The World Health Organisation (WHO) has commended India for its progress in recent years in reducing the maternal mortality ratio (MMR) by 77%, from 556 per 100 000 live births in 1990 to 130 per 100 000 live births in 2016. India’s present MMR is below the Millennium Development Goal (MDG) target and puts the country on track to achieve the Sustainable Development Goal (SDG) target of an MMR below 70 by 2030.
A statement issued by WHO said that four key actions are responsible for India’s remarkable achievement, according to Dr Poonam Khetrapal Singh, Regional Director for South East Asia.
First, India had made a concerted push to increase access to quality maternal health services. Since 2005, coverage of essential maternal health services has doubled, while the proportion of institutional deliveries in public facilities has almost tripled, from 18% in 2005 to 52% in 2016 (including private facilities, institutional deliveries now stand at 79%).
Second, state-subsidized demand-side financing like the Janani Shishu Suraksha Karyakram – which allows all pregnant women delivering in public health institutions to free transport and no-expense delivery, including caesarian section – has largely closed the urban-rural divide traditionally seen in institutional births. Overall, 75% of rural births are now supervised, as compared to 89% of urban deliveries.
Third, India has put significant emphasis on mitigating the social determinants of maternal health. Women in India are more literate than ever, with 68% now able to read and write. They are also entering marriage at an older age, with just 27% now wedded before the age of 18. These factors alone have enabled Indian women to better control their reproductive lives and make decisions that reflect their own interests and wants.
Finally, the government has put in substantive efforts to facilitate positive engagement between public and private health care providers. Campaigns such as the Pradhan Mantri Surakshit Matritva Abhiyan have been introduced with great impact, allowing women access to antenatal check-ups, obstetric gynecologists and to track high-risk pregnancies – exactly what is needed to make further gains and achieve the SDG targets.
India’s achievements are already having wide-ranging human impact, and are of immense inspiration to WHO Member States, both in the Region and beyond. As per WHO South-East Asia’s Flagship Priority of advancing maternal, newborn, child and adolescent health, the Organization will continue to provide technical and operational support as and where needed in India and across the Region to end preventable deaths due to pregnancy and childbirth and to ensure every woman has full control over her reproductive life.
Meanwhile, Unicef, too, has appreciated the achievement.
“India has shown impressive progress in reducing maternal deaths, with nearly 1000 fewer women now dying of pregnancy related complications each month in India as compared to 2013” said Dr. Yasmin Ali Haque, country representative of UNICEF in India.
She further added, “What is even more heartening to see is that the State of Uttar Pradesh, which accounts for the highest share of home deliveries in the country has led the charts with a near 30 per cent reduction, which is even higher than the national average of 22 per cent”.
However, even one maternal death is too many and it is our shared responsibility to end these preventable maternal and newborn deaths. Ensuring every women delivers with a safe pair of hands in an environment that treats her with respect and dignity going to be the key. It will be crucial that the same timely access and quality of care is afforded to every woman, especially those who live in the remotest and the poorest household of the country. The time for all of us to act is now, she added.