Maternal Mortality Ratio (MMR) of India has declined by 8 points in one year as per the latest Special Bulletin on MMR released by the Registrar General of India. This decline is important as it translates to nearly 2000 additional pregnant women saved annually. MMR has declined from 130/ lakh live births in 2014-16 to 122/ lakh live births in 2015-17 (6.2% decline), implying that India is on track to achieving the Sustainable Development Goal (SDG) target for reducing MMR by 2025, five years ahead of timeline of 2030.
11 States have achieved the ambitious target of MMR of 100/lakh Live Births by 2020 set under the National Health Policy 2017. These states are Kerala, Maharashtra, Tamil Nadu, Andhra Pradesh, Jharkhand, Telangana, Gujarat, Uttarakhand, West Bengal, Karnataka and Haryana. Another important feature of the latest MMR bulletin is that MMR for the States of Jharkhand, Bihar, Chhattisgarh, Madhya Pradesh, Uttar Pradesh and Uttarakhand have been published independently for the first time. A total of seven States, namely Karnataka, Maharashtra, Kerala, West Bengal, Odisha, Rajasthan, Telangana have shown a decline in MMR that is greater than or equal to the national average of 6.2%.
Various programs/initiatives of MoHFW which have led to this success are enlisted below.
1. Ayushman Bharat Health & Wellness Centres: Ayushman Bharat (AB) is an attempt to move from a selective approach to health care to continuum of care approach covering the primary, secondary and tertiary layers spanning preventive, promotive, curative, rehabilitative and palliative care. At the Ayushman Bharat Health & Wellness Centres, preventive screening of Oral, Cervical and Breast cancers is provided free of cost specifically for the women.
Till date more than 1.03 crore women have been screened for breast cancer and more than 69 lakhs women screened for cervical cancer.
2. Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA): The Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA) has been launched by the Ministry of Health & Family Welfare (MoHFW) in June, 2016. Under PMSMA, all pregnant women in the country are provided fixed day, free of cost assured and quality Antenatal Care. As part of the campaign, a minimum package of antenatal care services (including investigations and drugs) is being provided to the beneficiaries on the 9th day of every month. The Abhiyan also involves Private sector’s health care providers as volunteers to provide specialist care in Government facilities.
§ Total number of pregnant women Received Antenatal care under PMSMA – more than 2.39 crores
§ Total Number of High Risk Pregnancy Identified at the PMSMA Health Facility – more than 12.5 lakhs
§ Total Number of Volunteer Registered – 6219
3. Surakshit Matritva Aashwasan (SUMAN): The initiative aims at assuring dignified, respectful and quality health care at no cost and zero tolerance for denial of services for every woman and newborn visiting the public health facility in order to end all preventable maternal and newborn deaths. It also provides a positive birth experience to both mother and infant.
GOI launched the SUMAN Initiative on 10th October 2019. The initiatives aims to provide Assured, dignified, respectful and quality healthcare, at no cost and zero tolerance for denial of services, for every woman and newborn visiting the public health facility in order to end all preventable maternal and newborn deaths and morbidities and provide a positive birthing experience. Under SUMAN, all existing schemes for maternal and neonatal health have been brought under one umbrella in order to create a comprehensive and cohesive initiative which goes beyond entitlements and provides a service guarantee for the entitlements.
Several strategies have been adopted namely a responsive call centre for grievance redressal, a client feedback mechanism, centralized mechanism for maternal death reporting, special focus on community engagement, a mega IEC/ BCC campaign on zero preventable maternal and newborn deaths and intersectoral convergence, etc It is envisaged that such an approach will accelerate the rate of decline of maternal and neonatal mortality and pave the way for Zero Preventable Maternal and Newborn Deaths and high quality of maternity care delivered with dignity and respect.
4. MCH Wings: State of the art Maternal and Child Health Wings (MCH wings) have been sanctioned at District Hospitals/District Women’s Hospitals and other high case load facilities at sub-district level, as integrated facilities for providing quality obstetric and neonatal care. 650 dedicated Maternal and Child Health Wings (MCH Wings) with more than 42000 additional beds have been sanctioned.
5. Dakshata: GoI has launched a national training programme named ‘Dakshata’ in 2015. It is a strategic 3-day training capsule for building the skills of health care providers, including doctors, staff nurses and ANMs, for providing quality intrapartum care has been rolled out across States/ UT’s.As per the reports received from the states till date 16,400 health care providers have been trained in Dakshata trainings.
6. Maternal Death Surveillance and Response (MDSR): The process MDSR including Maternal Death Reviews has been institutionalized across the country both at facilities and in the community to identify not just the medical causes, but also some of the socio-economic, cultural determinants, as well as the gaps in the system, which contribute to these deaths. This is with the objective of taking corrective action at appropriate levels and improving the quality of obstetric care. The States are being monitored closely on the progress made in the implementation of MDSR and MNM.
7. Janani Suraksha Yojana (JSY): Cash assistance with delivery and post-delivery care. For pregnant women going to a public health institution for delivery, entire cash entitlement is to be disbursed to her in one go, at the health institution.
This program coupled with the JSSK program has lead to significant improvement in institutional delivery rate in the country. Institutional deliveries in India have risen sharply from 47% in 2007-08 to over 78.9% in 2015-16 (NFHS4) while Safe delivery has simultaneously climbed from 52.7% to 81.4% in the same period.
The number of JSY beneficiaries has risen from 7.39 lakhs in 2005-06 to an average one crore in last few financial years.
In the current FY 2019-20 (Up to Dec, 2019), a total of 75.7 lakhs number of JSY beneficiaries have been reported by the States/UTs.
8. Janani Shishu Suraksha Karyakaram (JSSK): This initiative entitles all pregnant women delivering in public health institutions to have absolutely free and no expense delivery, including caesarean section. The entitlements include free drugs, consumables, free diet during stay, free diagnostics and free blood transfusion, if required. This initiative also provides free transport from home to institution, between facilities in case of a referral and drop back home. The scheme was expanded to cover complications during ante-natal and post-natal period and also sick infants up to 1 year of age.
9. ‘LaQshya’ programme (Labour Room Quality Improvement Initiative): Aims at improving quality of care in labour room and maternity Operation Theatre (OT). To reduce preventable maternal and newborn mortality, morbidity and stillbirths associated with the care around delivery in Labour room and Maternity OT and ensure respectful maternity care.
MoHFW launched "LaQshya" programme in December 2017 to improve the quality of care in Labour room and Maternity operation theatres. It will ensure that pregnant women receive respectful and the best quality of care during delivery and immediate post-partum. Total 2444 facilities are selected with 193 medical colleges. State orientation is complete in all States and UTs. Baseline assessment is complete in 2419 (99%) facilities.
Till date, 506 Labour rooms and 449 Maternity Operation Theatres are State certified. 188 Labour rooms and 160 Maternity Operation Theatres are LaQshya certified at National Level.
10. MIDWIFERY: The Government of India has taken a historic and landmark policy decision to roll out midwifery services in the country in order to improve the quality of care and ensure respectful care to pregnant women and newborns. The initiative was launched during the Partners Forum held at New Delhi in December 2018.
The ‘Midwifery Services Initiative’ aims to create a cadre of Nurse Practitioners in Midwifery who are skilled in accordance to competencies prescribed by the International Confederation of Midwives (ICM) and are knowledgeable and capable of providing compassionate women-centered, reproductive, maternal and newborn health care services
The first batch (30 participants from five states) of Midwifery educator training has launched on 6th November 2019 at National Midwifery Training Institute at Fernandez Hospital, Telangana.
11. Rashtriya Kishor Swasthya Karyakram (RKSK): GoI program to address the health needs to adolescents.
a) Menstrual Hygiene Scheme – 3.43 crore adolescent girls were provided sanitary napkins during April- December 2019
b) 3.53 crore adolescents provided IFA supplementation every week under Weekly Iron Folic Acid Supplementation (WIFS) program besides Nutrition Health Education during April- December 2019.
c) 52.15 lakh adolescents received counselling and clinical services at Adolescent Friendly Health Clinics (AFHCs) during April - December 2019 . The number of AFHCs increased from 7,470 in March 2019 to 7,947 in September 2019.
d) Significant progress has been made in implementation of Peer Education program with selection of 91,290 Peer Educators and training of 38,898 Peer Educators during April –December 2019, with a cumulative total of 3.45 lakh selected PEs.
e) 60,474 Adolescent Health Days (AHDs), a quarterly village level activity to create awareness about adolescent health issues and available services were conducted during April -December 2019.
12. Anemia Mukt Bharat (AMB) program: Government of India has launched the Anemia Mukt Bharat (AMB) strategy under the Prime Minister’s Overarching Scheme for Holistic Nourishment (POSHAN) Abhiyaan and the targets has been set to reduce anaemia by 3% per year. The 6x6x6 strategy under AMB implies six age groups, six interventions and six institutional mechanisms. The strategy focuses on ensuring supply chain, demand generation and strong monitoring using the dashboard for addressing anemia, both due to nutritional and non-nutritional causes.
The six population groups under AMB strategy are:
i. Children (6-59 months)
ii. Children (5-9 years)
iii. Adolescents girls and boys (10-19 years)
iv. Pregnant women
v. Lactating women
vi. Women of Reproductive Age (WRA) group (15-49 years)
The progress so far is as under (April-December, 2019-HMIS data as on 21st Feb 2020)
§ 4.70 crore children of age group 10-19 years (out of school girls) provided IFA blue tablets. (On an average 52.32 lakh out of school girls were given IFA Blue tablets every month)
§ 1.9 crore pregnant women and 95.18 lakh lactating women were provided 180 IFA Red tablets. (On an average 22.10 lakh pregnant women and 10.57 lakh lactating women were given IFA Red Tablets every month)
§ 14.26 crore children of age group 6-59 months were provided Iron Folic Acid (IFA) Syrup (On an average 1.58 crore children were given IFA syrup every month)
§ 21.29 crore children of age group 5-9 years (in school) were provided IFA Pink tablets. (On an average 2.36 crore in-school children were given IFA Pink Tablet every month)
§ 1.98 crore children of age group 5-9 years (out of school) were provided IFA Pink tablets. (On an average 22.06 lakh out of school children were given IFA Pink Tablet every month)
§ 36.06 crore children of age group 10-19 years (in school) provided IFA Blue tablets. (On an average 4 crore in-school children were given IFA Blue tablet every month)
13. National Programme for Family Planning - The programme has undergone transformation in terms of policy and actual programme implementation and currently being repositioned to not only achieve population stabilization goals but also promote reproductive health and reduce maternal, infant & child mortality and morbidity. Under the programme, the Ministry provides various family planning services at various levels of health system, and has recently expanded the basket of choices for women.
Post Partum IUCD (PPIUCD): A total of 19,44,495 PPIUCD insertions have been reported in FY 2019-20 (upto January, 2020) with PPIUCD acceptance rate of 16.5%.
Contraceptive Injectable MPA (Antara Program): A total of 15,58,503 doses have been administered across the country in FY 2019-20 (upto January, 2020).
Non-hormonal Pill Centchroman (Chhaya) - A total of 14,05,607 strips of Centchroman have been reported in FY 2019-20 (upto January, 2020).
Mission Parivar Vikas (MPV) - MPV was launched in November 2016 for substantially increasing access to contraceptives and family planning services in 146 High Fertility Districts in seven high focus States with Total Fertility Rate (TFR) of 3 and above. These Districts are from the States of Uttar Pradesh (57), Bihar (37), Rajasthan (14), Madhya Pradesh (25), Chhattisgarh (2), Jharkhand (9) and Assam (2) which constitutes 44% of the country’s population. The performance under MPV in FY 2019-20 (during the period April to December 2019) is as follows:
o Number of PPIUCD insertions – 4.66 lakh
o Number of Saas Bahu Sammelans conducted – 1.3 lakh
o Number of Nayi Pehel Kits distributed by ASHA – 2.5 lakh
14. PC-PNDT- Pre-Conception and Pre-Natal Diagnostic Techniques Act, 1994 is an Act of the Parliament of India enacted to stop female foeticide and arrest the declining sex ratio in India.
§ Central Supervisory Board (CSB) under PC & PNDT Act, 1994 has been reconstituted. 27th CSB meeting was held on 11th October, 2019.
§ As per Quarterly Progress Report (QPR) of September, 2019 submitted by States/UTs, 67,084 diagnostic facilities have been registered under the PC& PNDT Act. So far, a total of 2,220 machines have been sealed and seized for violations of the law. A total of 3,057 court cases have been filed by the District Appropriate Authorities under the Act and 607 convictions have so far been secured. Following conviction, the medical licenses of 142 doctors have been suspended/ cancelled.
§ National Inspection and Monitoring Committee (NIMC) conducted 9 visits in FY 2019-20 (till November 2019) to various States including Telengana, Tamil Nadu, Uttar Pradesh, Madhya Pradesh, Uttarakhand, Maharashtra, Karnataka, Delhi and Jharkhand.
§ During FY 2019-20, Capacity Building Workshops for District Appropriate Authorities and PNDT Nodal Officers were conducted in 9 States including Bihar, Rajasthan, Maharashtra, Madhya Pradesh, Odisha, Uttar Pradesh, Gujarat, Uttarakhand and West Bengal.
§ Orientation and sensitization of judiciary is being conducted through the National Judicial Academy. This year, the National Judicial Academy conducted a two-days training program for 35 District Judges covering 11 States.
§ The Ministry is taking proactive action to remove and monitor sex-selection advertisement on the Internet, which is in violation of the PC&PNDT Act through their Nodal Agency. The Ministry had sent total 577 complaints from January to June 2019 to the Search Engines for removal from the Internet.
§ In FY 2019-20 (up to November 2019), a program review meeting was conducted for 22 States including Odisha, Andhra Pradesh, Telangana, West Bengal, Jharkhand, Chhattisgarh, Bihar, Assam, Arunachal Pradesh, Nagaland, Manipur, Mizorarn, Meghalaya, Tripura, Himachal Pradesh, Punjab, Chandigarh, Haryana, Delhi, Uttar Pradesh, West Bengal and Sikkim