Why in news?
India has recorded a 22% drop in Maternal Mortality Rate (MMR).
What is MMR?
- MMR is defined as the proportion of maternal deaths per 1,00,000 live births.
- Maternal mortality is defined as the death of a woman while pregnant or within 42 days of termination of pregnancy.
- The causes could be related to or aggravated by the pregnancy or its management.
- Complications during pregnancy and childbirth are a leading cause of death and disability among women of reproductive age.
- The maternal mortality ratio represents the risk associated with each pregnancy, i.e., the obstetric risk.
What are the recent findings?
- MMR of India has declined from 167 in 2011-2013 to 130 in 2014-2016.
- The decline has been most significant in Empowered Action Group (EAG) states.
- These include Bihar, Jharkhand, Madhya Pradesh, Chhattisgarh, Odisha, Rajasthan, UP and Uttarakhand.
- Besides, Assam has also registered a decline from 246 to 188.
- Among the southern states, the decline has been from 93 to 77 and in the other states from 115 to 93.
How has NRHM contributed to this?
- With Janani Suraksh Yojna (JSY) under National Rural Health Mission, institutional births nearly doubled.
- It increased from around 38% to 78% between National Family Health Survey III (2005-06) and NFHS IV.
- The web-based Mother and Tracking System tracked every pregnancy in the country since 2010.
- It sends messages to health workers and expectant mothers about ante-natal checkups, vaccinations etc.
- NRHM also allowed auxiliary nurse midwives (ANMs).
- They administer antibiotics, intravenous fluids and drugs during emergencies under supervision.
- For Ceasarean sections, there are first referral units (FRUs).
- FRU is a district or sub-divisional hospital or community health centre which has the facilities in this regard.
- The Accredited Social Health Activist (ASHA) attended to women who were not going to hospitals for deliveries.
- NRHM took efforts to increase the frequency of visits by ASHAs.
- The basic issue however was of improving standards.
- The incentive system of ASHAs was thus devised.
- It was ensured that they got good money only if they visited throughout the 9 months.
- Nutritional support through anganwadis was a major componenet.
- Besides these, the Janani Shishu Suraksha Karyakram (JSSK) was implemented.
- It entitles all pregnant women delivering in public health institutions to free delivery, including C-sections.
What are the continuing concerns?
- Infrastructure - A recent report highlighted a tribal woman in labour in Kerala being carried on a sling made of clothes.
- But Kerala leads in most health indices, including MMR.
- Thus, beyond indices, instances like the above underlines the need for basic physical infrastructure such as roads.
- MDG - India has made sustained progress in reducing maternal mortality.
- However, it missed the millennium development goal (MDG) of reducing MMR by 75% from 437 in 1990 to 109 in 2015.
- NRHM - Janani Suraksh Yojna (JSY) is one of the main strategies or policy shifts under NRHM.
- It is a conditional cash transfer scheme to motivate pregnant women for institutional deliveries.
- In better developed states of South India, it is limited to women below poverty line up to first two childbirths.
- But notably, maternal mortality steeply rises in grand multiparous women, delivering a child after third pregnancy onward.
Source: Indian Express
