Context:

The United Nations Population Fund (UNFPA) has acknowledged India’s significant progress in maternal health, emphasizing the nation’s commitment to women's health and well-being. In a recent recognition ceremony, Dr. Natalia Kanem, Executive Director of UNFPA, presented a plaque and certificate to Smt. Punya Salila Srivastava, Union Health Secretary, highlighting the UNFPA's enduring partnership with India in promoting health initiatives for women.

 Context of Maternal Health in India:

The maternal mortality rate is a critical indicator of a country’s health system and reflects the effectiveness of healthcare services available to women during pregnancy, childbirth, and the postpartum period. According to the Sample Registration System (SRS), India’s national average MMR declined from 130 to 97 maternal deaths per 100,000 live births between 2014-2016 and 2018-2019. Eight states have already achieved the target MMR of below 70, demonstrating the country’s commitment to improving maternal health outcomes.

 Key Factors Contributing to Success:

1. Improved Family Planning Services

One of the most significant contributors to the reduction in MMR has been the advancement in family planning services. The use of modern contraceptive methods among currently married women has increased from 47.8% to 56.5%. This rise can be attributed to increased awareness, education, and accessibility of contraceptive options, empowering women to make informed decisions regarding their reproductive health.

2. Expanded Contraceptive Options

The introduction of new contraceptive methods has expanded the range of choices available to Indian women. Options such as subdermal implants and injectable contraceptives have enhanced the basket of family planning services, allowing women to choose methods that best suit their needs and lifestyles. This diversification is crucial in promoting effective family planning and reducing unintended pregnancies, which can lead to maternal health complications.

3. Collaboration and Partnership

The partnership between the Government of India and the United Nations Population Fund (UNFPA) has played a pivotal role in addressing maternal health challenges. This collaboration has facilitated the implementation of effective policies and programs aimed at improving health services for women and children. Joint efforts have ensured that maternal health remains a priority on the national agenda, fostering an environment conducive to sustainable health improvements.

4. Government Initiatives:

National Health Mission (NHM)

·         Launch Date: 2005

·         A flagship program aimed at providing accessible and affordable healthcare services, including maternal healthcare, through the Reproductive, Maternal, Newborn, Child, and Adolescent Health (RMNCH+A) strategy.

Janani Suraksha Yojana (JSY)

·         Launch Date: 2005

·         A conditional cash transfer program promoting institutional deliveries and postnatal care for low-income pregnant women.

Pradhan Mantri Matru Vandana Yojana (PMMVY)

·         Launch Date: September 1, 2017

·         Offers cash incentives and wage compensation for pregnant and lactating women for their first live birth, promoting prenatal care and institutional deliveries.

Surakshit Matritva Aashwasan Yojana (SUMAN)

·         Launch Date: October 10, 2019

·         Ensures every woman and newborn receives dignified healthcare without cost, aiming to eliminate preventable maternal and newborn deaths.

Janani Shishu Suraksha Karyakram (JSSK)

·         Launch Date: 2011

·         Guarantees free and cashless delivery services, including cesarean sections, in public health facilities.

What is Maternal Mortality?

According to the World Health Organization (WHO), maternal death is defined as the death of a woman while pregnant or within 42 days of pregnancy termination, from any cause related to or aggravated by the pregnancy or its management, excluding accidental or incidental causes.

Causes of Maternal Mortality

1.    Postpartum Hemorrhage: Excessive bleeding after childbirth can lead to severe complications if not managed promptly.

2.    Hypertension: High blood pressure during pregnancy poses serious health risks for both mother and baby, including the possibility of stroke.

3.    Sepsis: A severe infection occurring during or after childbirth can lead to systemic inflammation and organ failure.

4.    Complications During Delivery: Issues like obstructed labor or the need for emergency cesarean sections increase risks for both mother and infant.

5.    Abortion-Related Complications: Unsafe abortions can lead to significant health risks and mortality.

6.    Pre-Eclampsia: Characterized by high blood pressure and organ damage, this condition affects maternal and fetal health if untreated.

7.    Eclampsia: A severe progression of pre-eclampsia, causing seizures during pregnancy or childbirth, posing immediate danger to both mother and child.

Challenges in Reducing Maternal Mortality Rate (MMR) in India:

·        Regional Disparities: States with limited healthcare infrastructure often report higher MMR. Bridging these gaps is essential for equitable maternal healthcare outcomes.

·        Socioeconomic Factors: Women from marginalized communities and low-income households face higher risks due to limited access to healthcare facilities and resources.

·        Quality of Healthcare Services: Many areas, especially remote regions, lack skilled healthcare providers and adequate medical supplies, compromising the quality of maternal healthcare.

·        Awareness and Education: Limited awareness regarding the importance of antenatal and postnatal care hampers timely healthcare-seeking behavior.

·        Cultural and Social Factors: Traditional beliefs and societal norms can hinder women's access to maternal healthcare services, creating barriers to necessary care.

Strategies for Reducing MMR in India

• Promoting Community Integration: Enhancing community integration is crucial for identifying and addressing healthcare inequities. By strengthening health education and collaborating with NGOs, India can effectively reach underserved populations. Utilizing Accredited Social Health Activists (ASHA) to facilitate communication between healthcare systems and communities can empower local health workers to educate women about available services and encourage health-seeking behavior. This grassroots approach fosters trust and improves access to essential maternal healthcare services.
• Tackling Maternal Mental Health: Maternal mental health is often overlooked, yet it plays a vital role in overall maternal and infant well-being. Integrating maternal mental health into national policies can help address issues like peripartum depression. Developing targeted programs that provide mental health support during pregnancy and the postpartum period will ensure that women receive holistic care. Training healthcare providers to recognize and respond to mental health issues can further enhance the support available to mothers.
• Addressing Technology Barriers: Leveraging digital health initiatives can significantly improve access to maternal healthcare, especially in low-resource settings. Implementing telemedicine and mobile health applications can facilitate remote consultations and provide educational resources to pregnant women. By bridging the technology gap, these initiatives can ensure that women in rural areas receive timely information and care, ultimately enhancing their health outcomes. Collaborating with tech companies and healthcare providers to create user-friendly platforms can further enhance access and utilization.

Conclusion:

The recognition by UNFPA of India’s leadership in maternal health and family planning is a testament to the country's significant strides in improving the well-being of women and children. The impressive 70% reduction in the Maternal Mortality Ratio between 2000 and 2020 illustrates the effectiveness of targeted health policies and initiatives like SUMAN and PMSMA. This progress not only positions India closer to achieving the Sustainable Development Goal of an MMR below 70 by 2030 but also highlights the vital role of collaboration between the Government of India and international partners such as UNFPA.

Source: PIB, UNFPA