Over the past few years, India has been making efforts to improve maternal health. A decline in maternal mortality has also been documented. But is this decline uniform? A recent study by the International Institute for Population Sciences, which analysed maternal deaths at the district level, has found serious imbalances. Maternal Mortality Rate — deaths on account of childbirth per one lakh live births — is a measure of women’s reproductive health. Under the United Nations Sustainable Development Goals, all countries are expected to lower their MMR to below 70 by 2030. At present, India’s MMR is 103. Dishearteningly, this figure is not representative of ground realities. The findings published in PLOS Global Public Health journal suggest that about 70 per cent of India’s 640 districts had failed to meet the global target between 2017 and 2020. There are other inconsistencies. Arunachal Pradesh, and not Assam as per periodical government surveys, has the highest MMR among the states. Alarmingly, around 128 districts across six states and two Union territories have an MMR count of above 200. There are regional anomalies too. Northeastern, northern, eastern and central Indian states have consistently reported a high MMR, but even southern and western states — they are better off economically — have medium to high MMR districts. Significantly, districts with high populations of scheduled castes and scheduled tribes have shown peak MMR levels. These data sets point to uneven growth and embedded inequalities.
The absence of reliable ground data has proved to be a major hurdle in attaining the UN target. But some inferences can be drawn. One of the key findings has been the negative relationship between MMR and institutional care. This indicates that even though the rate of institutional deliveries has gone up, the majority of women remain deprived of sufficient antenatal care. Unsafe abortion is one of the leading causes of MMR; Punjab being a case in point. The latest information reiterates the need to implement micro-level healthcare policies. The Centre must raise the incentives under the Janani Suraksha Yojana, a national health scheme aimed at promoting institutional delivery, to ensure quality and equitable access. A bottoms-up approach and integrated policy action can be pivotal to reducing preventable maternal morbidities. However, building a comprehensive data collection mechanism must be one of the first steps.
