By Apoorva Mandhani
A recent study conducted by researchers from Jawaharlal Nehru University and the Indian Institute of Technology, Roorkee, revealed that catastrophic maternal health care expenses has pushed 46.6% of mothers in India into poverty, with the illiterate being especially susceptible to this massive expenditure. Nearly 63% of households nationwide have had to spend 40% of their income on maternal health. The study has revived the need for a fillip in maternal healthcare in the country.
A step in the wrong direction?
The study especially holds relevance in the context of the Cabinets move to revise the Indira Gandhi Matritva Sahyog Yojana (Maternity Benefits Programme). The scheme, which has been run as a pilot project in 53 districts since October 2010, provides every pregnant and lactating woman above the age of 19 years with Rs. 6,000. The Union Cabinet has now decided to limit the benefits of the scheme to only the first live birth for a mother, instead of the existing practice of providing such benefits for two live births. The change could deprive almost half the number of potential beneficiaries, and might also discourage a preference for institutional deliveries in families.
This is especially troubling given the fact that India has one of the highest Maternal Mortality Rates (MMR) in South East Asia, as per the 2017 World Health Statistics report. India accounts for almost 15 percent of maternal deaths around the world each year. Hence, achieving the next generation of maternal health goals would require innovative approaches to unyielding hiccups. In such a scenario, a cutback on a program which is essential for the health of the nation and the economy seems like a move in the wrong direction.
Repairing rural and urban discrepancies
There exists a manifest rationale of focusing on institutional deliveries, as affirmed by the Janani Suraksha Yojana (JSY) and the Accredited Social Health Activist (ASHA) programs. While JSY offers financial incentives for pregnant women to utilise maternal healthcare services at medical facilities, ASHA trains rural women to act as guiding liaisons between expectant mothers and the public health system. It has, however, been found that the benefits do not reach many uneducated, poverty stricken women. These women do not receive payments due to administrative lags and inaccessible health facilities. Besides, the maternal and newborn health community has been focusing primarily on the rural poor, despite the fact that India has been urbanising at a rate that has overwhelmed many municipal governments. Such dynamics necessitate the need to research new ways to reach women and newborns in poor urban settings as well.
Forging a way ahead
Improving maternal health outcomes may seem like a daunting task in a country as diverse as India. However, the country has nearly achieved the ambitious Millennium Development Goal (MDG) to reduce the maternal mortality ratio by three-quarters from 556 deaths per 100,000 live births to 174, between 1990 and 2015. The new target of the Sustainable Development Goals, the successor of the MDGs in 2016, is to reduce the global maternal mortality ratio to less than 70 per 100,000 live births by 2030 and reduce national mortality rates by at least two-thirds from 2010 baselines. While achieving these goals would require a renewed focus on equity, it is important to understand that the mortality ratio alone does not provide a complete picture of the state of maternal health; it leaves out the quality of care and the rate of morbidity, among other challenges.
Furthermore, the idea of the adoption of a more “patient-centered” maternity care, which respects womens choices, needs to be deliberated upon. This requires developing more practical guidelines for care in low-resource settings, developing more research proposals which explore equity issues, collecting more disaggregated data, and creating patient feedback mechanisms. Moreover, it has been suggested that the great potential of home-based care needs to be tapped into, in order to reach out to women in the comfort of their homes. This should, however, be undertaken while maintaining the quality of services, by introducing a system of accreditation for facilities and services, alongside guidelines, protocols, and checklists to promote best practices. Most importantly, it is time that maternal health is viewed as a sound investment strategy for development, by recognising the need for integrated healthcare in the lives of women.
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