Maternal Health

IN NEWS:

• According to a recently released report by the United Nations, India leads a list of 10 countries that together account for 60 percent of global maternal deaths, stillbirths, and newborn deaths, and 51 percent of live births globally.

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.

• 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)

GOVERNMENT 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