requires a collective effort. Following Prime Minister Modi urging the private sector in his radio address, Mann ki Baat, to supplement the efforts of the government under the Pradhan Mantri Surakshit Matritva Abhiyan by providing free antenatal care to pregnant women on the 9th of every month, more than 1.25 crore antenatal checkups have been conducted and nearly 6 lakh high-risk pregnancies have been identified.
It’s said that good is not good if better is possible, but with strong Central leadership, intense commitments of states, and the tireless efforts of millions of health workers, India will give the world a new headline in the SDG era.
JP Nadda is Union minister of health and family welfare
The views expressed are personal