Progress can often be uneven. According to the Union health ministry, the maternal mortality ratio in India has declined by 10 points and the country will soon achieve its Sustainable Development Goals of 70 per lakh live births by 2030. The special bulletin on MMR released by the registrar general of India shows a steady fall in the last few years — it was 103 for 2017-19 — indicating that the country is likely to meet the National Health Policy target of 100 per lakh live births by 2020. Seven states — Kerala, Andhra Pradesh, Jharkhand, Gujarat, Telangana, Maharashtra and Tamil Nadu — have already achieved the SDG target and nine have met the NHP goal, which includes Karnataka and Haryana in addition to the former. But progress has been far from equal. While the MMR is much below 70 in some states, others like Uttarakhand, Punjab, West Bengal, Bihar, Rajasthan and Odisha continue to record MMR between 100-150. Not only has the percentage of decline varied massively among states, but some states — West Bengal, Haryana, Uttarakhand and Chhattisgarh — have also witnessed a spike in MMR. Bengal recorded an increase of 10 points.
The MMR is a major indicator of a nation’s social, economic and cultural ambience. A consistent decline in MMR shows that there has not only been an improvement in the economic status of underprivileged families — they now can afford better nutrition and medical care — but that there is also cultural support to prioritize the reproductive health of women. However, a closer look reveals that the all-India average camouflages the poor performance of some states. Most maternal deaths can be attributed to obstetric causes, such as haemorrhage, sepsis, anaemia, that are preventable. Lack of awareness about antenatal and post-partum care, fragmented obstetric services, early pregnancy are some of the persistent areas of concern that have to be jointly addressed by the Central and state healthcare apparatus. The gains notwithstanding, policymakers must recognize and monitor the disparities between states. This will be a test of India’s federal spirit. Additional targeted efforts to improve access to and quality of healthcare services along with awareness programmes hold the key. Unless the government focuses on meeting the specific needs of the poorly-performing states, India will fail to achieve a uniform MMR across the country.
