India’s quest for safe motherhood for all
Each year, India celebrates Safe Motherhood Day on April 11 to renew and reaffirm our commitment to ensure that every woman in India has access to essential and universal maternal health services, with dignity and respect. The survival and well-being of mothers is not only important in their own right but central to solving broader economic, social and developmental challenges. In spite of the unprecedented challenges brought on by the ongoing pandemic, India, like many countries, declared that no matter what, ensuring access to safe delivery and antenatal and postnatal care is a non-negotiable agenda.
India has made rapid strides in the reduction of maternal and newborn mortality through massive and strategic investments made under the National Health Mission (NHM). Today we have brought the Maternal Mortality Ratio (MMR) down to 113 from 556 in 1990. Our MMR has fallen faster than the global decline and we have done remarkably well to be on track to achieve the Sustainable Development Goal 3 (SDG 3) of an MMR below 70 by 2030.
Safe motherhood is closely tied to the continuum of care, which is a crucial interplay of pre-pregnancy and pregnancy factors including family planning, nutrition, adolescent health and access to safe abortion services. It also encompasses a positive birthing experience to ensure that women give birth in an environment that is safe and allows them to have control through decision-making.
Among the many pathbreaking schemes that support this mission, the Janani Surakhsa Yojana (JSY) under the NHM, a demand promotion scheme, was the first to be implemented. This was followed by the Janani Shishu Suraksha Karyakram (JSSK), which gives numerous free entitlements including free dietary support, drugs, diagnostics and ambulance facilities to expectant women, helping to reduce out-of-pocket expenditure. As a result of these interventions, institutional deliveries have risen to nearly 80%.
Carrying forward the vision of Prime Minister (PM) Narendra Modi, the Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA) was launched in 2016 to provide special free antenatal care to pregnant women across the country in order to detect and prevent highrisk pregnancies. In 2018, PM Modi launched the ambitious Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PMJAY), to provide financial cover for secondary and tertiary care, including for services related to childbirth. Additionally, the government has also taken a giant leap towards providing accessible and affordable health care by setting up Ayushman Bharat-health and Wellness Centres (AB-HWCS), to deliver a comprehensive range of services encompassing care during pregnancy and childbirth.
Even with such landmark moves, the schemes, by themselves, are not enough to achieve the numbers set by our policies and commitments. There is scope for greater improvement in the quality of health care services. Thus, in 2017, the government launched Labour room Quality improvement Initiative (Laqshya) to improve quality of care in labour room and maternity operation theatres in public health facilities by focusing on intrapartum and immediate post-partum period and upholding the agenda of respectful maternity care and birth companionship.
In another landmark policy decision, the government rolled out the Midwifery Initiative in 2018 to provide women-centric essential maternal, newborn, and reproductive health care through a specialised workforce comprising Nurse Practitioners in Midwifery (NPMS) in designated Midwifery-led Care Units (MLCU). Nevertheless, there is a need to go beyond service delivery to assured service delivery. In the same spirit, in 2019, Surakshit Matritva Aashwasan (SUMAN) was launched, assuring delivery of maternal and newborn health care services with respect and dignity and ascertaining zero tolerance for denial of services. This initiative envisages to provide service guarantee along with large-scale community engagement and a responsive grievance redressal system.
The 360-degree approach builds on the success so far and pushes for momentous change that powers quality service delivery with human dignity. In this regard, the Medical Termination of Pregnancy (Amendment) Bill, 2021, has now received the assent of the President of India and is duly notified. It increases the ambit and access to safe abortion services and will ensure dignity, autonomy, confidentiality and justice for women who need to terminate pregnancies. Another noteworthy milestone in the arena of women’s health is the inter-ministerial convergence of my ministry of health and family welfare with the ministry of women and child development for the POSHAN Abhiyaan.
As the government strives to bring about a visible improvement in health outcomes for women and children through newer initiatives, a stronger national commitment becomes a prerequisite to success. We are committed to withstand new challenges and envisage assuring safe motherhood for all. In this endeavour, everyone has a role to play. Collaborative efforts are needed to meet the health needs of women, but as it is with every endeavour for the people, it can never happen without the people’s involvement.
Hence, I urge all stakeholders and, most importantly, members of civil society to come together and make concerted efforts with solidarity and compassion to prioritise the health of women which shall ultimately contribute to building a prosperous, healthy and empowered New India.