A decline in maternal mortality rate was possible due to the effective implementation of PMSMA. But this should not be the end of the story
At a time when mainstream attention largely rests on the trivial to the tantalising, it will be heartening to explore some stories of goodness and success from India’s ‘not so heard’. Poor women of the country, who have lived on with the curse of enduring suffering and pain, have finally got some reason to cheer. Three States, viz Kerala, Maharashtra and Tamil Nadu have successfully achieved the ambitious target of Sustainable Development Goal (SDG) of reducing Maternal Mortality Ratio (MMR) to less than 70 deaths per 100,000 live births much ahead of the set target of 2030. While Uttar Pradesh topped the chart in reducing MMR, other States like Uttarakhand, Kerala, Madhya Pradesh and Chhattisgarh were not too far in achieving the goal.
However, the story is not just about an impressive slide in MMR, as indicated by a report released by Sample Registration Survey last month, but also about ‘uniformity’ shown in the decline by various States and Union Territories. While Uttar Pradesh and Uttarakhand recorded more than 25 per cent drop, the decline for Assam, Bihar, Jharkhand, Haryana, Madhya Pradesh, Chhattisgarh and Kerala has been between 20-25 per cent. This is just the beginning. The best is yet to come. The impact of the Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA), aimed to provide fixed-day free, comprehensive and quality ante-natal services to pregnant women on the ninth of every month, will be reflected in the coming years.
In the past 23 months since the launch of the PMSMA, no less than 1.3 crore pregnant women have received ante-natal check-ups, of which 6.5 lakh were identified as high risk pregnancies. Most of the high risk pregnancies (HRPs) face higher chance of maternal deaths but are preventable if identified at an early stage and followed up with adequate care, including birth preparedness and obstetric care. As many as 25 lakh check-ups were conducted in high priority districts identified by the Government for focussed attention. Bulk of the PMSMA beneficiaries, including high-risk pregnancies, were from rural settings, hard-to-reach areas and urban slums, and may not otherwise have access to maternal healthcare but for this initiative of the Government that brought together the private sector, Government and hundreds of volunteers with a common goal of safe motherhood.
Be it Vibha Augustine of the Banwasi Sewa Ashram, who dedicated herself for the cause of women in far-off Sonbhadra area of Uttar Pradesh, or Pooja Upadhyay, who travels all the way from Raipur to left-Wing Extremism (lWE)-affected Narayanpur in south Bastar, these crusaders are in mission mode. Upadhyay was nominated by the Chhattisgarh Government for the ‘IPledgeFor9’ Achievers Award. Down south, Suman Bhalke from Bidar was the first gynaecologist to volunteer under the PMSM campaign from Karnataka and was awarded for exemplary services while Archana H of Kasargod district in Kerala continues to work relentlessly for the cause though the State has already achieved the Sustainable Development Goal target on MMR.
‘IPledgefor9’ Achievers Awards were presented to individuals and teams of doctors from the private sector and States for their exemplary services, outstanding support to institutions and commitment from support partners in achieving the mission’s objectives of safe motherhood to every woman in the country. There are many States, such as Telangana, Andhra Pradesh, Gujarat, West Bengal, Karnataka and Haryana that are close to achieving the SDG target on MMR in the coming years. If the enthusiasm of the private and public sector are clubbed with the dedication of volunteers, there should be no doubt that these States would have reached the target in the next couple of years.
Going by the percentage of decline in MMR in the rest of the States, we can expect those which continue to have high maternal mortality figures to come within the achievable range. Madhya Pradesh and Chhattisgarh are two States in the Empowered Action Group (EAG) that have shown a drop of nearly 22 per cent touching 173 per 100,000 live births from 221. Among the non-EAG States, Andhra Pradesh and Haryana have shown a decline of close to 20 per cent in MMR which is the highest decline. Andhra Pradesh’s MMR now stands at 74 as against 92; while Haryana settled at 101 against 127.
The challenge was to provide quality services to over two crore pregnant women in India that required vision, policy and implementation at the ground level. One of the biggest achievements of PMSMA has been that the programme has successfully reached out to difficult and some of the remotest areas of the country. The Government’s efforts in improving access to maternal health services leading to an increase in institutional births has significantly contributed to ground-breaking reduction from 2013 levels. Now, it is time to address related social determinants of unsafe motherhood such as preventing early marriage of girls, delaying first childbirth, gap between two children and most important, promoting girl education.
(The writer is a strategic communications professional)
