Mothers require better healthcare, not just access
A study published in The Lancet Obstetrics, Gynaecology & Women’s Health last week has underscored the successes of the country’s maternal health programme. But it has also flagged a worrying slowdown in progress since 2015. Maternal mortality in 2023 was nearly a fifth of what it was in 1990. The steepest decline occurred in the first decade and a half of this century, driven largely by more effective government interventions, a rise in institutional deliveries, and greater public awareness. Yet, India still accounts for one in 10 maternal deaths globally, and the report highlights persistent systemic challenges that stand in the way of meeting the Sustainable Development Goal of reducing maternal mortality to 70 deaths per lakh births by 2030. Pregnant women continue to die due to haemorrhages, infections, and blood pressure-related disorders.
The Covid pandemic exposed the fragility of India’s maternal health programme. Frontline workers were diverted to meet the crisis, institutional deliveries were delayed and antenatal visits fell. The government has shown awareness of the challenge. It has strengthened programmes like LaQshya to improve the quality of care in labour rooms. The Pradhan Mantri Surakshit Matritva Abhiyan has emphasised the use of online portals and a greater role for anganwadi workers in tracking the health of pregnant women. However, implementation remains uneven. Health is a state subject, and the efficacy of the government’s programmes depends on local administrative capacity and political will. While Gujarat, Maharashtra, and the states in South India are on track to meet the SDG goal, government reports and the Lancet study highlight gaps in the healthcare systems of Uttar Pradesh, Madhya Pradesh, Bihar, Rajasthan, Chhattisgarh, Odisha, Jharkhand, and Assam.
Addressing these deficits requires a decisive shift in strategy. Strengthening primary and secondary healthcare systems is essential so that complications are detected early and managed promptly. Functional emergency transport systems, well-equipped labour rooms, availability of specialists, and access to blood banks can mean the difference between life and death. At the same time, policies focused solely on expanding healthcare infrastructure will fall short unless they account for the social determinants of health. It’s well-known that large sections of women eat last and their nutritional requirements are not met, leading to anaemia and poor health outcomes. The Lancet report’s message on a comprehensive strategy that combines improving healthcare with increasing the social agency of women should not be lost on policymakers.
- 1The editorial highlights challenges in India's federal structure, where 'Health' is a State List subject under the Seventh Schedule. While central schemes like LaQshya and Pradhan Mantri Surakshit Matritva Abhiyan aim to improve maternal care, their uneven implementation by states like Uttar Pradesh and Bihar, compared to southern states, demonstrates the critical role of local administrative capacity in achieving national health objectives.
- 2India's struggle with maternal mortality directly impacts its international commitments, particularly the UN's Sustainable Development Goal (SDG) 3, which targets reducing the maternal mortality ratio to less than 70 per 100,000 live births by 2030. Despite progress, India still accounts for a significant portion of global maternal deaths, making its domestic health policy crucial for achieving this international benchmark and upholding its global health leadership role.
- 3The persistence of preventable maternal deaths raises questions about the enforcement of the Right to Health, interpreted as part of the Right to Life under Article 21 of the Constitution. This issue also relates to Directive Principles, such as Article 47, which mandates the state to improve public health. The failure to provide adequate maternal healthcare could be framed as a violation of these fundamental constitutional guarantees.
- 4The editorial underscores the critical link between social determinants and maternal health outcomes, which has significant economic implications. Issues like widespread anaemia in women, stemming from poor nutrition and social norms, not only lead to higher mortality but also reduce workforce productivity and increase healthcare costs. Policies must address women's social agency and nutritional status for sustainable economic and social development.