A recent report by United Nations has brought to the fore the need for India to take stock of the measures which have been undertaken so far to address the issue of maternal mortality. The report, titled “Trends in Maternal Mortality, 1990 to 2013”, states that India accounts for the highest country-wise proportion (17%) of the estimated 289,000 maternal deaths of 2013, with the figure standing at an disturbing 50, 000 deaths.
Improving Maternal Health is one of the Eight Millennium Development Goals (MDGs). One of the targets for achieving this Goal is to reduce by three-quarters, between 1990 and 2015, the Maternal Mortality Ratio (MMR). As per the UN report, there are only 11 countries which are currently ‘on track’ to attain the said target. India is among the list of 63 countries which are categorized as ‘making progress’, with a 65 per cent decline in its maternal mortality ratio from 560 in 1990 to 190 in 2013.
Studies have shown that the major causes of the high maternal mortality in India is attributable to socio-economic factors such as early age of marriage & pregnancy, lack of community awareness & sensitization, lack of availability of healthcare facilities in remote areas, lack of connectivity/ transportation, delivery by unskilled birth attendants, etc. Medical causes include Haemorrhage, Hypertensive disorder of pregnancy, obstructed labour, unsafe abortion, Anaemia etc.
The Government of India has been making concerted efforts to address these challenges. Janani Suraksha Yojana (JSY) was launched in 2005, with the objective of reducing maternal mortality by promoting institutional delivery among poor pregnant women through cash incentives. In 2011, The Government of India launched the Janani-Shishu Suraksha Karyakram (JSSK), a national initiative to provide completely free and cashless services to pregnant women accessing public health institutions for treatment, so as to reduce their out-of-pocket expenses.
These initiatives have been fairly successful, considering the backdrop of India’s large population and the complexities of its federal structure. However, much more still needs to be done to address this issue. It is important to understand that the problem of high maternal mortality in India is to a large extent, due to debilitating social factors. It is not only the institutions and delivery mechanisms which need to be strengthened but, more importantly, mass-level awareness and community sensitization programmes needs to be promoted, highlighting the importance of a scientific approach towards pregnancy care, especially among the deprived sections of the society.
Notably, the United Nations report on Maternal Mortality states that while assessing the extent of progress towards attainment of the MDGs, some common elements emerge for better performers. These facilitators are - Leadership and partnership, evidence and innovation, development and implementation of dual long-term and short-term strategies, adaptation to change and a committed approach towards human rights.
These elements, if followed with more fervour, can chart the way forward for India to address this issue at a social level. A sound leadership committed to the creation of an egalitarian society which has a greater degree of respect for human rights in general and women’s rights in particular, can greatly enhance India’s ability to address the challenge of maternal mortality. It is only when one half of our population is empowered in both letter and spirit and treated as truly equal, can India reach the next level in its Economic, Social and Human Development.