Focus on maternal, newborn deaths

The year 2016 was a particularly progressive one for maternal and neonatal health in India. The government announced several initiatives for the benefit of pregnant mothers and newborn babies in the country. Many of the interventions implemented by the government last year focused on rural India where the burden of maternal and neonatal mortality is the highest.

While preventable maternal and neonatal deaths have gone down, India continues to have the highest maternal and neonatal mortality in the world. According to a 2016 Maternal Health Report by Lancet, India accounts for 15% of world’s casualties due to pregnancy and childbirth. To meet our maternal and child health goals, this year, we must execute the schemes and initiatives we undertook last year well and ensure that our most vulnerable women and children have access to life-saving interventions.

The government recently implemented a scheme under which pregnant woman will be provided with Rs 6,000 to cover hospital admission, vaccination and nutritional food. This scheme will to an extent help tackle two big challenges contributing to maternal and neonatal mortality in India – malnutrition and home delivery without the presence of a skilled birth attendant (SBA).

Malnutrition is very closely linked to both maternal and child mortality. If a woman is too thin and does not gain the recommended weight during pregnancy, it increases the likelihood of the baby being born prematurely, having a low birth weight, and not surviving after birth.

Ante-natal checkups entail important pre-pregnancy tests which monitor the growth and development of the foetus and can correct any micronutrient deficiencies in the mother. Ante-natal care is also an opportunity for the doctor to counsel the pregnant woman and her family on positive health behaviours such as nutrition and breast care.

Private sector role

To boost ante-natal care for pregnant women, Prime Minister Narendra Modi announced the Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA) also known as ‘I pledge for 9’, which invites the private sector to provide free ante-natal services (ANC) on the ninth of every month on a voluntary basis to pregnant women, especially those living in under-served, semi-urban, poor and rural areas.

Furthermore, during the campaign, a minimum package of ante-natal care services will be provided to pregnant women in their second or third trimesters at government health facilities.

According to The Pneumonia and Diarrhoea Progress Report for 2016 by the Johns Hopkins Bloomberg School of Public Health, India has the highest number of pneumonia and diarrhoea deaths among children in the world with nearly three lakh children dying in 2016.

The government has added rotavirus vaccine in its Universal Immunisation Programme to protect young children against the leading cause of severe diarrhoea. The government also announced that in 2017, the pneumococcal conjugate vaccines’ (PCV) that combats pneumonia will be rolled out as part of the Universal Immunisation Programme in a phased manner.

While India has made considerable progress in reducing maternal and child mortality, the rates of child and maternal deaths continue to remain unacceptably high due to a range of development challenges. Proven, high-impact interventions are available, but they do not reach all the women and newborns who need them.  Many women give birth at home and may not see a skilled health worker before or after delivery.

Skilled health workers often lack access to critical supplies and medicines. Even when infants survive, their chance for a healthy and productive life is greatly reduced by the death or disability of the mother.

Our focus should be on ending preventable maternal and newborn deaths. To achieve that, public-private partnerships are important. We need to educate our men and women on the importance of trained deliveries, empower them to make family planning decisions, support increased use of reproductive health services and provide financial assistance to the underserved populations so they have better access to emergency care and comprehensive obstetric, ante-natal and post-partum care.

(The writer is Chairman and Neonatologist, Cloudnine Group of Hospitals)