What are the steps to be taken to reduce maternal mortality in India?

Understanding the Causes of Maternal Mortality

To effectively reduce maternal mortality, it is crucial to understand its primary causes, which are largely preventable. Globally and in India, these include:

• Obstetric Hemorrhage: Excessive bleeding during pregnancy, childbirth, or postpartum.
• Infections: Often arising after childbirth due to poor hygiene or inadequate care.
• Hypertensive Disorders: Such as pre-eclampsia and eclampsia.
• Unsafe Abortions: Contributing significantly to maternal deaths, particularly in regions with limited access to safe services.
• Delivery-related Complications: Including obstructed labor.
• Pre-existing Conditions: Worsened by pregnancy, such as anemia, malnutrition, and other non-communicable diseases like diabetes and hypertension.

Beyond direct medical causes, socio-economic and cultural factors like early marriage, lack of female education, poverty, and limited access to healthcare facilities exacerbate the risks.

Steps to Reduce Maternal Mortality in India

A multi-pronged strategy encompassing improvements in healthcare delivery, socio-economic empowerment, and robust policy frameworks is essential to further reduce maternal mortality in India.

1. Strengthening Healthcare Infrastructure and Service Delivery

• Enhancing Antenatal Care (ANC):
  • Promoting early registration of pregnancy and ensuring at least four comprehensive ANC visits, as recommended by WHO.
  • Early detection and management of high-risk pregnancies through regular screening for conditions like anemia, hypertension, and diabetes.
  • Providing iron and folic acid supplementation and nutritional counseling.
  • Implementing initiatives like Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA) to provide assured, free, and quality antenatal care by specialists on a fixed day every month.
• Promoting Institutional Deliveries:
  • Increasing the proportion of births occurring in well-equipped health facilities with skilled birth attendants.
  • Incentivizing institutional deliveries, especially among economically disadvantaged women, through schemes like Janani Suraksha Yojana (JSY).
  • Ensuring availability of essential equipment, drugs, and blood transfusion services at delivery points.
  • Implementing programs like Janani Shishu Suraksha Karyakram (JSSK) to provide free delivery, including C-sections, in public health institutions.
• Improving Intrapartum and Postnatal Care:
  • Ensuring skilled attendance at birth and immediate care for complications like postpartum hemorrhage and infection.
  • Strengthening emergency obstetric and neonatal care (EmONC) services, particularly in rural and remote areas.
  • Implementing programs like LaQshya (Labour Room Quality Improvement Initiative) to enhance the quality of care in labor rooms and maternity operation theatres.
  • Providing comprehensive postnatal care, including family planning services and newborn care.
• Capacity Building of Health Workforce:
  • Training and deploying a sufficient number of skilled birth attendants (doctors, nurses, ANMs, ASHAs) with practical skills in managing labor and delivery complications.
  • Regular refreshers and training on emergency protocols.
• Access to Safe Abortion Services:
  • Ensuring availability and accessibility of safe and legal abortion services to prevent deaths from unsafe procedures.

2. Addressing Socio-Economic and Cultural Determinants

• Women's Education and Empowerment:
  • Promoting girls' education to delay marriage and first pregnancy, and enhance their agency in healthcare decisions.
  • Raising awareness about maternal health, danger signs during pregnancy, and the importance of seeking timely medical care.
• Nutritional Support:
  • Tackling anemia and malnutrition among women of reproductive age through initiatives like Anaemia Mukt Bharat and POSHAN Abhiyaan.
  • Providing financial incentives and nutritional supplements to pregnant and lactating mothers, such as through Pradhan Mantri Matru Vandana Yojana (PMMVY).
• Improved Transportation and Connectivity:
  • Developing robust transport systems, especially in remote areas, to facilitate timely referral of pregnant women to higher-level facilities.
  • Utilizing emergency ambulance services effectively.
• Community Engagement:
  • Involving Accredited Social Health Activists (ASHAs) and Anganwadi Workers (AWWs) in community-level awareness, counseling, and facilitating access to services.
  • Empowering women's self-help groups (SHGs) to promote maternal health practices.
• Gender Equality and Addressing Discriminatory Practices:
  • Combating harmful traditional practices and ensuring women's equitable access to food, resources, and decision-making within households.

3. Policy and Governance Interventions

• Robust Monitoring and Evaluation:
  • Mandatory reporting and audit of all maternal deaths to identify systemic deficiencies and implement corrective measures.
  • Data-driven decision-making to target interventions in high-MMR states and regions.
• Inter-sectoral Convergence:
  • Collaboration between health, women and child development, education, and rural development ministries to address the multi-faceted determinants of maternal mortality.
• Universal Health Coverage:
  • Strengthening primary health care (PHC) and ensuring that quality maternal care is accessible and affordable for all women, especially marginalized groups, through initiatives like Ayushman Bharat – Health and Wellness Centres.
  • Implementing Surakshit Matritva Aashwasan (SUMAN) to provide assured, dignified, respectful, and quality healthcare at no cost for every woman and newborn.
• Strategic Focus on Vulnerable Regions:
  • Prioritizing healthcare investments in high-MMR states such as Assam, Uttar Pradesh, and Madhya Pradesh, leveraging mobile health units and telemedicine.

The collective impact of these steps is crucial for India to not only achieve but also surpass the SDG target of an MMR below 70 by 2030, ensuring that every woman has the right to a safe motherhood.