Progress and Persistent Gaps
India has achieved remarkable success in slashing maternal deaths, with figures in 2023 being nearly one-fifth of those in 1990. This decline, significantly
driven by government initiatives, increased institutional births, and heightened public awareness, saw its most rapid pace in the first fifteen years of this century. However, the nation still contributes to a concerning one in every ten maternal deaths globally. A recent study in The Lancet Obstetrics, Gynaecology & Women’s Health points to ongoing systemic hurdles preventing India from reaching the Sustainable Development Goal of 70 maternal deaths per lakh births by 2030. Pregnant women tragically continue to succumb to preventable causes like severe bleeding, infections, and high blood pressure complications, underscoring that simply providing access to healthcare is not enough; the quality of that care is paramount.
Pandemic's Toll and Government Efforts
The COVID-19 pandemic starkly revealed the vulnerabilities within India's maternal healthcare system. Essential frontline workers were redeployed to manage the health crisis, leading to disruptions in institutional deliveries and a drop in vital antenatal check-ups. Recognizing these setbacks, the government has proactively bolstered programs such as LaQshya, aimed at enhancing the standard of care in labor rooms. Initiatives like the Pradhan Mantri Surakshit Matritva Abhiyan are also being strengthened, leveraging online platforms and empowering anganwadi workers to diligently monitor the health of expectant mothers. Despite these commendable efforts, the effectiveness of these programs remains inconsistent across different regions.
The Implementation Divide
The decentralised nature of healthcare in India, where it is a state subject, means that the success of national programs hinges critically on local administrative capabilities and the political will of state governments. While states like Gujarat, Maharashtra, and those in South India appear to be on a trajectory to meet the SDG targets, the Lancet study, alongside government reports, consistently highlights significant deficiencies in the healthcare infrastructure and delivery systems of Uttar Pradesh, Madhya Pradesh, Bihar, Rajasthan, Chhattisgarh, Odisha, Jharkhand, and Assam. This disparity underscores a crucial point: policies and funding must be tailored to address the unique challenges and capacities of each region to ensure equitable maternal healthcare.
A Holistic Strategy Needed
Effectively tackling the remaining maternal mortality requires a fundamental strategic pivot. A robust strengthening of primary and secondary healthcare facilities is non-negotiable, ensuring that potential complications during pregnancy and childbirth are identified and managed with utmost speed and efficiency. Essential components of this enhanced system include functional emergency transportation networks, adequately equipped labor rooms, the availability of skilled specialists, and reliable access to blood banks – factors that can decisively influence life-or-death outcomes. However, merely expanding physical infrastructure will not suffice. Policies must also grapple with the broader social determinants impacting women's health, acknowledging that systemic issues like poor nutrition, where women often eat last and suffer from inadequate intake, directly contribute to conditions like anaemia and adverse health results.
Empowerment and Quality Care
The message from the Lancet report is clear and must be heeded by policymakers: a truly comprehensive strategy for maternal health necessitates a dual approach. It must not only focus on improving the tangible aspects of healthcare delivery and infrastructure but also on actively increasing the social agency and empowerment of women. This means addressing deep-rooted societal norms that impact women's access to resources, their decision-making power, and their overall well-being. By integrating quality healthcare improvements with efforts to enhance women's social standing and control over their lives, India can move closer to its goal of ensuring every mother has a safe and healthy pregnancy journey and childbirth experience.
