Context

Recently, the nationwide lockdown due to coronavirus pandemic has brought the dark side of healthcare system in India in which a pregnant woman died in an ambulance in Noida after being turned away from a number of private and government hospitals.

Status of Maternal Deaths in India

• According to Sample Registration System (SRS) 2015-2017, India’s Maternal Mortality Ratio came down to 122 deaths per 1,00,000 live births from 167 per 1,00,000 births in 2011-13.
• As per the SRS bulletin, nearly 2,000 maternal deaths have been averted per year and the figure has declined from 167 in 2011-2013 to 130 in 2014-2016 and to 122 in 2015-17, registering a 6.15 per cent reduction since the last survey figures of 2014-2016.
• Karnataka has shown the highest percentage decline in Maternal Mortality Rate (MMR) but Uttar Pradesh and Madhya Pradesh have shown an increase by 15 points each in MMR.
• The decline has been most significant in EAG States from 188 to 175.
• The ratio has reduced considerably from 77 to 72 per 1,00,000 live births among southern states and in the other states from 93 to 90.
• Independent MMR data of Jharkhand (76), Chhattisgarh (141) and Uttarakhand (89) has been released for the first time in the SRS 2015-2017 bulletin.

Challenges faced by Maternal Health in India

• The recent incident in Delhi NCR has raised a question on the healthcare facility for women in remote areas if she is neglected in capital city.
• Haemorrhage is the leading cause of maternal mortality in the country followed by sepsis and abortion.
• India has a blood supply deficit of 25 per cent as against the prescribed reserve of 1 per cent of the population.
• According to the National Family Health Survey (NFHS)-4, despite improvements, only 58.6 per cent of mothers had received an antenatal check-up in the first trimester and 51.2 per cent of mothers had undergone at least four antenatal care visits.
• The shortage of trained human resources, especially doctors and auxiliary nurse midwives, remains a key challenge to improving maternal health outcomes.

Impact of COVID-19 Pandemic on Healthcare of Women

• There was lack of plan from the government to provide emergency healthcare facility during the extended lockdown period.
• The recent epidemics have identified pregnant women as people being ‘high risk’ but no reference was made this time on the need to provide emergency services for pregnant women.
• Frontline workers were pressed into community surveillance, monitoring and awareness building for COVID 19.
• The public health system was overburdened with handling the pandemic: most secondary and tertiary hospitals were either those designated as COVID-19 facilities or those unequipped with enough PPE kits.
• In the last 12 weeks, approximately 9,00,000 pregnant women (15% of the six million women giving birth) who needed critical care had to face enormous hurdles to actually obtain treatment at an appropriate hospital.
• Although 80% doctors and 64% beds are in the private sector, clinics have closed down and private hospitals have stepped back fearing infections, while larger hospitals have begun charging exorbitant amounts.
• As India struggles to manage the COVID-19 pandemic, the hard-won gains of the last 15 years can be erased with one stroke.

Steps taken by Government to promote Maternal Health in India

• Over the last 15 years, the state has been promising maternal well-being to pregnant women provided they turn up at public hospitals during labour.
• The government has instituted an elaborate tracking system under the Ministry of Health and Family Welfare to track every pregnant woman, infant and child until they turn five.
• Focus on quality and coverage of health services through public health initiatives under the National Health Mission such as LaQshya, Poshan Abhiyan, Pradhan Mantri Surakshit Matritva Abhiyan, Janani Shishu Suraksha Karyakram, Janani Suraksha Yojana and Pradhan Mantri Matru Vandana Yojana have contributed to the decline on India’s overall MMR.
• India is now committed to ensuring that not a single mother or newborn dies due to a preventable cause and move towards zero preventable maternal and newborn deaths through the recently launched Surakshit Matritva Aashwasan Initiative (SUMAN).
• The WHO last year lauded India’s progress in reducing the MMR saying the progress puts the country on track towards achieving the Sustainable Development Goal (SDG) target of an MMR below 70 by 2030.

Remedial Measures to be adopted to improve Maternal Health in India

• A comprehensive package of services delivered by multiple ministries will need to be brought under the POSHAN Abhiyaan umbrella to foster convergence among programmes focused on the pre-pregnancy (reducing child marriages, birth spacing), pregnancy (antenatal checks, nutrition counselling) and post-pregnancy (institutional deliveries, post-natal care) phases.
• Auxiliary nurse midwives should be taught routine care as well as life-saving skills that emphasize detection of complications and referrals for hospital deliveries for women with high risk of complications.
• The work should be done intensively with communities to encourage women and their families to enlist the aid of trained attendants at deliveries and to increase the number of women who seek antenatal care.
• The communities also need to be educated to identify problem situations that arise when trained attendants are not available.
• The health care workers should take advantage of women’s antenatal visits as a crucial point of contact between health services and pregnant women.
• The focus in gynaecology training needs to be on imparting practical skills in the management of labour and deliveries.
• Evidence suggests that girls who attain a basic education level are more likely to exert greater influence in limiting the size of their families in adulthood and thus focusing on women’s education and empowerment through the self-help group movement has helped States such as Bihar to achieve a sharp fall in MMR.

Way Forward

• The health policymakers need to acknowledge the shortcoming of an overstretched and under-resourced system in responding to the critical care needs of pregnant women during crises.
• The role of private players needs to be scrutinized in order to provide emergency healthcare facilities to pregnant women in future epidemic and pandemics.
• The pandemic has amplified many inequalities and shows up sharply the state’s negligence of responsibility for prevention of lives lost, putting the entire responsibility of health protection on the individual citizen.
• In order to win back the trust of pregnant women, the state will have to account publicly for how the millions of deliveries took place; or how abortions, miscarriages and childbirth complications were handled.
• As the country slowly emerges from a total lockdown into a longer-term management strategy, it is time to consider doing things differently for improving maternal well-being.

Source: The Hindu