Maternal Mortality Ratio (MMR): SRS 2007-09:
As per the latest RGI-SRS Report, for the period 2007-09, the MMR of India is 212 per 100,000 live births. The MMR in India has declined from 301 in 2001-03 to 254 in 2004-06 and to 212 in 2007-09. The percentage decline from 2001-03 to 2004-06 was to the tune of 16 percent and from 2004-06 to 2007-09, the decline is 17 percent. States like Tamil Nadu and Kerala have an MMR of 97 and 81 respectively, whereas MMR is higher in states like Assam (390) followed by UP including Uttarakhand (359), Rajasthan (318) and Bihar including Jharkhand (261). About two-thirds (approximately 70 %) of maternal deaths occur in the 264 high focus districts of a handful of states – Bihar and Jharkhand, Orissa, Madhya Pradesh and Chhattisgarh, Rajasthan, Uttar Pradesh and Uttarakhand and in Assam.
Annual Health Survey 2010-11:
It has been launched to get district disaggregated data for better planning & intervention. Results released recently for 284 districts of 8 EAG States and Assam have ranked these states based on MMR. Assam, Uttarakhand and UP have shown a declining trend in MMR as compared to SRS (2007-09). However situation in Bihar, Jharkhand, MP, Chhattisgarh and Rajasthan needs improvement.
MH Indicators and State-wise MMR as per SRS 2007-09 and AHS 2010-11 is placed at Annexure I & II respectively.
Annual Health Survey 2010-11:
Under National Rural Health Mission (NRHM), several initiatives are under implementation to achieve the goal for reduction in Maternal Mortality. These interventions are as follows:
Essential Obstetric Care
This includes quality antenatal care including prevention and treatment of anemia, institutional / safe delivery services and post natal care. To provide essential obstetric care services GoI is operationalizing the PHCs for 24 X 7 services and also training the SNs/LHVs/ANMs in Skilled Attendance at Birth.
Quality Ante Natal care
Quality ANC includes minimum of at least 4 ANCs including early registration and 1st ANC in first trimester along with physical and abdominal examinations, Hb estimation and urine investigation , 2 doses of T.T Immunization and consumption of IFA tablets for 100 days.
Post natal care for mother and newborn
Ensuring post natal care within first 24 hours of delivery and subsequent home visits on 3rd, 7th and 42nd day is the important components for identification and management of emergencies occurring during post natal period. The ANMs, LHVs and staff nurses are being oriented and trained for tackling emergencies identified during these visits.
Skilled Attendance at Birth
Government of India has a commitment to provide skilled attendance at every birth both at community and Institution level. To manage and handle some common obstetric emergencies at the time of birth, a policy decision has been taken permitting Staff Nurses (SNs) and ANMs to give certain injections and also perform certain interventions under specific emergency situations to save the life of the mother.
Provision of Emergency Obstetric and Neonatal Care at FRUs
Provision of Emergency Obstetric and Neonatal Care at FRUs is being done by operationalziing all FRUs in the country. While operationalising, the thrust is on the critical components such as manpower, blood storage units and referral linkages etc. Availability of trained manpower (Skill Based Training for MBBS doctors) is linked with operationalization of FRUs. The initiatives being undertaken in this regard are:
Augmentation of skilled human resources for Maternal Health:
To overcome the shortage of skilled manpower particularly Anesthetists and Gynecologists, the following key skill based training programs are being implemented:
An 18 Weeks Training Progamme of MBBS Doctors in Life Saving Anesthesia Skills for Emergency Obstetric Care.
A 16 weeks Training programme of MBBS Doctors in Obstetric Management Skills including C-Section, in collaboration with Federation of Obstetric and Gynecological Society of India.(CEmOC).
A 10 days Training Programme in Basic Emergency Obstetric Care for Medical Officers(BEmOC)
A 3 weeks Training Programme for ANMs/SNs/LHVs as Skilled Birth Attendants(SBA)
Referral Services at both Community and Institutional level
GoI has a thrust to establish a network of Basic patient care transportation ambulances with aim to reach the beneficiary in rural area within 30 minutes of the call for quick service delivery.
Presently states have been given the flexibility to establish assured referral systems to transport pregnant mothers and sick newborns, etc which includes different models including public, private partnership models.
Other Major Interventions are:
Safe Abortion Services/ Medical termination of Pregnancy (MTP):
Provision of comprehensive safe abortion services at public health facilities including 24*7 PHCs/ FRUs (DHs/ SDHs /CHCs) with a focus on “Delivery Points”.
Capacity Building of Medical officers in safe MTP Techniques and of ANMs, ASHAs and other field functionaries to provide confidential counseling for MTP and promote post-abortion care including adoption of contraception.
District Level Committees have been framed and empowered to accreditate the facilities for conducting safe abortion services under MTP Act including approval of private and NGO sector facilities for conducting MTPs.
A tool (format) to facilitate monitoring of Comprehensive Abortion Services and implementation of the MTP Act has been implemented all levels by GoI.
Supply of Nischay Pregnancy detection kits to sub centres for early detection of pregnancy so that safe abortion services can be provided to intended pregnancies covered under the MTP Act.
Development of standard IEC/BCC material on Safe Abortion.
Orientation/Training of ASHAs to equip them with skills to create awareness on abortion issues in women and the community and facilitate women in accessing services.
Provision of RTI/STI services:
Under NRHM, provision of STI/RTI care services is a very important strategy to prevent HIV transmission and promote sexual and reproductive health under the National AIDS Control Program (NACP III) and Reproductive and Child Health (RCH II). Enhanced Syndromic case management (ESCM) with minimal laboratory tests is the cornerstone of STI/RTI management under NACP III. Services are being provided to all FRUs, CHCs and at 24 X 7 PHCs.
Setting up of Blood Storage Centers (BSC) at FRUs:
Timely treatment of complications associated with pregnancy is sometimes hampered due to non-availability of Blood Transfusion services at FRUs. The Drugs and Cosmetics Act has been amended to facilitate establishment of Blood Storage Centers at such FRUs.
Village Health and Nutrition Day
Organizing of Village Health & Nutrition Day (VHNDs) at Anganwadi center at least once every month to provide ante natal/ post partum care for pregnant women, promote institutional delivery, immunization, Family Planning & nutrition are the part of various services being provided during VHNDs. A total of 3.23 crores Village Health and Nutrition Days(VHNDs) have been organized till March, 2012 since the launch of NRHM.
Government of India has launched Janani Shishu Suraksha Karyakaram (JSSK) on 1st June, 2011, which entitles all pregnant women delivering in public health institutions to absolutely free and no expense delivery including Caesarean section. The initiative stipulates free drugs, diagnostics, blood and diet, besides free transport from home to institution, between facilities in case of a referral and drop back home. Similar entitlements have been put in place for all sick newborns accessing public health institutions for treatment till 30 days after birth. All the States and Union Territories have since then initiated implementation of the scheme.
Maternal Death Review
The process of maternal death review (MDR) has been implemented & institutionalized by all the States as a policy since 2010. Guidelines and tools for conducting community based MDR and Facility based MDR have been provided to the States. The States are reporting deaths along with its analysis for causes of death.
Delivery Points (DPs)
All the States & Union Territories have identified DPs above a certain minimum benchmark of performance to prioritize and direct resources in a focused manner to these facilities for filling the gaps like trained and skilled human resources, infrastructure, equipments , drugs and supplies, referral transport etc. for providing quality & comprehensive RMNCH (Reproductive, Maternal, Neonatal & Child Health) services.
Web Enabled Mother and Child Tracking System
Name Based Tracking of Pregnant Women and Children has been initiated by Government of India as a policy decision to track every pregnant woman , infant & child upto 3 yrs, by name for provision of timely ANC, Institutional Delivery, and PNC along-with immunization & other related services.
A Joint MCP Card
Ministry of Health & Family Welfare and Ministry of Women and Child Development (MOWCD) has been launched as a tool for documenting and monitoring services for antenatal, intranatal and postnatal care to pregnant women, immunization and growth monitoring of infants.
Tracking of severe Anaemia during pregnancy & child birth by SCs and PHCs:
Severe anemia is a major cause for pregnancy related complications that may lead to maternal deaths. Effective monitoring of these cases by the ANM as well as the Medical Officer in charge of PHC has been started to line list these cases and provide necessary treatment.
Technical Guidelines & Service Delivery Posters:
GoI has developed & disseminated standard technical guidelines & service delivery posters for standardizing the quality of service delivery during ANC, INC, PNC, etc from tertiary to primary level of institutions.