Maternal Health Care in India  

Maternal Health Care in India  

Why in News: India accounted for over 17% of global maternal deaths in 2020, the highest share among the 10 countries responsible for 60% of global maternal deaths, stillbirths, and neonatal deaths, according to a United Nations report in May 2023.

UPSC Syllabus: 

Mains: GS1: Society

Global Maternal Mortality:   

Maternal Mortality Ratio (MMR)   

• The maternal mortality ratio (MMR) is defined as the number of maternal deaths per 100,000 live births.
• It is a crucial indicator of maternal health and the effectiveness of the healthcare system.

Current global maternal mortality data

• According to the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF), approximately 295,000 women died during and after pregnancy and childbirth in 2017.
• The majority of these deaths (94%) occurred in low-resource settings, and most were preventable.
• In 2020, an estimated 287,000 maternal deaths occurred worldwide, down slightly from 309,000 in 2016.

Sustainable Development Goals (SDGs) related to maternal health

• The Sustainable Development Goal (SDG) aims to reduce the global maternal mortality rate to less than 70 per 100,000 live births by 2030.
• Achieving this goal requires substantial improvements in access, quality, and healthcare equity, particularly in low-resource areas.

Global trends and regional disparities: The maternal mortality ratio (MMR) varies considerably across regions.

• Sub-Saharan Africa is the region with the highest maternal mortality ratio (MMR), accounting for approximately 68% of the global maternal mortality rate.
• Despite significant progress, the maternal mortality rate in Southern Asia remains high.
• Developed regions: The maternal mortality ratio (MMR) is much lower, reflecting better access to quality health services.

Primary causes of maternal deaths

Pregnancy and childbirth complications lead to maternal deaths.

Severe bleeding (postpartum hemorrhage)

• Severe bleeding, especially postpartum hemorrhage, is one of the leading causes of maternal deaths.
• It occurs when there is excessive bleeding after delivery.
• According to the World Health Organization (WHO), postpartum hemorrhage is responsible for approximately 27% of maternal deaths globally.
• Timely administration of uterotonics, skilled delivery attendance, and access to emergency obstetric care are important to prevent and manage severe bleeding.

Infection 

• Infections, especially postpartum infections, if not treated promptly, can lead to severe sepsis and maternal death.
• According to WHO reports, infections are responsible for about 11% of maternal deaths worldwide.
• Maintaining hygiene during delivery, giving antibiotics when necessary, and providing postpartum care can significantly reduce the risk of infection.

Hypertension (pre-eclampsia and eclampsia)

• High blood pressure during pregnancy, especially pre-eclampsia and eclampsia, can lead to serious complications and maternal death.
• According to the WHO, hypertensive disorders cause about 14% of maternal deaths globally.
• Regular antenatal check-ups, blood pressure monitoring, and timely management of pre-eclampsia with medications and delivery planning are essential.

Delivery-related complications

• Obstetric complications such as obstructed labor, uterine rupture, and severe lacerations can lead to maternal death if not managed appropriately.
• These complications account for a significant proportion of maternal deaths, especially in low-resource settings.
• Access to skilled birth attendants, emergency obstetric care, and timely surgical interventions such as cesarean sections are critical.

Unsafe abortion 

• Unsafe abortion procedures can result in serious complications, including bleeding, infection, and organ damage, leading to maternal death.
• According to the WHO, unsafe abortion causes approximately 13% of maternal deaths globally.
• Safe abortion services, post-abortion care, and educating women about family planning can all help to reduce the incidence of unsafe abortions.

Indirect causes

• Indirect causes include pre-existing medical conditions such as malaria, diabetes, hepatitis, and anemia that can worsen during pregnancy and contribute to maternal death.
• Indirect causes account for a significant number of maternal deaths, particularly in areas where these conditions are more prevalent.
• Effective management of pre-existing conditions, regular antenatal care, and access to comprehensive health services are important.

Challenges in Maternal Healthcare

Rural-urban disparities

• There is a significant disparity in maternal healthcare access and quality between rural and urban areas.
• Rural women often face barriers such as lack of transport, inadequate health facilities, and cultural practices.

Socio-economic factors 

• Social factors, such as poverty, illiteracy, and gender inequality, significantly influence maternal health outcomes. Economic factors play a significant role in maternal health outcomes.
• These factors often hinder women’s access to timely and adequate healthcare services.

Quality of care

• While access to healthcare services has improved, the quality of care remains inconsistent.
• Understaffed healthcare facilities, a lack of essential supplies, and inadequate healthcare provider training all affect the quality of maternal care.

Recommendations for improving

Strengthening the healthcare infrastructure

• Investing in healthcare infrastructure, especially in rural areas, is essential.
• This includes building more healthcare facilities, ensuring the availability of essential medical supplies, and improving transportation for emergency cases.

Improved training programs

Public awareness campaigns

Maternal healthcare in India is state-specific

The status of maternal healthcare in major states

Kerala

• Kerala has one of India’s lowest MMR.
• As per SRS 2018-20, Kerala has an MMR of 30 per 100,000 live births, reflecting the state’s strong healthcare infrastructure and effective healthcare policies.
• According to NFHS-5, Kerala has almost universal institutional deliveries, with 99.8% of births occurring in health facilities.
• In Kerala, 96.9% of women received at least four antenatal care (ANC) visits, reflecting high awareness and access to maternal healthcare services.

Uttar Pradesh

• Uttar Pradesh has a high maternal mortality rate of 173 (SRS 2018–20) per 100,000 live births, indicating significant challenges in maternal healthcare.
• Institutional deliveries in Uttar Pradesh have improved but remain below the national average, where 76.4% of births took place in health facilities (NFHS -5).
• Only 43.8% of women visited for antenatal care (ANC) at least four times, indicating the need for better healthcare outreach and services.

Maharashtra

• Maharashtra has a moderate MMR of 46 (Sample Registration System (SRS) 2018–20) per 100,000 live births, indicating a better healthcare scenario than many states, but there is still room for improvement.
• Institutional deliveries are high in Maharashtra, with 94.6% of births taking place in health facilities (NFHS-5).
• Maharashtra’s antenatal care (ANC) visits are high, with 75.7% of women receiving at least four ANC visits during pregnancy.

Bihar

• Bihar has the highest MMR with 130 per 100,000 live births (Sample Registration System (SRS) 2018–20), indicating serious challenges in maternal health services.
• Institutional deliveries are relatively low, at 63.8% (NFHS-5), reflecting barriers to accessing health facilities.
• Only 38.8% of women in Bihar received at least four antenatal care (ANC) visits, underscoring the need for improved maternal health service outreach.

Key Components of the Maternal Health Care System

Surveys and reports

National Family Health Survey (NFHS): The NFHS, conducted by the Ministry of Health and Family Welfare, provides comprehensive data on maternal health indicators such as antenatal care, institutional deliveries, and maternal mortality rate.

Sample Registration System (SRS): At the national and state levels, the Sample Registration System (SRS) provides estimates of the maternal mortality rate (MMR).

Health Management Information System (HMIS): The Health Management Information System (HMIS) collects real-time data from health facilities across India, helping to monitor maternal health indicators and identify areas needing improvement.

Health care interventions

Antenatal Care (ANC)

Routine check-ups: regular antenatal visits to monitor the health of the mother and fetus, manage pre-existing conditions, and detect potential complications.

Supplements and Immunization: Provide iron and folic acid supplements, tetanus toxoid immunization, and other essential drugs to prevent pregnancy complications.

Skilled birth attendance

Institutional delivery: encouraging deliveries in healthcare facilities equipped with skilled birth attendants to manage normal and complicated births.

Training programs: continuous training for healthcare providers, including doctors, nurses, and midwives, to ensure high-quality maternal care.

Postpartum care (PNC)

• Monitoring the health of the mother and the newborn, postpartum.
• To manage postpartum complications and provide breastfeeding support, regular postpartum visits are necessary.
• The government has appointed Accredited Social Health Activists (ASHAs) to provide home-based postpartum care and support.

Monitoring and evaluation

Quality Assurance Program 

LAKSHAY Programme: The LAKSHAY Programme aims to improve the quality of care in labor rooms and obstetric operation theaters through regular audits, feedback mechanisms, and adherence to clinical protocols. 

Maternal Death Surveillance and Response (MDSR): A system to identify, notify, and review maternal deaths to understand their causes and implement corrective action.

Technological Integration

Implementation of digital health records and mobile applications for tracking maternal health data, appointment reminders, and health education.

Telemedicine: the use of telemedicine services to provide remote consultation and follow-up care, particularly in rural and deprived areas.

Government Initiatives for Maternal Health Care in India

Janani Suraksha Yojana (JSY)

Objectives

Features

• Pregnant women receive cash incentives for giving birth in health facilities.
• Accredited Social Health Activists (ASHA) receive special incentives for their encouragement and facilitation of institutional deliveries.

Impact

• There has been a surge in institutional deliveries, particularly in low-income groups.
• Maternal and neonatal mortality have significantly decreased.

Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA)

Objectives

Features

• The program offers free antenatal check-ups for pregnant women in their second and third trimesters.
• Identification and management of high-risk pregnancies.
• Essential drugs and immunizations are provided.

Impact

• An improvement in antenatal care coverage.
• It is crucial to identify and handle pregnancy-related issues promptly.

LaQshya Programme

Objective

Features

• Health facilities undergo regular audits and assessments.
• Standard operating procedures and protocols are being implemented.
• Healthcare providers can benefit from capacity-building and training programs.

Impact

• The quality of care for mothers and newborns has increased.
• Reduction in maternal and newborn mortality.

Janani Shishu Suraksha Karyakram (JSSK)

Objective

Features

• Free delivery and cesarean section services.
• Free transportation to health facilities.
• Provide free medicines, diagnostics, and blood transfusion services.
• Free diet during hospital stays.

Impact

• There has been an increase in access to maternal and newborn health services.
• There is a decrease in the monetary strain on households.

Ayushman Bharat—Pradhan Mantri Jan Arogya Yojana (PMJAY)

Objective

Features

Provide health insurance coverage up to Rs. 5 lakh per family annually for secondary and tertiary care hospitalization.

Impact

• There has been an increase in access to quality maternal health services.
• There is a decrease in the financial obstacles to obtaining health care.

Mission Indradhanush

Objective

Features

• Focus on high-priority districts with low immunization coverage.
• Intensification of immunization drive to cover missed and left out children and pregnant women.
• The Universal Immunization Programme (UIP) provides all vaccines.

Way forward for maternal healthcare in India

Strengthen healthcare infrastructure

Focus on rural areas: Invest in building and upgrading healthcare facilities in rural and remote areas to ensure equitable access to maternal healthcare services.

Specialized maternal care units: Establish specialized maternal and neonatal care units in district and sub-district hospitals to handle high-risk pregnancies and complications.

Enhancing quality of care

Regular training programs: Implement continuous training and skill development programs for healthcare providers, including doctors, nurses, and midwives, to ensure high-quality maternal care.

Quality assurance programs: Strengthen quality assurance programs such as targets to monitor and improve quality of care in labor rooms and obstetric operation theatres.

Empowering community health workers

• Recognised social health workers in providing maternal health services including antenatal and postnatal care and promoting institutional delivery 

• Enhance the role of maternal health workers (ASHA). 

• Organise community awareness programs to educate women and families about the importance of maternal health care and available government schemes.