MMR DOWN, BUT NOT EVEN TILL MDG LEVELS: On
Thursday, when The Indian Express reported how the country’s
maternal mortality ratio had come down from 167 per 100,000 live
births in 2011-13 to 130 in 2014-16, another report described how a tribal
woman in labour in Kerala was carried
on a sling made of clothes for want of a road. While Kerala leads in
most health indices, including MMR, what the woman went through underlines how
these indices are often held hostage to physical infrastructure such as roads.
And while India has made sustained progress in reducing maternal mortality, it missed
the millennium development goal (MDG) of reducing MMR by 75% from 437 in 1990
to 109 in 2015.
EFFORTS UNDER NRHM AND JSY DELIVERING RESULTS: In
2010, an article in the Indian Journal of Public Health by the chief UNICEF
officer in Chennai was critical of India’s likely failure to meet the MDG, yet
spoke favourably of initiatives under the National Rural Health Mission,
which was launched in 2005 to develop rural health infrastructure. “Under NRHM, one
of the main strategies or policy shifts to reduce maternal mortality is Janani
Suraksh Yojna (JSY) — a conditional cash transfer scheme to motivate
pregnant women for institutional
deliveries. In better developed states of South India, the cash
incentive however is limited to women below poverty line up to first two
childbirths… It is well known that maternal mortality steeply rises in grand
multiparous women delivering a child after third pregnancy onward. A few
state governments… with a high MMR… have judiciously modified the guidelines to
implement the scheme and included all women irrespective of their parity or
economic status,” the article said. With JSY, institutional births doubled from 38.7% to
78.9% between National Family Health Survey III (2005-06) and NFHS IV.
In addition, the web-based Mother and Tracking System
headquartered in the National Institute of Health and Family Welfare, New
Delhi, tracked every pregnancy in the country since 2010, sending out messages to health
workers and expectant mothers about ante-natal checkups, vaccinations etc.
3 PRONGED APPROACH ON MMR WITH ASHA PLAYING KEY ROLE:
NRHM also allowed auxiliary nurse midwives (ANMs) to administer antibiotics,
intravenous fluids and drugs during emergencies under supervision. For
Ceasarean sections, there are first referral units (FRUs). “We took a three-pronged
strategy on MMR — first was to improve institutional deliveries and
SoPs, increase the frequency of visits by ASHAs and attend to women
who were not going to hospitals for deliveries. The basic issue was of
improving standards. We devised the incentive system of ASHAs in such a
way that they got good money only if they visited throughout the nine months…
What added to all of this was the nutritional support from anganwadis.
States also upped their game, many FRUs were set up,” said Environment
Secretary C K Mishra who, as Health Secretary, oversaw these initiatives.
FREE DELIVERY AT PUBLIC INSTITUTIONS: Another
programme was Janani
Shishu Suraksha Karyakram (JSSK) that entitles all pregnant women
delivering in public health institutions to free delivery, including C-sections.
ONE FREE DAY AT PRIVATE ESTABLISHMENTS: In a Mann
ki Baat programme in 2016, Prime Minister Narendra Modi appealed
to private hospitals to devote one day of the month for check-ups of pregnant
women. Under the Pradhan
Mantri Surakshit Matritva Abhiyan, pregnant women can walk into private
establishments on the 9th of the month.
ALL STATES ARE NOW SHOWING IMPROVEMENT: In 2015,
an article in The BMJ said: “While some states like Maharashtra, Tamil Nadu and
Andhra Pradesh were able to bring down maternal mortality rate even lower than
stipulated ratio; many others were marginally off by the target. Sadly, states
like Assam, UP, Rajasthan, MP and Bihar showed dismissive reports.” This
time, these were the states that spearheaded the MMR reduction.
Credit: Indian Express Explained (http://indianexpress.com/article/explained/how-india-has-reduced-maternal-mortality-and-what-challenges-remain-5208681/)
Reach Us
if you face difficulty in understanding the above article.
No comments:
Post a Comment