Targets 3.1 and 3.2 of Sustainable Development Goal (SDG) 3 – good health for all – sets indicators for reducing the global maternal mortality rate (MMR) to less than 70 per 1,00,000 live births and global neonatal mortality rate (NMR) to as low as 12 per 1000 live births by 2030. Closer home, the National Health Mission (NHM) had a 2017 target to reduce the national infant mortality rate (IMR) to 25 per 1000 live births and national MMR to 100 per 1,00,000 live births. While such lofty targets have been set and significant progress has been made, progress is not universal. This article explores the situation of mother and child survival in rural India and highlights factors requiring urgent concern.
EVERYDAY AROUND THE WORLD….
-830 women die from preventable causes related to pregnancy and childbirth -7000 newborns die due to poor essential care practices during and immediately after birth
In India the UNICEF Child Mortality Report 2017 states that the IMR is 35 per 1000 live births. The MMR stands at 130 per 1,00,000 live births as per the Sample Registration System (SRS) data.
While continuous efforts made by the Government of India through its National Health Mission (NHM) have depicted a gradual trend of improvement in MMR and IMR over the years, there is still much left to be desired.
Based on my experience in evaluating different programs working to improve maternal and neonatal health and healthcare facilities and access in villages across three states of India – Orissa, Rajasthan and Madhya Pradesh – I list five top areas, which I believe require urgent attention.
Focus on strengthening the ‘continuum of care’ – ensure integrated service delivery in various life stages including adolescence, pre-pregnancy, childbirth and post-natal period, childhood and through reproductive age. In addition services should be available at all levels – home and community, primary and community healthcare facilities, hospitals.
Optimally train and utilize the available human resources – Shortage of qualified human resource in maternal and neonatal facilities is a glaring reality. While a one-sided solution to this is to hire more staff, an essential and long term solution is to regular skill, re-skill and up-skill the existing human resource. Trainings should be practical and carefully monitored to make an impact on performance.
Change the ‘awareness narrative’ – While majority community-based programs share information to increase awareness on maternal and neonatal health practices, the retention of information shared is very low. This points to the need for locally and contextually relevant ways to share information. This could include mediums like interesting videos, street plays, community folk dance/songs etc.
Make good hygiene and sanitation the building block – Cleanliness and hygiene in both healthcare facilities and in the villages and homes of patients presents a dismal situation. This calls for an approach wherein while on one hand healthcare facilities invest in better protocol and practices for cleanliness, on the other hand patients and other stakeholders are made critically aware on the importance and techniques of maintaining cleanliness and hygiene, especially in terms of the health benefits for their newborn.
In conclusion –
A holistic approach to maternal and neonatal healthcare requires effort to focus on the health and development of a woman right since birth and through puberty, adolescence and early adulthood. Moreover, the responsibility for change does not lie only with medical professionals. Local communities should be equally involved in securing good health, hygiene and nutrition for all, especially adolescent girls, pregnant and lactating mothers and newborn children. Furthering and strengthening maternal and neonatal health and healthcare services will require increased efforts, stronger collaborations and advocating and liasoning for system level alterations in practice.
- Rini D’Souza, Associate Consultant