Decline in MMR in India

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