NEW DELHI — With more than 100,000 women dying in childbirth every year, India accounts for 20 percent of the world’s maternal deaths. Poor access to health and nutrition services for mothers correlates with the low weight of 43 percent of Indian children under the age of five.
One major contributor to reducing maternal mortality is encouraging more mothers to deliver in health facilities. As women increase their use of maternal health services, maternal and infant deaths decrease. In states with lower rates of maternal death, the majority of mothers deliver in health facilities.
In the southern states of Kerala and Tamil Nadu, 95 percent of deliveries occur in health facilities. In these states, maternal mortality rates are 81 and 97 per 100,000 live births respectively. In the central state of Uttar Pradesh and the northern state of Rajasthan, only 25 to 45 percent of deliveries occur in health facilities, and maternal mortality rates are 359 and 318 per 100,000 live births respectively. In the nation as a whole, two out of five births take place at home.
Antenatal care is another important contributor to the improvement of maternal health in India. Antenatal care provides preventative services that monitor signs of pregnancy complications, detecting and treating both preexisting and concurrent problems. Antenatal care also serves as an entry point for women into the healthcare system.
Maternal health in India has improved at a slow but steady pace. Organizations such as UNICEF and USAID’s Maternal and Child Survival Program (MCSP) work on many of India’s issues.
MCSP began working in India in March 2015 to expand access to high-quality family planning services in an effort to reach the Family Planning 2020 commitment. MCSP provides technical support to the governments of India in expanding contraceptive options by including newer, proven, modern contraceptive methods.
Since its beginning, MCSP has advocated successfully for the inclusion of modern contraceptive methods in the current basket of family planning options in the public health system in India. These methods include injectable contraceptives and progestin-only pills. MCSP also improves the quality of delivery tools and facilitates the translation of these tools into regional and local languages.
At a community health center in Salepur, a town in the western state of Odisha, MCSP has made great strides in improving maternal health in India. The health center contains 16 beds and facilitates over 100 deliveries per month. After a two-day training with MCSP, the clinic made a shift towards respectful, “client-centric” care with an emphasis on quality over quantity.
MCSP supports the Ministry of Health and Family Welfare to deliver high-quality family planning in five states by helping to expand the country’s contraceptive choices. In Salepur, permanent methods of family planning are the preferred choice. MCSP’s two-day training was aimed at improving minilaparotomy, or “minilap,” a procedure for permanently occluding the fallopian tubes.
MCSP focuses on post-operation care and proper follow up as well as counseling in informed choice and consent. Sterilization of tools and cleanliness such as aprons, masks and instruments has improved to prevent infections, and the clinic has seen a drastic decrease in complications from minilap.
UNICEF is another organization committed to improving maternal health in India. The Janani Shishu Suraksha Karyakaram (JSSK) scheme encompasses free maternity services for women and children, a nationwide scale up of emergency referral systems and maternal death audits and improvements in governance and management of health services at all levels.
Adolescent and illiterate mothers in rural areas have a higher chance of death during childbirth. Teen marriage and pregnancy is much more prevalent in remote and rural areas of the country, and mothers in the lowest economic bracket have a 2.5 times higher maternal mortality rate. For these reasons, UNICEF focuses on adolescent mothers.
UNICEF also supports courses for skilled birth attendants and supports work for the Maternal Death Review to identify the causes and locations of maternal death and provide evidence for policy and planning.
UNICEF works in Madhya Pradesh to upgrade health centers and government provided ambulances. In 2008, none of the women in this state gave birth in hospitals. By 2013, eight out of 10 women delivered in hospitals, and every year about half a million women use the ambulance service to transport to hospitals for safer, cleaner deliveries.
– Phoebe Cohen