Maternal health indicators-thoughts from our journey

By Sushma Shende

Last week, we got some good news from the Sample registration system (SRS) data released by the Office of the Registrar General- that India had secured a 22% reduction in maternal mortality rates since 2013. Simply put, this means that nearly one thousand fewer women die from delivery and pregnancy-related complications each month.​

Breaking this data down, while this is certainly a good achievement from a pan-India perspective, state-wide performance varies sharply- for instance, Kerala leads the table at just 46 deaths per 100,000 live-births whereas Assam at a worrying 237 deaths per 100,000 live-births.

While the Government of India has introduced schemes such as the Janani Suraksha Yojana, a conditional cash-transfer for women who deliver in hospitals, that has resulted in reducing the maternal mortality by over 69 percent since 1990, as a nation, we have a long way to go to catch up with better-performing Asian countries. SNEHA’s work on maternal health in urban areas has focused on the dual approach of strengthening health systems and impacting the health seeking behavior in the communities.

Our maternity referral model ,which MCGM and SNEHA successfully established in the Mumbai municipal corporation hospitals and later on scaled to seven adjoining cities is showing encouraging results. It has helped in improving the communication and coordination among the levels of care, in turn resulting in pregnant women in complicated labor, reaching appropriate health care facilities and on time.Hence, we strongly feel a robust maternity referral network needs to be established across the country.

Another big lesson we have learnt is that, if we empower community women with appropriate knowledge about health facilities and basic care during pregnancy, delivery and post-natal period,and support them to take decisions ,they work as peer support to the pregnant women and help them in reaching the appropriate health facilities in difficult times or when family members are not around. We have been working with Health committees and community volunteers in all our project areas who are our change agents in this movement of maternal survival.

Last, but not the least, it is important to strengthen primary care, with regards to maternal health. Early registration of pregnancy, regular and quality antenatal check-ups at a locally accessible health care centre can help curb maternal mortality and morbidity. Health Posts in urban India are the first touch-point for providing free primary health services to the community. A well-functioning Health Post can ensure quality antenatal care to pregnant women, in proximity to where they live and can help motivate women to register early for institutional deliveries, and make monitoring of pregnancy convenient. It can also help promote timely and appropriate referral of High-Risk cases and reduce caseload of monitoring normal pregnancies to maternity homes and Health Posts. However, Health Posts are under pressure to run a number of parallel health programs such as polio, family planning and tuberculosis in addition to census and survey work. This dilutes both the quality and reach of prenatal, maternal and neonatal health services. There is a dire need to re-divert the attention of Health Posts to core antenatal services.

We are closely working with urban Health posts in seven municipal corporations of Maharashtra to conduct situational and facility-level analysis and studies existing structures, performance and issues faced by Health Posts. Vision Building workshops are facilitated with the Health Post staff to build a common vision for delivering best possible services to mothers and children in most vulnerable communities.

SNEHA helps develop protocols and create IEC material, while simultaneously training Health Post staff on clinical and non-clinical aspects. We also support health posts staff to conduct health education sessions at the weekly antenatal care clinics. Our advocacy efforts are continuously on to ensure the following core services: weight measurement, Blood Pressure checking, provision of IFA tablets, tetanus vaccination, abdominal investigations, referrals for investigation and management of danger signs, maintenance of Mother-Child Tracking System records and Mother & Child cards are provided at Health posts.

Sushma is an anthropologist and is Program Director of our Child Health & Nutrition program. She previously used to lead our Maternal & Newborn Health Program.

Also read: Breastfeeding | SNEHA