Given India’s unsatisfactory progress in maternal health, a multi-pronged approach is needed to ensure healthy lives for mothers and their babies
Over the last few decades, India has confronted several major socio-economic changes. The country has witnessed profound shifts in politics and policy, diplomacy and digitisation. However, what has remained unchanged is the state of public healthcare services. The Pradhan Mantri Jan Arogya Yojana Abhiyan (PMJAY) may be one of the world’s largest publicly-funded health insurance schemes but it is certainly not the finest. Fundamental impediments like inadequate health infrastructure and low doctor-to-patient ratio remain a roaring challenge. Perversely, the deficit is acute in both rural and urban areas. There is an increasing dependency on private healthcare services. India has one of the world’s highest rates of out-of-pocket spending in healthcare, thus pushing the people into the poverty trap.
We are the world’s sixth largest economy with a Gross Domestic Product (GDP) of $2.6 trillion, yet we have not addressed crucial indicators like Maternal Mortality Ratio (MMR) and Infant Mortality Rate (IMR). Government policies and schemes may boast of attempting to achieve universal healthcare and free treatment but delivery mechanisms have faltered frequently. India continues to add almost a fourth to the worldwide maternal morbidity and mortality even after renewed efforts. As reported by UNICEF in 2017, around 44,000 women in our country die annually due to preventable pregnancy-related causes. Janani Suraksha Yojana (JSY), a maternity benefit scheme of the Union Government, which ensures a conditional cash transfer to underprivileged and marginalised sections for promoting institutional delivery, had very little impact in reducing the MMR.
Though the policy led to a phenomenal rise in institutional deliveries thanks to Accredited Social Health Activists (ASHA), it failed to address crucial components like antenatal care and neonatal care. The “incentive” structure of the JSY resulted in sluggish progress. To supplement JSY, the Government launched the Janani Shishu Suraksha Karyakram (JSSK), that focussed on other vital aspects such as transportation, medicines, C-sections and care for sick newborns, which were free of cost. However, a few incidents were reported where patients had to pay from their pockets for even basic items like syringes and gloves. Inadequate implementation of the scheme has resulted in no-takers for the benefits.
Yet another scheme, the Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA) introduced in 2016, appears to be comprehensive and has all the components of maternal healthcare. But to make the policy a success, State Governments need to be committed towards executing it in a coherent and transparent manner. We can ensure steady progress with an all-inclusive schedule of activities, including educating and empowering women about maternal health, family planning initiatives, reproductive wellness and sanitation and hygiene. Actions have to be coupled with transparent communication tools, including effective Information Education and Communication (IEC), Interpersonal Communication (IC) and Behaviour Change Communication (BCC). The potential of communication methods like documentaries, nukkad natak, puppet shows and community radio campaigns cannot be overlooked.
Further, it is essential to develop a consistent skill and knowledge-building process around efficient management of labour and delivery across health centres. To be precise, “respectful maternity care” must be provided to the mothers, which includes a clean bathing place and toilet, warm place for the child and privacy for breastfeeding. Healthcare centres require well-planned Emergency Obstetric Care (EMOC) training programmes that can achieve twin objectives. First, train the obstetricians, nurses and nursing attendants. Second, strengthen the skills of frontline workers, ASHA workers and Auxiliary Nurse Midwives (ANM). Such an integrated approach can be made effective if training schedules are formulated on evidence-based clinical guidelines and techniques. It must be an uncompromising arrangement that adheres to strict guidelines and subdues harmful practices. Government interventions both at the national and State level must be strategised through a series of care, beginning from pregnancy care to childbirth and finally postpartum care. Statistics on maternal deaths must not be taken lightly. We need a steady momentum to transform the “silent emergency” of maternal deaths into a war-cry as it is a matter of basic human rights for survival and social justice for women.
(The writer is CEO a leading research and advisory firm)