Multiple policy decisions in maternal health and nutrition with a focussed approach have got us close to achieving the national target of reducing the maternal mortality ratio to less than 100 by 2020. But there’s a long way to go
India has registered a 77 per cent decline in Maternal Mortality Ratio (MMR) in the last three decades. The Sample Registration System (SRS), released in July this year, showed a significant decline in MMR from 556 per 100,000 live births in 1990 to 130 per 100,000 live births in 2015. India has committed itself to the attainment of Sustainable Development Goal (SDG) targets by 2030 by ensuring health of its most vulnerable populations. Increasing institutional deliveries and reduction in maternal deaths indicate that we are steadily marching towards achieving the goals of reducing MMR to less than 70 per 100,000 live births by 2030 or earlier.
While there is a lot to cheer, there is also a lot to achieve. The good news is that we are getting there. Policies and programmes of the Government are designed to propel us towards the goal. The life cycle approach employed by the National Health Mission ensures the best possible health outcome for women through their reproductive life-cycle. In April 2015, India was validated for Maternal Neonatal Tetanus Elimination (MNTE) ahead of the global target of December 2015. The elimination of tetanus as a public health problem means that in India, the annual rate of maternal and neonatal tetanus is now less than one per 1,000 live births.
The holistic ‘continuum of care’ approach has been also adopted in the newly launched Ayushman Bharat scheme to provide universal health coverage through two key components — preventive, promotion and comprehensive primary healthcare through the 1.5 lakh health and wellness centres (HWCs), and secondary and tertiary in-patient healthcare through the Pradhan Mantri Jan Arogya Yojana.
The HWCs inter alia provide services for screening and management of non-communicable diseases ie diabetes, hypertension and three common cancers (oral, cervical and breast). This will not only save lives but also result in productive lives of women, and healthy families and communities.
Last year, the Ministry of Health launched ‘LaQshya’, a quality improvement initiative for labour rooms, and maternity operation theatres and a safe delivery application, mHealth tool, to enable health workers better manage the quality of care in labour rooms and deliveries in peripheral areas. Similarly, a 24-hour call centre was set up in Telangana to track pregnant women in the tribal pockets so as to ensure that they get antenatal checkups on time. Innovation, training and better outreach are helping the Government in bringing down maternal deaths.
Similarly, the Pradhan Mantri Surakshit Matritva Abhiyan, launched in 2016 for providing free and comprehensive antenatal care services on the ninth day of every month to women in their second and third trimesters of pregnancy at designated Government centres, has had a huge impact. Over eight lakh high-risk pregnancies have been identified from more than 1.6 crore antenatal check-ups conducted at 13,100 centres across the country. These pregnancies were periodically monitored to ensure safe birth.
The Pradhan Mantri Matru Vandana Yojana provides a cash incentive of Rs 5,000 to encourage antenatal check-ups, institutional delivery and postnatal care among the marginalised pregnant women and lactating mothers. This has significantly contributed to rein in maternal and neonatal mortality. This shall be scaled up to cover all districts of the country. Free maternal, newborn and infant care with protection from out-of-pocket expenditure is being assured through the Janani Shishu Suraksha Karyakram initiative, which ensures free transport, blood, diet, service fee and laboratory services for all mothers and infants. The dedicated army of community health workers — over 10 lakh Accredited Social Health Activists and Auxiliary Nurse Midwives serving at sub-centers within villages — ensure a strong primary healthcare platform in which women, adolescents and children receive essential health information and basic services at home.
To address issues, like early marriages, poor nutrition and gender inequality, the Government in 2016 had launched the Mission Parivar Vikas in 146 high fertility districts across seven States — Rajasthan, Madhya Pradesh, Uttar Pradesh, Bihar, Chhattisgarh, Assam and Jharkhand. This has helped improve access to contraceptive services by introducing new concepts like nayi pahal kits which made family planning information and commodities easily available for newlyweds.
Besides, the Centre is putting in place a system to study and find ways to eliminate disparities in maternal health outcomes across India. States are being encouraged to focus on monitoring safe (child) birthing guidelines. Also, the Government has espoused its commitment towards building a healthy nation by boosting the health budget by 11.5 per cent (Rs 52, 800 crore) in 2018-19 over the previous year’s Rs 47, 352.51 crore. Healthy women are imperative to building healthy families, healthy communities and a healthy nation. The multiple policy decisions in maternal health and nutrition with a focussed approach have got us this far and we are hopeful that these will take us closer to achieving our targets. The steady decline in maternal deaths needs to be sustained and accelerated to achieve the national target of reducing MMR to less than 100 by 2020.
The Government with the Partnership for Maternal, Newborn & Child Health is co-hosting the 4th Partners’ Forum in New Delhi on December 12-13 to provide a platform for national and global health leaders, healthcare providers, academics, civil society, women, and more than 1,000 partners from over 52 countries. It will discuss common ideas and strategies so that every woman, child and adolescent is protected from premature mortality and can achieve the best possible state of health. With collective energy, we shall be able to ensure that women of our country are healthy, thus making for a healthy nation.
(The writer is Secretary, Ministry of Health & Family Welfare)