• Mothers and Children, representing a significant proportion of the population are often considered as vulnerable or special-risk groups. The issues influencing maternal and neonatal health are numerous. About 303,000 mothers and 2.7 million infants die every year, and many of them are affected by preventable illnesses. (1)  

• The Sustainable Development Goals have established targets related to maternal and neonatal health under the aegis of achieving Universal Health Coverage by 2030. (1)  

• In May 2023, the World Health Organization (WHO) released a report titled “Improving Maternal and Newborn Health and Survival and Reducing Stillbirth: Progress Report 2023”, which depicts the current state of maternal and newborn health worldwide. (2)  

• This report highlights targets like at least 4 antenatal visits, skilled birth attendants for all births, postnatal care within 2 days, and care for small and sick newborns. (2) 

• Other targets include Emergency Obstetric Care (EmOC) within a travel time of 2 hours and at least 65% of reproductive age group women making informed decisions by themselves about sexual and reproductive health. (2) 

• According to the report,  globally there are 4.5 million deaths, including 0.29 million maternal deaths, 1.9 million stillbirths, and 2.3 million newborn deaths. (2) 

• Highest deaths are found in Sub-Saharan Africa and Central and Southern Asia. (2) 

• India is the top-ranked country accounting for 60% of maternal deaths worldwide. (2)

• A significant decline in the Maternal Mortality Ratio was observed from 130 in 2014-16 to 97 per 100,000 live births in 2018-20. (3)

• Despite the improvement in the national figures, some states are still burdened by high maternal deaths.

• Sample Registration System India 2020 shows, an infant mortality rate (IMR) of 28 per 1000 live births and a stillbirth rate of 3 in 2018-20. (4)

• As per the National Family Health Survey 5 (NFHS 5), the Neonatal mortality rate (NNMR) is 24.9 per 1,000 live births. (5)

• These rates reflect the overall effectiveness of the health system.

Causes of maternal deaths:

• Direct obstetric deaths: postpartum haemorrhage, infections, eclampsia, prolonged or obstructed labour, and complications of abortion.

• Indirect obstetric deaths: anaemia, malaria, heart diseases. (6)

Importance of maternal healthcare services:

• ANC helps to promote, protect, and maintain the health of pregnant women, detect high-risk cases, anticipate complications and prevent them, and remove anxiety associated with delivery thus reducing mortality. (6)

• According to the National Family Health Survey 5 (NFHS 5) report, 88.6% were institutional births, and 89.4% of births were attended by skilled health personnel. (5)

• Reasons for not delivering in a health facility were high cost, not trusting the facility/poor quality service, and husband/family being a hindrance in seeking healthcare. Even today, in conservative communities and rural India, decisions related to healthcare are made by either husbands or families.

• Only 58.1% of mothers had at least 4 antenatal visits, whereas 78% received postnatal care within 2 days.

• 30% of mothers did not receive any AWC services during pregnancy.

• The most common reasons cited by mothers for not receiving ANC were “husbands and family did not think it was necessary or did not allow for ANC” (28%), high cost (27.7%), inadequate transportation, and the mother herself not wanting ANC.(7)

• Apathetic families, inadequate male involvement, lack of awareness and ignorance in the family, and delay in seeking care are some of the main reasons for bad maternal health outcomes. Emotional neglect can also lead to mental stress.

• In a country like ours, where an enormous portion of the population lives below the poverty line, the financial burden can be massive, leading to a lack of access to essential ANC. Financial strain also paves the way for poor decision-making which leads to home deliveries etc.

 Programmes implemented for supporting pregnant women:

Apart from these, there are initiatives by the Government of India that aim at reducing maternal deaths and the catastrophic cost of ANC, such as:

Strengths of government initiatives:

• Active involvement of the community, NGOs, and private practitioners.

• Integration of various health programmes.

• Introduction of Village Health Sanitation and Nutrition Day (VHNSD) as a platform for preventive services to marginalized and vulnerable communities.

• Strengthened infrastructure and Public-Private Partnership

• Decentralization and evidence-based planning.

  
  

 Limitations of government initiatives:

• Lack of knowledge about the schemes.

• Under-utilisation of services for maternal health.

• Due to geographical barriers, beneficiaries are unable to get care.

• Irregular and untimely incentives for ASHA workers who are already overburdened with multiple duties and responsibilities.

• Lack of motivation among care providers

• Lack of political will.

 Way forward:

• Despite the different programmes, women are still facing numerous obstacles when it comes to maternal healthcare.

• The significance of seeking appropriate healthcare during pregnancy and childbirth is impaired because of apathetic families and high costs.

• Health initiatives with strict guidelines are urgently needed to build empathy and protect the rights of pregnant women.

• Involving male members of the house in childbirth should also be addressed. The maternal and child well-being greatly depends on the role played by the families. Therefore it is important to provide counselling and raise awareness among family members of pregnant women regarding care in pregnancy and post-natal period.

• By strengthening the existing programmes and comprehensive health insurance schemes, the problem of hefty costs can be reduced.

• Raise awareness through campaigns, community engagement programmes, and interventions to handle culturally sensitive issues are need of the hour.

• Women’s empowerment through education can remove cultural and societal constraints, like decision-making power.

• By implementing these measures maternal and child health as well as the family and community as a whole may improve.

 References:

1.    WHO. 2023. Quality of care in India. (Online) Available at: https://www.who.int/india/health-topics/quality-of-care (Accessed on 2nd September 2023)

2.    Improving Maternal and Newborn Health and survival and reducing stillbirth- Progress report 2023: Available from: https://www.who.int/publications/i/item/9789240073678 (Accessed on 18th June 2023)

3.    Significant Decline in the Maternal Mortality Ratio Available from: https://pib.gov.in/PressReleaseIframePage.aspx?PRID=1879912#:~:text=As%20per%20the%20Special%20Bulletin,at%2097%2F%20lakh%20live%20births. (Accessed on 18th June 2023)

4.    SRS_Bulletin_2020_Vol_55_No_1 Available from: https://censusindia.gov.in/nada/index.php/catalog/42687( Accessed on 18th June 2023)

5.    NFHS 5: Available from: https://main.mohfw.gov.in/sites/default/files/NFHS-5_Phase-II_0.pdf

 (Accessed on 18th June 2023)

6.    Park’s Textbook of Preventive and Social Medicine. 25th Ed. Jabalpur: Banarasidas Bhanot Publishers:2019

7.    NFHS 5: Available from: http://rchiips.org/nfhs/NFHS-5Reports/NFHS-5_INDIA_REPORT.pdf(Accessed on 18th June 2023)

8.    Respectful maternity care orientation package for health care providers: Available from: https://platform.who.int/docs/default-source/mca-documents/policy-documents/operational-guidance/afg-mn-32-01-operationalguidance-2017-eng-523476805-respectful-maternity-care-providers.pdf.  (Accessed on 18th June 2023)

9.    Kamineni V, Murki AD, Kota VL. Birth preparedness and complication readiness in pregnant women attending urban tertiary care hospital. J Family Med Prim Care. 2017 Apr-Jun;6(2):297-300. doi: 10.4103/2249-4863.220006. PMID: 29302536; PMCID: PMC5749075