UNICEF’s concerted action to increase access to quality maternal health services.
A moment of unimaginable joy is what a mother feels when a newborn is placed on her arms – a joy every mother should have the right to experience. But for many pregnant women in India this memory will never come to be, the moment of birth is often frightening.
Maternal Mortality Ratio of India has declined by 8 points from 130/ 100,000 live births in 2014-16 to 122/ 100,000 live births in 2015-17 (6.2 per cent decline) This translates to 2000 additional mothers saved annually in 2017 as compared to 2015. Total annual deaths declined from 32,000 maternal deaths in 2015 to 30,000 deaths in 2017. This translated to every 20 minutes a mother dying due to pregnancy or childbirth related cause.
Maternal mortality is considered a key health indicator and the direct causes of maternal deaths are well known and largely preventable and treatable.
The major complications that account for nearly two-thirds of all maternal deaths are severe bleeding (mostly bleeding after childbirth), infections (usually after childbirth), high blood pressure during pregnancy (pre-eclampsia and eclampsia), complications from delivery and unsafe abortions.
Pregnancy-related complications are the number one cause of death among girls between 15 and 19 years of age. Because adolescent girls are still growing themselves, they are at greater risk of complications if they become pregnant. Moreover, child brides are less likely to receive proper medical care while pregnant or to deliver in a health facility, compared to women married as adults.
All women need access to antenatal care in pregnancy, skilled care during childbirth, and care and support in the weeks after childbirth. All births should be assisted by skilled health professionals, as timely management and treatment can make the difference between life and death for both the mother and the baby.
The Government of India has been focusing on initiatives to improve maternal health indicators. Much progress has been made in ending preventable maternal deaths in the past two decades: Globally the number of women and girls who die each year due to issues related to pregnancy and childbirth has dropped considerably, from 451,000 in 2000 to 295,000 in 2017, a 38 per cent decrease.
In India the number of women and girls who die each year due to issues related to pregnancy and childbirth has dropped considerably, from 103,000 in 2000 to 35000 in 2017, a 55 per cent decrease.
However, coverage of life-saving health interventions and practices remains low due to gaps in knowledge, policies and availability of resources. In a few areas there is a gap between the rich and the poor and an urban and rural divide. Access to health services is often dependent on a families’ or mother’s economic status and where they reside.
UNICEF works with the Ministry of Health and Family Welfare (MoHFW), Ministry of Women and Child Development (MWCD), NITI Aayog and state governments to support planning, budgeting, policy formulation, capacity building, monitoring, and demand generation. It supports the capacities of health managers and supervisors at district and block-level to plan, implement, monitor and supervise effective maternal health care services with a focus on high-risk pregnant women and those in hard-to-reach, vulnerable and socially disadvantaged communities. UNICEF supports the implementation of various interventions by Government of India, including:
Reaching every mother: UNICEF supports the implementation of MoHFW policy that every delivery should be attended by a skilled health care provider in a health care facility.
Continuum of Care: Improving the health and nutrition of mothers-to-be and providing quality maternal and new-born health services through a continuum of care approach. This includes improving access to family planning, antenatal care during pregnancy, improved management of normal delivery by skilled attendants, access to emergency obstetric and neonatal care when needed, and timely post-natal care for both mothers and newborns.
Antenatal care: All pregnant mothers must register for antenatal care at the nearest health facility as soon as aware of the pregnancy to assure healthy progress of their pregnancy and timely identify high risk issues affecting their health or their baby’s well-being.
The Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA) launched by MoHFW, provides a fixed day for assured, comprehensive and quality antenatal care free of cost to pregnant women on 9th of every month. This Programme strengthens antenatal care detection and follow up of high risk pregnancies, contribute towards reduction of maternal deaths and reduce the MMR of India.
Janani Shishu Suraksha Karyakaram (JSSK): this scheme encompasses free maternity services for women and children, a nationwide scale-up of emergency referral systems and maternal death audits, and improvements in the governance and management of health services at all levels.
To achieve the global goal of improving maternal health and to save women’s lives we need to do more to reach those who are most at risk, such as women in rural areas, urban slums, poorer households, adolescent mothers, women from minorities and tribal, Scheduled Caste and Scheduled Tribe groups.