Country longitude: maternal health and challenges

Context and background Public health in any country is important in the government’s agenda, especially for women and children. The health sector in the country is a matter of the states, but the central government has

Context and background


Public health in any country is important in the government’s agenda, especially for women and children. The health sector in the country is a matter of the states, but the central government has taken it as a mission. Nutrition week is being celebrated in the country, which aims to make them healthy by keeping special care of nutrition in women and children. In the PMNCH Partners Forum (Maternity, Neonatal and Child Health Participation Forum) in Delhi, Prime Minister Narendra Modi said that the full emphasis of the government is to improve the health of women and children. The Prime Minister said that India is committed to increasing the expenditure in public health sector to 2.5 percent of GDP by 2025.

Better results of government efforts

  • As far as maternal mortality is concerned, India has achieved tremendous success in reducing it.
  • In 1990, where the mortality rate of women was 556 per one lakh per child, it has now come down to 130.
  • In 1990, the maternal mortality rate was 77 percent, it has now come down to 40 percent, which is more than the global growth.
  • It is also encouraging that the maximum decline in MMR in socio-economically backward areas has been recorded.
  • As a result of many schemes and programs in the field of health and nutrition, the expected improvement was noticed.
  • As per Janani Suraksha Yojna (JSY) in 2005, institutional delivery was 38.7 percent in 2005-06, it increased to 78.9 percent due to cash promotion in 2015-16.
  • Prime Minister’s Safe Motherhood Campaign (PMSMA) was started in the year 2016 by the Prime Minister, whose objective is to reduce maternal and newborn infant mortality through safe pregnancy and safe delivery.
  • Under this nationwide program, on the 9th of every month, pregnant women are provided with assured, comprehensive and high quality childbirth care which is showing the effect.
  • Apart from this, promoting institutional delivery was also encouraged by providing a cash incentive of Rs.5000 for encouraging pre-pregnancy for pregnant women and lactating mothers under Prime Minister Mata Vandana Yojana.
  • The above statistics are certainly encouraging but there is still a lot to be done in this area. At present, there is a need to make efforts to bring the maternal mortality rate which is 130 during childbirth on Zero to zero.

Maternity leave promotion plan

  • In order to encourage private sector employers to implement the extended 26-week Maternity Leave Rule, the Labor Ministry is working on an incentive scheme for the return of 7 weeks wages to those employers.
  • The Ministry of Labor and Employment is working on such an incentive scheme, under which the women employees with a salary limit of up to Rs 15,000 / – will be given 7 weeks’ remuneration to employers who are employed and 26 weeks of payday maternity leave. Will be done.
  • Some conditions have also been fixed for this and it has been estimated that by implementing the proposed incentive scheme, the Government of India, the Labor and Employment Ministry, will have to bear the financial burden of about Rs 400 crore.

Purpose of Incentive Scheme

  • Implementing the 26-week extended Maternity Leave Rule is proving to be good in the public sector context but it has been reported in the report that for women working on private sector as well as contracts or contracts, Not being proved right
  • It is generally assumed that private sector bodies do not encourage women employees, because if women are employed, they have to give maternity leave especially with a salary of 26 weeks.
  • At the same time, the Ministry of Labor and Employment is receiving complaints about the effect that when the employer receives this information that any of his female staff is pregnant or if he applies for maternity leave, he has done it without any concrete basis. The contract is terminated.
  • The Labor Ministry has received several memorandums in this regard which have been told how an extended period of maternity leave is proving to be harmful for women employees because they have not been able to do so without any solid foundation even before going on maternity leave. To resign, or to be rescinded.
  • Therefore, the Ministry of Labor and Employment required to bring such a stimulus plan.
Team Vision Input

Role of socio-economic and environmental factors

  • The good news is that collective efforts in India have been intensified in order to improve the neonatal and maternal health according to United Nations’s sustainable development goals.
  • Although the challenges still remain, especially the small and separate population, especially women and children, need health care.
  • To successfully deal with these challenges, we need to make immediate and more cooperative collaborative efforts that can address the complex socio-economic factors responsible for the growing health of children and women in India.
  • Weak populations, such as urban and rural poor and traditionally marginalized communities, such as tribal and dalit children, are more likely to not have access to health services, and they have higher risk of morbidity and mortality.
  • These socio-economic factors are still in spite of efforts to be addressed by governments and civil societies.
  • Better inspection and operation of services is required through the participation of competent platforms such as civil society organizations and Information Technology (IT).
  • The only reason for the disease is not germs, environmental factors, such as nutrition deficiency, safe water, sanitation and hygiene etc. can also play an important role.
  • There is a need to make systematic efforts to eliminate inequality in maternal health outcomes across the country, with the adoption of a comprehensive and integrated policy approach, there is a need to monitor the implementation of the guideline related to safe delivery.

Regional inequality is a big challenge

  • Maternal mortality is significantly different between states and states. For example, MMR of Kerala was 46 in comparison to Assam’s 237 in 2016.
  • To overcome these inequalities it is important that data related to various causes of maternal mortality should be analyzed at regular intervals and policy actions should be given priority accordingly.
  • For this, there is a need to promote inspection and surveillance systems such as Mother and Child Tracking System and Health Management Information System.
  • At present, haemorrhage is the major cause of maternal mortality in the country, due to secretion of sepsis and abortion, are also major causes of death. This indicates the need for a national blood transfusion service network.
  • Dysfunctional disorders are another important cause in South India due to which EAG states and abortion related deaths are more in Assam, therefore there is a need for policy intervention.
  • To overcome regional inequalities, it is also important that health and nutrition services be eligible for access to the most vulnerable groups.
  • For example, according to the National Family Health Survey (NFHS) -4, only 58.6 percent of mothers have access to pre-delivery check-ups in the first quarter, despite improvement.
  • We should take a lesson from the states which have been successful in improving the MMR especially among the weaker groups. For example, due to limited access to medical services in Telangana, there was high MMR among women in tribal areas.
  • In response to this, the state government implemented 24-hour call center service through its ‘Amma Vody’ program, which provides financial incentives for institutional delivery.
  • These call centers help track pregnant women and ensure that they get pre-delivery check-ups on time.
  • Although institutional delivery plays an important role in reducing maternal mortality, it is also important to focus equally on other policy interventions that affect maternal health.
  • For example, according to NFHS-4, one in two pregnant women is anemic. The Nutrition Campaign started by the government is playing an important role in improving the nutritional status of women.
  • To achieve this, a comprehensive package of services provided by different ministries is required to be brought under the nutrition program.
  • Similarly, there is a need to increase investment for girls’ education. It is true that girls who receive basic education can become more successful in limiting the size of their families when they become adults.
  • Due to focus on women’s education and their empowerment through self-help group campaign, Bihar states have recorded rapid decline in MMR.

Training and Monitoring Need

  • The lack of trained human resources, especially doctors and ANM (auxiliary nurses and midwives), remains an important challenge to improve maternal health outcomes.
  • There is a need to make the human resources compensation package more attractive for the personnel working in remote and rural areas.
  • In addition, with the focus on training in the treatment of female and maternal diseases, practical skills are provided in delivery management.
  • The Union Health Ministry has launched the ‘Target’ labor room improvement initiative. This is a secure delivery mobile application for health workers who work to manage delivery of ICU (intensive care units) and OHDU (obstetric high dependency units).

Which things need to pay more attention to?

  • Given the importance of motherhood, newborn and female health, there are four priority areas which need special attention.
1. Still birth
  • Children born dead are called still births. They contain half children who die during delivery.
  • That is, the child who is found dead after birth is 10 minutes or half an hour before he is alive.
  • We need to strengthen delivery facilities, emergency care and better care before delivery.
2. Newborn baby
  • Neonatal problems have not been solved yet.
  • At present, the infant mortality rate is close to 24 and it needs to bring us down from single digit i.e. 10. However, the goal of achieving this goal in the next 5-6 years has been given.
3. Teenage health
  • Our focus is on the adolescent’s health, but we still need to do it better.
  • We also need to pay attention to the health of the adolescent because our demographic dividend has the potential to take us very much in the next 30 years.
  • Teenagers of 12, 15, 16 and 18 years are our workforce, they will have an important contribution to the development of the country, so it is our responsibility to make them healthy.
  • They have to protect against overweight, heart disease and bad habits. If they do not have mental and physical well-being then we can not get the benefit of our demographic dividend.
4. Female cancer
  • In women, surgical cancer is the most common and there is also a great reason for untimely death. There are all the means of identifying and treating it at our right time in our country.
  • This disease should be identified and treated as a mission.

Conclusion


Although India has performed far better than the global average to reduce maternal mortality rates between 1990 and 2016, but from the perspective of MMR, standing with major economies like Brazil (44), China (27) and Japan (5) We have to decide a long trip now. Our plans are doing better and they need to be implemented more efficiently. It is the responsibility of our system to abolish the curse of maternal mortality and respect motherhood rights.