According to the Report of Registrar General of India, sample registration system (RGI-SRS), the maternal mortality ratio (MMR) of India for the period 2011-13 stood at 167 per 100,000 live births (Table 1), while the infant mortality rate (IMR) for 2013 stood at 40 per 1000 live births (Table 2).
Given the high rate of MMR and IMR, the National Health Mission (NHM) of the Indian government, has implemented certain programmes and schemes to tackle the problem. Special focus is on states with poor public health indicators such as Bihar and Odisha.
The various schemes and initiatives are:
- Promotion of institutional deliveries through Janani Suraksha Yojana (JSY) among poor pregnant women.
- Pregnant women delivering in public health institutions under the Janani Shishu Suraksha Karyakaram (JSSK) are entitled to absolutely free/no expense delivery, including caesarean sections. The initiative stipulates free diet drugs, diagnostics and blood, besides free transport from home to institution, or between facilities in case of a referral and drop back home. Similar entitlements have been put in place for ante-natal and post–natal complications during pregnancy and all sick infants accessing public health institutions for treatment.
- Capacity building of bachelor of medicine and bachelor of surgery (MBBS) doctors in anaesthesia (LSAS) and obstetric care including C-section (EmOC) skills to overcome the shortage of specialists, particularly in rural areas.
- Capacity building of staff nurses (SN) and auxiliary nurse midwifery (ANM) and skilled birth attendant s (SBA) under the Dakshata programme to equip them for conducting normal deliveries, identifying complications and if needed, making referrals at the earliest to higher facilities.
- A new initiative for setting up of skill labs with earmarked skill stations for different training programmes in states with the necessary allocation of funds under NHM.
- Operationalization of adequate numbers of primary health centres for round- the- clock basic emergency obstetric care services.
- Operationalization of adequate numbers of first referral units (FRU) for round-the-clock comprehensive emergency obstetric care services.
- Establishing maternal and child health (MCH) wings at high case load facilities to improve the quality of care provided to mothers and children.
- Name-based web enabled tracking of pregnant women and new born babies for regular and complete services.
- Mother and child protection card in collaboration with the Ministry of Women and Child Development to monitor service delivery for mothers and children.
- Engagement of more than 9.15 lakh accredited social health activists (ASHAs) to generate demand and facilitate accessing of health care services by the community.
- Village health and nutrition days in rural areas as an outreach activity.
- Health and nutrition education through information education communication (IEC) and behaviour change communication (BCC) to promote dietary diversification, inclusion of iron and folic acid-rich food as well as food items which promote iron absorption.
- Distribution of long lasting insecticide nets (LLINs) and insecticide treated bed nets (ITBNs) to prevent the problem of anaemia in pregnant women due to malaria.
- Distribution of safe motherhood booklets to pregnant women to educate them on dietary diversification and consumption of iron and folic acid (IFA).
- Operationalization of comprehensive abortion care services and reproductive tract infections and sexually transmitted infections (RTI/STI) at health facilities with a focus on ‘delivery points’.
- Supporting of over 21,000 ambulances under NHM to interlay transport pregnant women to institution for delivery and also for referral.
- Newer operational guidelines prepared and disseminated to states for screening, diagnosis and management of gestational diabetes mellitus (GDM) and hypothyroidism during pregnancy, calcium supplementation during pregnancy and lactation, de-worming during pregnancy, maternal near miss (MNM) review, screening for syphilis during pregnancy, uterotonic use during labour and prevention and management of primary health centres.
- Facility based new born care (FBNC) at different levels to reduce child morbidity and mortality, besides special new born care units (SNCUs), newborn stabilisation units (NBSUs) and newborn care corners (NBCCs) for sick newborns at different levels.
- Home based new born care (HBNC) through ASHAs at the community level and early detection and referral of sick new born babies.
- Launching of India New born Action Plan (INAP) to reduce neonatal mortality.
- Newer interventions to reduce newborn mortality using vitamin K injections at birth, antenatal corticosteroids for preterm labour, kangaroo mother care and injection gentamicin to young infants in cases of suspected sepsis.
- Observation of intensified diarrhoea control fortnight (IDCF) to focus on oral rehydration salts (ORS) and zinc distribution for management of diarrhoea.
- Launching of integrated action plan for pneumonia and diarrhoea (IAPPD) in four states with highest child mortality (Uttar Pradesh, Madhya Pradesh, Bihar and Rajasthan).
- Establishment of nutritional rehabilitation centres (NRCs) for management of severe acute malnutrition in children.
- Promotion of appropriate infant and young child feeding practices.
- Operationalization of the Rashtriya Bal Swasthya Karyakram (RBSK) for health screening and early intervention services to provide comprehensive care to all children in the 0-18 years age group The purpose of these services is to improve the overall quality of life for children through early detection of birth defects, diseases, deficiencies, and development delays, including disability.
- Implementation IFA supplemental programme under the national iron plus initiative (NIPI), through a life cycle approach. Age and dose specific IFA supplementation programme is being implemented for the prevention of anaemia among vulnerable age groups such as under-5 children, children in the 6–10 years’ age group, adolescents, pregnant and lactating women, and women of reproductive age.
- Training of doctors, nurses and ANMs for essential newborn care, early diagnosis and management of common ailments among children under the Navjaat Shishu Suraksha Karyakram (NSSK), integrated management of neonatal and childhood illnesses (IMNCI), facility based newborn care (FBNC), infant and young child feeding practices (IYCF).
- Reproductive maternal new born child health + adolescent (RMNCH+A) interventions for achieving improved maternal and child health outcomes.
- Identification of 184 high priority districts (HPDs) for focused monitoring and supportive supervision for improved maternal and child health outcomes in low-performing areas.
The Indian government has embarked on a National Health Mission (NHM), assisted by various new and ongoing schemes, to bring down maternal and infant mortality in India. These cover the entire gamut of essential services to ensure a healthier new generation of Indians. However, it is important that there is continuum of care maintained, and the focus especially in low-performing regions is never lost. Only then can India repay the results of this initiative.