Written By: Longjam Dineshwori | Updated : January 19, 2023 2:27 PM IST
Fast-track progress towards SDG target 3.1 aiming for (MMR) maternal mortality ratio of 70, nations like India must improve their current MMR, which stands at 97 significantly.
India has been making a remarkable progress in lowering the Maternal Mortality Ratio (MMR) in the country, and the government is optimistic about attaining Sustainable Development Goal (SDG) target of MMR much before the stipulated time.
The SDG target is to reduce the maternal mortality ratio to less than 70 per 100 000 live births. India's MMR came down to 97 per lakh live births in 2018-20 from 130 in 2014-16, as recorded by the Registrar General of India (RGI). Eight states have already achieved the SDG target, and they are Kerala (19), Maharashtra (33), Telangana (43), Andhra Pradesh (45), Tamil Nadu (54), Jharkhand (56), Gujarat (57) and Karnataka (69). This significant achievement is largely credited to the various healthcare initiatives to ensure quality maternal and reproductive care.
As per the government estimates, the Infant Mortality Rate (IMR) came down to 30 per 1,000 live births in 2019 from 37 per 1000 live births in 2015. The UN's proposed SDG target for child mortality call for all countries to bring down neonatal mortality to at least 12 deaths per 1,000 live births and under-5 mortality to at least 25 deaths per 1,000 live births.
Under the National Health Mission (NHM), India has made significant investments to provide accessible quality maternal and newborn health services and minimize preventable maternal and newborn deaths and morbidity. Various schemes have been implemented to improve the Infant IMR and Maternal Mortality Rate (MMR) and accomplish the SDG target. The initiatives taken up by Govt. include:
Surakshit Matritva Aashwasan (SUMAN): It focuses on assured, dignified and respectful delivery of quality maternal and newborn healthcare services at no cost and zero tolerance for denial of services to any woman and newborn visiting a public health facility.
Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA): Through this program, all pregnant women are assured a minimum package of antenatal care services in their 2nd/3rd trimesters of pregnancy, free of cost, at designated government health facilities. This initiative is particularly lauded for its focus on identifying high-risk pregnancies and facilitating their appropriate management.
LaQshya: Launched on December 11, 2017, this program is aimed at improving quality of care for mothers and newborn during delivery and immediate post-partum period. It benefits every pregnant woman and newborn delivering in public health institutions, including all government medical college hospitals, district hospitals, designated FRUs and high case load CHCs.
Anaemia Mukt Bharat (AMB): The aim is to tackle anaemia and it includes testing and treatment of anaemia in school going adolescents and pregnant women.
Despite a number of measures being undertaken to improve mother and child health and nutrition in India, there is a lot more than can be done, opines Dr. Antaryami Dash, Deputy Director - Health and Nutrition, Bal Raksha Bharat (Save the Children, India).
Dr. Dash said, "With targeted interventions, India is prepared to achieve the 2030 SDG targets for reducing child mortality. Similar improvements have been noticed in India's nutritional indices, as seen from the five panels of national family health surveys. There are states where the decline has been impressive, but when we look at the national average, this becomes elusive. The first 1000 days of life (from conception to the first two years of a child's life) are covered by a number of government-sponsored health and nutrition initiatives. This period is known as the window of opportunity during which developmental interventions show a major impact. To name a few, schemes like Poshan 2.0, Saksham Anganwadi, PMSMA, PMMVY, SUMAN, HBYC, MAA, Anemia Mukt Bharat, etc. have contributed a lot in ensuring our children survive and thrive."
However, she pointed out that the coverage of health and nutrition interventions still remains low in many states, and operational guidelines for village-level convergence to address health and nutritional challenges lacks clarity.
"The Indian government, its development partners, and civil society organisations are committed to achieving the goals set forth in the national nutrition policy. The main objective of this strategy is to establish a multi-sectoral convergence to address health and nutritional challenges. The Government of India's Operational Guidelines for the Convergent Action Plan (CAP) aim to clarify multi-sectoral participation. Based on the existing services, the CAP framework has identified the activities and indicators that contribute to better nutrition. The CAP requires programme managers to set goals for the key indicators, identify bottlenecks, and define monitoring mechanisms across the main thematic areas. However, studies do not show any clear operational guidelines for village-level convergence," she told TheHealthSite.
"According to the NITI Aayog monitoring report, Poshan Abhiyaan improved nutritional outcomes for pregnant women, children, and lactating mothers. The coverage of Poshan Abhiyan still remains low in most states. This report emphasized expanding the reach and enhancing the quality of essential health and nutrition interventions," Dr. Dash added.
Highlighting that civil society organizations play a key role in facilitating convergence activities at the community level, Dr. Dash said, "These organizations can become the partners of choice for the identification of the community's nutritional needs, sharing ideas, and project implementation in partnership with the Government. It will also support in strategical identification of tasks and their implementation with agreed plans at the local level. The Government should lead this movement by enabling civil society organizations, agencies, businesses, and the scientific community to play a significant role in implementing policy commitments, capacity building, and targeted funding."
The Federation of Obstetricians and Gynaecological Societies of India (FOGSI), India's professional organization representing practitioners of obstetrics and gynaecology, is complementing government efforts towards achieving maternal health goals through its flagship initiative Manyata.
FOGSI's Manyata focuses on improving the quality of maternity services in private sector facilities in India by promoting the adoption and practice of quality standards in maternal health for antenatal, intrapartum, and postpartum care.
The positive impact of the Manyata initiative was highlighted in recent study by Ariadne Labs (Affiliated to Harvard University). The assessment of Manyata certified facilities found a 70 per cent improvement in the healthcare staff's knowledge and skills, including management of life-threatening complications, such as obstructed labour, pre-eclampsia and/or eclampsia and postpartum hemorrhage, as well as increased private facilities' adherence to standard clinical practices.
It is important that every woman in the country receives quality services wherever and whenever she seeks care, highlighted Dr Hrishikesh D. Pai, President, FOGSI, and Chief Administrator, FOGSI-Manyata initiative.
He added, "Through our efforts, we have demonstrated that, as a professional association, we can organize private providers and improve quality and built a momentum for quality care in private sector across India."
Dr Madhuri Patel, Secretary General, FOGSI, also underscored that improving the quality of maternal healthcare in the country is certainly the need of the hour as "India has one of the highest numbers of maternal deaths in the world."
The experts at FOGSI highlighted that involvement of the private sector is essential to improve last mile delivery of the government's maternal health interventions and advance quality of care.
Launched in 2013, FOGSI's Manyata currently has a network of 2000 facilities spanning 22 states across the country.
