Why Are The Various ‘Abhiyaans’ Not Improving India’s Maternal Mortality Rate?

Over the last few decades, India has endured significant socio-economic changes. The country has witnessed profound shifts in politics and policy, in diplomacy and digitization, however, what has remained unchanged is access to quality public health care.

With the launch of Pradhan Mantri Jan Arogya Abhiyaan, the Indian health care system may be designated as one of the ‘world’s largest’ but it is certainly not the finest. The fundamental impediments like inadequate hospitals and doctors remain a roaring challenge. Perversely, the deficit of public health care infrastructure and services is acute in both rural and urban areas, increasing the dependency on private health care services. India has one of the world’s highest rates of out-of-pocket spending in health care, consequently, pushing the people into poverty.

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We are the world’s sixth largest economy at $2.6 trillion, yet it is paradoxical that we are incapable of addressing the crucial indicators like Maternal Mortality Ratio (MMR) and Infant Mortality Rate (IMR). The government policies and schemes may boast of attempting universal health care and free treatment, but the delivery mechanism has faltered frequently. India continues to add almost a fourth to the world-wide maternal morbidity and mortality, even after several efforts.

As reported by UNICEF in 2017,  around 44,000 women in India die annually due to preventable pregnancy-related causes. Janani Suraksha Yojana (JSY), a maternity benefit scheme by the Central Government that ensured a conditional cash transfer to underprivileged and marginalized sections for promoting institutional delivery, had very little impact on maternal mortality. Though the policy witnessed a phenomenal rise in institutional deliveries through ASHA workers, it failed to address crucial components like antenatal care and neonatal care.

The “incentive” structure of the JSY resulted in sluggish progress. To supplement JSY, the government launched Janani Shishu Suraksha Karyakram (JSSK), focusing on other vital aspects like transportation, medicines, C-sections, care for sick newborns, as free services. However, the inadequate robust monitoring framework surfaced as a barrier resulting in no takers for the benefits.

An additional scheme, Pradhan Mantri Surakshit Matritva Abhiyan was introduced in 2016 which appears to be comprehensive and compels important components of maternal health care. To make the policy victorious, the state level government now needs to be committed towards a coherent and transparent on-ground execution. We can ensure steady progress with an all-inclusive schedule of activities, including educating and empowering women about maternal health, family planning initiatives, reproductive wellness, sanitation, and hygiene. The actions have to be coupled with transparent communication tools including effective Information Education & Communication (IEC), Interpersonal Communication (IC), and Behavior Change Communication (BCC). We can’t overlook the potential of communication methods like documentaries, nukkad natak, puppetry shows and the community radio campaigns, which can achieve a great deal in combating the maternal and neonatal deaths.

It’s important to build a consistent skill and knowledge building process around efficient management of labour and delivery across health centres. To be exact, respectful maternity care that must be provided to the mothers; a clean bathing place and toilet, warm place for the child and privacy for breastfeeding, will motivate them to stay longer at the health centre for better care.

The health care centers require well-planned Emergency Obstetric Care (EMOC) training programmes aimed at two-levels. Firstly, intended at training the obstetricians, nurses and nursing attendants. Secondly, aimed to strengthen the skills of front line workers, Accredited Social Health Activists (ASHA) and Auxiliary Nurse Midwives (ANM). The integrated approach can be made effective if the training schedules are formulated on evidence-based clinical guidelines and techniques. It must be an uncompromising arrangement to adhere to guidelines and subdue potentially harmful practices.

The government interventions both at the national and state level, unmistakably, must be strategized through a series of care beginning from pregnancy care to childbirth and finally the postpartum care. Statistics on maternal deaths cannot be taken lightly. We need a steady momentum to transform the “silent emergency” of maternal deaths into a war cry as it is a matter of basic human rights for survival and social justice for women.

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