Introduction

Maternal mortality remains a pressing public health concern in India, reflecting the overall efficiency and accessibility of maternal healthcare services. It serves as a key indicator of the country's healthcare quality and highlights gaps in reproductive health infrastructure. A maternal death is defined as the death of a woman during pregnancy or within 42 days of the termination of pregnancy, from causes linked to pregnancy or its management, excluding accidental or incidental factors. Addressing maternal mortality is essential not only for the well-being of women and newborns but also for achieving long-term global health goals.

Understanding Maternal Mortality and MMR Trends in India

The Maternal Mortality Ratio (MMR) is a crucial parameter used to measure maternal deaths per 100,000 live births during a specific period. India has shown remarkable progress in reducing maternal mortality over the years, with MMR declining from 130 in 2014-16 to 97 in 2018-20. This improvement has been largely driven by government interventions, better healthcare access, and increased institutional deliveries.

India was recognized by the World Health Organization (WHO) in 2015 for eliminating maternal and neonatal tetanus, a significant milestone in maternal and child healthcare. However, despite an overall downward trend, disparities persist across states. While states such as Kerala, Maharashtra, Telangana, Andhra Pradesh, Tamil Nadu, Jharkhand, Gujarat, and Karnataka have already met the Sustainable Development Goal (SDG) target of reducing MMR below 70 per 100,000 live births, several other states still face challenges in achieving this benchmark.

Maternal Health Trends Based on NFHS-5 (2019-21)

The National Family Health Survey-5 (NFHS-5) provides a comprehensive overview of maternal healthcare advancements in India:

• Antenatal Care (ANC) in the first trimester increased from 59% in NFHS-4 (2015-16) to 70% in NFHS-5 (2019-21), ensuring early maternal health monitoring.
• The proportion of pregnant women receiving four or more ANC visits grew from 51% to 59%, indicating improved access to essential maternal health services.
• Institutional deliveries witnessed a significant rise from 79% to 89% at the national level, with states like Kerala, Goa, Lakshadweep, Puducherry, and Tamil Nadu achieving 100% institutional births.
• In rural India, 87% of deliveries now take place in healthcare facilities, while in urban areas, this figure stands at 94%, showing increased reliance on medical support.

A large proportion of maternal deaths occur in the 20-29 years age group, emphasizing the need for stronger maternal healthcare policies targeted toward young mothers.

Policy Interventions to Reduce Maternal Mortality

India is actively working toward the Sustainable Development Goal (SDG) target of reducing MMR below 70 per 100,000 live births by 2030. The country has already met the National Health Policy (NHP) 2017 goal of reducing MMR below 100 by 2020. Several flagship programs and initiatives have been implemented to achieve these objectives.

1. National Health Mission (NHM) and RMNCAH+N Strategy

The National Health Mission (NHM) plays a pivotal role in maternal healthcare, particularly through the Reproductive, Maternal, Newborn, Child, and Adolescent Health and Nutrition (RMNCAH+N) strategy. This framework is designed to provide holistic maternal and child health services across states.

2. Key Government Schemes for Maternal Healthcare

a) Janani Suraksha Yojana (JSY) (2005)

• • Encourages institutional deliveries among socio-economically disadvantaged women.
  • Focuses on reducing maternal and neonatal mortality by offering financial incentives for safe childbirth.

b) Pradhan Mantri Matru Vandana Yojana (PMMVY) (2017, Revised as PMMVY 2.0 in 2022)

• • Provides financial assistance of ₹5000 for the first live birth.
  • PMMVY 2.0 encourages gender equity by offering additional incentives if the second child is a girl.

c) Janani Shishu Suraksha Karyakaram (JSSK) (2011)

• • Ensures free medical services for pregnant women and sick newborns.
  • Covers transport, medicines, diagnostics, and blood transfusions at no cost.

d) Surakshit Matritva Aashwasan (SUMAN) (2019)

• • Guarantees quality maternal and newborn healthcare with zero denial of services.
  • Aims to eliminate preventable maternal and newborn deaths.

e) Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA) (2016)

• • Provides free Antenatal Care (ANC) services on the 9th of every month.
  • Extended PMSMA (e-PMSMA) focuses on high-risk pregnancies, offering incentives for expectant mothers and ASHA workers.

f) LaQshya (2017)

• • Enhances the quality of maternity care in labour rooms and operation theatres.
  • Focuses on ensuring dignified and safe childbirth experiences.

Strengthening Maternal Healthcare Infrastructure

1. Expanding Medical Training and Human Resources

• • Training doctors in Anesthesia and Obstetric Care to bridge the shortage of specialists.

2. Improving Hospital Infrastructure

• • Upgrading First Referral Units (FRUs) with better staff, blood storage, and emergency care services.
  • Developing Maternal and Child Health (MCH) Wings in high-burden districts.
  • Setting up Obstetric ICUs and High-Dependency Units (HDU) to handle complicated pregnancies.

3. Awareness and Outreach Programs

• • Maternal Death Surveillance Review (MDSR) helps identify gaps in healthcare delivery.
  • Village Health, Sanitation, and Nutrition Days (VHSND) provide community-level maternal health services.
  • Anaemia Mukt Bharat (AMB) under POSHAN Abhiyan tackles nutritional deficiencies in pregnant women.

Lessons from State-Level Innovations

Several states have implemented unique healthcare models that have significantly contributed to reducing maternal mortality:

• Madhya Pradesh’s ‘Dastak Abhiyan’ – A community-based approach for early detection of maternal health risks.
• Tamil Nadu’s Emergency Obstetric Care Model – A referral-based healthcare network that ensures timely intervention for maternal complications.

Conclusion

India has made substantial progress in reducing maternal mortality, successfully achieving the NHP target of an MMR below 100 by 2020. However, achieving the SDG target of MMR below 70 by 2030 remains a challenge that requires continued policy focus, enhanced healthcare infrastructure, and improved access to maternal health services. By strengthening existing initiatives and adopting innovative approaches, India can further reduce maternal mortality and ensure safer pregnancies and childbirth for all women.