Lancet study shows challenge before India in meeting 2030 maternal mortality goals
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Context
A recent Lancet study highlights that despite significant long-term progress, India faces challenges in meeting the Sustainable Development Goal (SDG) of reducing its Maternal Mortality Ratio (MMR) to below 70 deaths per 100,000 live births by 2030. While India's MMR has fallen dramatically, from 508 in 1990 to 116 in 2023, the rate of decline has slowed. The country still accounted for approximately 24,700 of the 2.4 lakh global maternal deaths in 2023, underscoring persistent gaps in maternal healthcare.
UPSC Perspectives
Social Issues & Governance
The Lancet data underscores the critical intersection of health and governance in achieving social development targets. Maternal Mortality Ratio (MMR) is a sensitive indicator of the overall health system's strength and equity. The Sustainable Development Goal 3.1 sets a global target of reducing MMR to below 70 per 100,000 live births by 2030. India's own Sample Registration System (SRS) data from the Registrar General of India shows an MMR of 88 for 2020-22, indicating progress but also the distance yet to be covered. The primary causes of maternal death, such as haemorrhage, hypertension, and infections, are largely preventable with timely and quality care. Wide inter-state variations exist, with states like Kerala and Tamil Nadu nearing the SDG target, while Uttar Pradesh, Bihar, and Madhya Pradesh lag significantly, pointing to deep-rooted regional disparities in healthcare infrastructure and access. These disparities highlight the need for targeted interventions and strengthening of public health systems in high-burden states.
Government Interventions & Policy
To tackle maternal mortality, the Government has launched a multi-pronged strategy under the umbrella of the National Health Mission (NHM). Key schemes include: Janani Suraksha Yojana (JSY): A cash assistance scheme launched in 2005 to promote institutional deliveries among poor pregnant women. Janani Shishu Suraksha Karyakram (JSSK): Launched in 2011, it aims to eliminate out-of-pocket expenses by providing free delivery (including C-sections), drugs, diagnostics, diet, and transport for pregnant women and sick infants in public health institutions. Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA): Provides fixed-day (9th of every month) comprehensive and quality antenatal care, free of cost, to all pregnant women, with a focus on identifying and managing high-risk pregnancies. LaQshya Programme: A Quality Improvement Initiative launched in 2017 to improve the quality of care in labour rooms and maternity operation theatres, aiming to reduce mortality and morbidity and promote Respectful Maternity Care (RMC). These initiatives have collectively boosted institutional deliveries, which rose from 38.7% in 2005-06 to 88.6% in 2019-21, and improved antenatal/postnatal care. However, the slowing progress noted by Lancet suggests that policy focus must now shift from mere access to ensuring the quality of care and addressing systemic bottlenecks.
Economic & Way Forward
The challenge of reducing MMR is intrinsically linked to economic factors and requires sustained investment. The economic cost of maternal mortality extends beyond the family to the nation, affecting productivity and demographic outcomes. The National Health Policy (2017) aims to increase public health expenditure to 2.5% of the GDP, a crucial step for strengthening the healthcare system. The slowdown in MMR reduction post-2015, as highlighted by the Lancet study, necessitates a renewed focus. The way forward involves a convergence of schemes for better impact, such as linking maternal health benefits with nutritional support programs. Strengthening the Reproductive, Maternal, Newborn, Child, Adolescent Health Plus Nutrition (RMNCAH+N) strategy is vital. Key priorities should include: bridging the human resource gap by training more skilled birth attendants and specialists, improving emergency obstetric care in rural and remote areas, using technology for better tracking of high-risk pregnancies, and ensuring robust data monitoring to identify and address implementation gaps swiftly. Addressing the social determinants of health, such as female literacy, nutrition, and early marriage, is equally important for a sustainable solution.