Maternal Health

MAY 2

Mains   > Social justice   >   Health   >   Women and Child issues

WHY IN NEWS

  • Recently Union Health Ministry had said that India is on the verge of achieving the Sustainable Development Goals (SDGs) target of a Maternal Mortality Ratio (MMR) of 70 maternal deaths per lakh live births by 2030

STATISTICS

  • In India, maternal health has been a key issue for successive governments since independence with the Maternal Mortality Ratio (MMR) being as high as 2,000 per one lakh live births in the 1940s.

What is Maternal Mortality Ratio or MMR?

It is the number of maternal deaths during a given time period per 1 lakh live births. “Maternal mortality is considered a key health indicator and the direct causes of maternal deaths are well known and largely preventable and treatable”, says the UNICEF.

  • In the 1950s, this came down to 1,000 and subsequently improved to 600 in the 1990s (at that time, the global MMR was 400), thanks to a rapid improvement in healthcare infrastructure, that rate has been reduced significantly.
  • According to Sample Registration System (SRS):
    • There is a "progressive reduction" in MMR from 130 in 2014-2016 to 122 in 2015-17 to 113 in 2016-18, and 103 in 2017-19.
    • The target 3.1 of Sustainable Development Goals (SDG) is to reduce the global MMR to less than 70 per 1,00,000 live births.
    • Nine states have already achieved SDG target - Kerala (30), Maharashtra (38), Telangana (56), Tamil Nadu (58) etc.
  • According to the National Family Health Survey (NFHS-4):
    • Institutional deliveries have increased from 39% in 2005-06 to 79% in 2015-16.

SIGNIFICANCE OF MATERNAL HEALTH:

  • Better human capital and labour productivity:
    • Epidemiological evidence suggests that a mother’s health significantly affect the biological development of the foetus
    • Events which occur while a child is in utero (in the womb) cast a long shadow over cognitive development and health status even in adulthood >> Therefore improved maternal health gives better human capital >> which in turn results in better labour productivity
  • For better outcome in schooling:
    • A healthy mother is more likely to give birth to a healthy baby who learns better and stays on in school longer as a result
  • Tackling neo-natal and infant mortality:
    • A leading cause of neonatal mortality is low birth weight >> Women who begin pregnancy too thin and who do not gain enough weight during pregnancy are far more likely to have low birth weight babies
  • Nutritional security of children:
    • Maternal care and institutional delivery >> has direct implication on the nutritional intake and its absorption in child

CHALLENGES

  • Malnutrition among women:
    • 42.2 per cent of Indian women are underweight at the beginning of pregnancy.
    • 50.4% of pregnant women were found to be anaemic in 2016, as per the NFHS 4
  • Low weight gain during pregnancy:
    • Women in India gain only about 7 kilograms during pregnancy, which is substantially less than the 12 kg gain that the WHO recommends for underweight women
  • Social norms:
    • Social norms accord young women low status in joint households >> results in low intake of nutrition
  • Lack of resources within public sector facilities:
    • Public health care systems lacks equipment and technical competence to provide comprehensive maternity care
  • Unsafe abortions:
    • More than 10 women die every day due to unsafe abortions in India
    • Stricter provisions under The Medical Termination of Pregnancy Act contribute to women seeking illegal and unsafe options
  • Lack of institutional delivery:
    • Over the past two decades, India has made progress in increasing the number of institutional deliveries. But 21% of births still happens outside the institutional setup (NFHS 4)

INITIATIVES

  • LaQshya (Labour room Quality Improvement Initiative):
    • It aims to improve the quality of care in the labour room and maternity operation theatres in public health facilities.
    • A comprehensive strategy has been adopted that includes infrastructure up-gradation, ensuring the availability of vital equipment, improved and adequate human resources and improving skills of healthcare workers.
    • The quality of the labour rooms and maternity operation theatres will be assessed through the National Quality Assurance Standards (NQAS).
  • POSHAN Abhiyaan - National Nutrition Mission
    • It aims to improve nutritional outcomes among pregnant women, lactating mothers and children by reducing the level of stunting, underweight, anaemia and low birth weight by 2022.
  • Janani Suraksha Yojana (JSY):
    • It integrates cash assistance with delivery and post-delivery care to reduce the maternal and neonatal mortality rate and promote institutional delivery of the pregnant women, especially with weak socio-economic status.
  • Pradhan Mantri Surakhit Matritva Abhiyan (PMSMA):
    • It aims to provide free comprehensive and quality antenatal checkups for pregnant women across the country.
  • Pradhan Mantri Matru Vandhana Yojana (PMMVY):
    • It provides a cash benefit to the pregnant women in their bank account directly to address their nutritional needs and compensate for their wage loss.
  • Surakhit Matritva Aashwasan Initiative (SUMAN)
    • It aims to provide free quality healthcare to all pregnant women, mothers up to 6 months after delivery and all sick newborns who are visiting a public health facility.
  • The National Food Security Act of 2013
    • It has provisions for universal cash entitlement for pregnant women of at least 6,000 rupees.

BEST PRACTICE:

  • Kangaroo mother care (KMC):
    • The intervention where babies are placed in skin-to-skin contact with their mothers and exclusively breast fed has been recommended worldwide for stable low-birthweight newborns
  • The maternal and child health care service (MCHS) in Norway
    • MCHS offers all pregnant women and children free health care services

PRACTICE QUESTION:

Q. In order to enhance the prospects of social development, sound and adequate health care policies are needed particularly in the fields of maternal health care. Discuss