The recent Civil Registration System update shows that India is on its path to achieving one of the United Nations Sustainable Development Goals as the ratio of mothers dying while giving birth continues to decline in the country. The recent Sample Registration Sample update for the year 2017-19 shows that the maternal mortality ratio in the country has fallen by 10 points to 103 per one lakh live births.
The United Nations SDG target is to reduce this ratio of maternal mortality to 70 deaths per one lakh live births by 2030.
According to the World Health Organisation a woman's death is counted as a maternal death when she is in the reproductive age group (15-49) and loses her life during pregnancy or 42 days after termination of pregnancy. This maternal mortality ratio is the number of mothers who succumbed while giving birth for every one lakh live births. The maternal mortality rate is calculated as the number of women in the ages 15-49 per lakh of women in that age group.
In the 2017-19 period, India has seen the highest point reduction when compared to the last three rounds. In 2014-16, the maternal mortality ratio stood at 130. It dropped down to 122 in 2015-17, 113 in 2016-18, and finally 103 in 2017-19.
Seven Indian states- Kerala (30), Maharashtra (38), Telangana (56), Tamil Nadu (58), Andhra Pradesh (58), Jharkhand (61), and Gujarat (70) have already achieved the UN's SDG Target. Through the National Health Policy, India had set another target of achieving a ratio of 100 deaths/ per lakh live births by 2020. Karnataka (83) and Haryana (96) have additionally achieved this benchmark.
Uttarakhand (101), West Bengal (109), Punjab (114), Bihar (130), Odisha (136) and Rajasthan (141) have a ratio ranging between 100-150, while Chhattisgarh (160), Madhya Pradesh (163), Uttar Pradesh (167) and Assam (205) have a concerning MMR that is over 200.
Although there is an overall decline in the ratio, West Bengal, Haryana, Uttarakhand, and Chhattisgarh have shown an increase of 11 points, 5 points, 2 points, and 1 point respectively. The Ministry believes that these states should re-strategise and intensify their efforts to ensure that the ratio sees reduction.
It is also important to note what schemes have helped in bringing about this reduction in the ratio in the country and understand the efforts states that have a high mortality ratio should undertake.
BOOM contacted Alok Vajpeyi, Joint Director, Knowledge Managment at Population Foundation of India to understand what strategies can these states improve.
Which Schemes Helped Bring About A Reduction In MMR?
Under the National Health Mission and National Rural Health Mission, India has designed programs to tackle the issue of maternal mortality.
"This reduction is a result of various government initiatives, focussing on improving the quality and coverage of health services under the National Rural Health Mission (now National Health Mission, or NHM), launched in 2005. India's political commitments to Millennium Development Goals (MDGs), especially MDG 4 and 5—focused respectively on reducing child mortality and improving maternal health by 2015—galvanized the country's efforts, " Vajpeyi stated.
The country launched the Janani Suraksha Yojana (JSY) as well as the Janani Shishu Suraksha Yojana (JSSK) in 2005 to ensure quality care was being offered to mothers across the country.
The JSY was launched with the intent of maximising institutional delivery. The government transfers cash to the women from the marginalised and economically backward societies if they choose a hospital to conduct their delivery. In the JSSK scheme, the government aims to eliminate out of pocket expenditure for pregnant women and infants who have fallen sick by providing free services that include caesarean section, free transport, diagnostics, medicines, other consumables, diet and blood in public health institutions.
"Simultaneous investments in family planning have stimulated improved service uptake have also contributed to a decline in MMR," Vajpeyi added.
Furthermore, in the last few years, the government has also launched initiatives such as the Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA) in 2016 which provides pregnant women free ante-natal services on the 9th of every month. They also started Pradhan Mantri Matru Vandana Yojana (PMMVY) in 2017 that gives direct bank transfer cash benefits to improve their nutrition levels.
Labour Room quality and staff behaviour was another reason that contributed to maternal mortality. Labour Room Quality Improvement Initiative (LaQshya) is an initiative which ensures that women receive better treatment at hospitals. Hospitals are graded on the basis of this checklist.
The Mother and Child Card along with the Safe Motherhood Booklet, Maternal and Child Health (MCH) Wings at hospitals, safe abortion centres, Maternal Death Surveillance Review (MDSR), and regular Information, Education and Communication programs have aided in bringing this change.
What More Needs To Be Done?
Even though there is a continuous decline, there are still several states that need to strategise and work in the direction of improving services. Several mothers have complained of backlogs and poor quality services across centres.
Other socio-economic factors such as women's education, access to family planning initiatives, access to medical personnel also play a role in reducing the maternal mortality ratio,
"While there are reasons to celebrate, we must be cognisant of the fact that MMR amongst the most marginalised communities continues to be disproportionately higher and going forward we need to reach out to them. The variations in MMR across states remain a concern and we need context-specific strategies to promote girls' secondary school education, women's empowerment, delaying age at marriage, and addressing social norms that impact women's health outcomes," Vajpeyi concluded.
The southern states that are considered to be developed continue to improve their indicators and the states that are a part of the empowered action group- such as those of north east along with Bihar and Uttar Pradesh need further assistance.