The latest SRS data shows that India has kept up its steady trend of reduction in maternal mortality ratio (MMR) — maternal deaths now stand at 130 per 100,000 live births. UNICEF India representative Dr Yasmin Ali Haque talks to Abantika Ghosh about how the National (Rural) Health Mission started in 2005 has been a game changer and the need for regular quality audits to ensure unnecessary ceasarean sections do not go up as India rolls out the ambitious National Health Protection Scheme. Excerpts:
The latest SRS data shows India has kept up the reduction in MMR. What is going right?
This is a huge achievement. This is a result of the continuing attention that India has been paying to MMR and in reducing the delays that a pregnant woman may face in accessing services. There is no way to predict which pregnant woman would face complications and when, but what can be done is to create awareness so that complications are identified and also strengthen the services to treat those complications. The focus on increasing institutional deliveries has ensured better quality of care. Quality of care is a big motivator for women to come to these institutions. In addition, the ambulance services have ensured better transportation facilities. So yes, India has reaped the benefit of institutional strengthening over the last few years.
How much of a role did N(R)HM play in this?
NHM has been the game changer. It ensured there were adequate financial and manpower resources – none of the health workers like ASHAs were there earlier. It also gave room for local flexibility. The conditional cash transfers for pregnant women ensured the institutional deliveries were up.There is also the matter of attitudes, societal attitude. System strengthening is a crucial part of it and the latest MMR figures are an indicator that the system is working. Another crucial factor for the future would be the Laqshya programme to address the issue of quality of care.
We are rolling out NHPM. Do you think it would have an impact on maternal health and the tertiary care structure would increase the already high rate caesarean sections?
There is always the risk of that happening. That is why it is very important to have quality of care audits. Inordinate increase in C-secs may happen more in urban areas than in rural areas so that issue needs to be addressed in the audits. But at the same time it will be able to reach the poorest households, the tribal areas. Health protection would ensure healthcare may be accessed by those that need them the most.
One of the features of the latest MMR data has been that the traditionally laggard states have shown the most improvement. It is heartening to see is that Uttar Pradesh, which accounts for the highest share of home deliveries in the country has led the charts with a near 30 per cent reduction, which is even higher than the national average of 22 per cent. However, even one maternal death is too many and it is our shared responsibility to end these preventable maternal and newborn deaths. Ensuring every women delivers with a safe pair of hands in an environment that treats her with respect and dignity is going to be the key. It will be crucial that the same timely access and quality of care is afforded to every woman, especially those who live in the remotest and the poorest households of the country. The time for all of us to act is now.
What role has UNICEF played in all of this?
UNICEF along with WHO has been working with the government to raise awareness and also strengthen the quality of care model. We helped with the model labour rooms – the layout, equipment, manpower training. We have been a privileged partner in all of this. Our next target is to work on child marriages.