Maternal mortality ratio declines by 8.8 percent, says govt

New Delhi: In the recent Bulletin released by the Registrar General of India, the maternal mortality ratio (MMR)  has declined by 10 points. The ratio has declined from 113 in 2016-18 to 103 in 2017-19 (8.8 % decline), the largest decline has been reported in the state of Kerala.

The country has been witnessing a progressive reduction in MMR from 130 in 2014-2016, 122 in 2015-17, 113 in 2016-18, and 103 in 2017-19.

With this persistent decline, India is on the verge of achieving the National Health Policy (NHP) target of 100/lakh live births by 2020 and is certainly on track to achieve the SDG target of 70/ lakh live births by 2030. The number of states which have achieved the Sustainable Development Goal (SDG) target has now risen from 5 to 7 viz. Kerala (30), Maharashtra (38), Telangana (56), Tamil Nadu (58), Andhra Pradesh (58), Jharkhand (61), and Gujarat (70). There are now nine (9) States that have achieved the target of MMR set by the NHP which include the above 7 and the States of Karnataka (83) and Haryana (96).

Five states [Uttarakhand (101), West Bengal (109), Punjab (114), Bihar (130), Odisha (136), and Rajasthan (141)] have MMR in between 100-150, while for 4 states namely, Chhattisgarh (160), Madhya Pradesh (163), Uttar Pradesh (167) and Assam (205) have MMR above 150.

Encouraging achievement has been reported by Uttar Pradesh [which has shown the maximum decline of 30 points], Rajasthan (23 points), Bihar (19 points), Punjab (15 points), and Odisha (14 points).

Remarkably, three states (Kerala, Maharashtra, and Uttar Pradesh) have shown more than 15% decline in MMR, while 6 states namely, Jharkhand, Rajasthan, Bihar, Punjab, Telangana, and Andhra Pradesh have shown a decline between 10-15%. Four states viz. Madhya Pradesh, Gujarat, Odisha, and Karnataka witnessed a decline between 5-10%.

Four states namely West Bengal, Haryana, Uttarakhand, and Chhattisgarh have shown an increase in MMR and hence will need to reappraise their strategy and intensify their efforts to accelerate the MMR decline to achieve the SDG target.

It is pertinent to point out that strategic investments under National Health Mission (NHM) through various schemes have been consistently yielding increasing dividends. Remarkable gains have been made under quality-of-care endeavors by the Government of India like Pradhan Mantri Surakshit Matritva Abhiyan and Labour Room Quality Improvement Initiative (LaQshya) in conjunction with the existing schemes like Janani Shishu Suraksha Karyakram and Janani Suraksha Yojana.

Additionally, flagship schemes by MoWCD such as the Pradhan Mantri Matru Vandana Yojana (PMMVY) and Poshan Abhiyan target nutrition delivery for vulnerable populations, particularly pregnant and nursing women and children. The achievement also bolsters the Government of India's resolve to 'Surakshit Matritva Aashwasan' for the women by creating a responsive health care system that strives to achieve zero preventable maternal and newborn deaths.

Furthermore, The Union health ministry has launched Maternal Perinatal Child Death Surveillance Response (MPCDSR) software in 2021 to create a one-stop integrated information platform to capture actionable data for maternal deaths. Together with this, the Government of India has initiated the creation of a new cadre of "Nurse Practitioner in Midwifery" under the Midwifery Initiative to ensure a positive childbirth experience for women with respect and dignity at the Midwifery care led units, which are underway at high caseload facilities.

Interventions for improving Maternal Mortality Rate (MMR):

 1. Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA) launched in 2016, provides pregnant women fixed day, free of cost assured, and quality Antenatal Care on the 9thday of every month.

2. Pradhan Mantri Matru Vandana Yojana (PMMVY) came into effect in 2017, is a direct benefit transfer (DBT) scheme under which cash benefits are provided to pregnant women in their bank account directly to meet enhanced nutritional needs and partially compensate for wage loss.

3. Labour Room Quality Improvement Initiative (LaQshya), launched in 2017 aims to improve the quality of care in the labor room and maternity operation theatres to ensure that pregnant women receive respectfully and quality care during delivery and the immediate post-partum period.

4. Government of India is implementing POSHAN Abhiyaan since 2018 with a goal to achieve improvement in the nutritional status of Children, Adolescent Girls, Pregnant Women, and Lactating Mothers, in a time-bound manner.

5.  Anemia Mukt Bharat (AMB): In 2018, the Union Health Ministry launched the Anemia Mukt Bharat strategy to reduce anemia prevalence both due to nutritional and non-nutritional causes, in the lifecycle approach. The strategy is estimated to reach out to 450 million beneficiaries including 30 million pregnant women.

6. Surakshit Matratva Ashwasan (SUMAN) came in effect from 2019 aims to provide assured, dignified, respectful, and quality healthcare at no cost and zero tolerance for denial of services for every woman and newborn visiting the public health facility to end all preventable maternal and newborn deaths.

7. Janani Suraksha Yojana (JSY), a demand promotion and conditional cash transfer scheme was launched in April 2005 with the objective of reducing Maternal and Infant Mortality by promoting institutional delivery among pregnant women.

8. Janani Shishu Suraksha Karyakram (JSSK) aims to eliminate out-of-pocket expenses for pregnant women and sick infants by entitling them to free delivery including cesarean section, free transport, diagnostics, medicines, other consumables, diet, and blood in public health institutions

9. Comprehensive Abortion Care services are strengthened through training of health care providers, supply of drugs, equipment, Information Education and Communication (IEC), etc.

10. Delivery Points-Over 25,000 'Delivery Points' across the country are strengthened in terms of infrastructure, equipment, and trained manpower for the provision of comprehensive RMNCAH+N services.

11. Functionalization of First Referral Units (FRUs) by ensuring manpower, blood storage units, referral linkages, etc.

12. Setting up of Maternal and Child Health (MCH) Wings at high caseload facilities to improve the quality of care provided to mothers and children.

13. Operationalization of Obstetric ICU/HDU at high caseload tertiary care facilities across the country to handle complicated pregnancies.

14. Capacity building is undertaken for MBBS doctors in Anesthesia (LSAS) and Obstetric Care including C-section (EmOC) skills to overcome the shortage of specialists in these disciplines, particularly in rural areas.

15. Maternal Death Surveillance Review (MDSR) is implemented both at facilities and at the community level. The purpose is to take corrective action at appropriate levels and improve the quality of obstetric care.

16. Monthly Village Health, Sanitation, and Nutrition Day (VHSND) is an outreach activity for the provision of maternal and child care including nutrition.

17. Regular IEC/BCC activities are conducted for early registration of ANC, regular ANC, institutional delivery, nutrition, and care during pregnancy, etc.

18. MCP Card and Safe Motherhood Booklet are distributed to pregnant women for educating them on the diet, rest, danger signs of pregnancy, benefit schemes, and institutional deliveries.