India must double antenatal visits by health workers to pregnant women to reduce the risk of stillbirth and pregnancy complications, according to a new World Health Organisation (WHO) guideline released last November. Is India ready to implement this and other new guidelines to protect its mothers? It is not, an analysis of government data and research studies shows.
The new guidelines are important, given that, despite a 62 per cent reduction in child mortality between 1990 and 2015, more children (1.3 million) below five years died in India in 2015 than anywhere in the world; the country had more stillborn babies than any other, 26 per cent of neonatal deaths, and close to a fifth of 303,000 maternal deaths in 2015.
The government, on February 15, joined a new network to improve the quality of care for maternal, newborn and child health, announced by the WHO and committed to halving preventable deaths of pregnant women and newborns in health facilities over the next five years.
The quality of antenatal care is vital to reduce the risk of stillbirths and pregnancy complications, and the absence of it explains why more women enrolling for hospital deliveries in India isn’t translating into fewer maternal deaths.
India’s maternal mortality rate (MMR) was 178 deaths per 100,000 live births in 2011-12, worse than Sri Lanka (30), Bhutan (148) and Cambodia (161), and worst among the BRICS countries: Russia (25), China (27), Brazil (44), and South Africa (138).
In November 2016, the government launched the Pradhan Mantri Surakshit Matritva Abhiyan, or the Prime Minister Safe Pregnancy Scheme, which aims to provide free and comprehensive care on the ninth day of every month during pregnancy. Pregnant women are provided special, free ante-natal checks in their second or third trimester at government health care facilities, including ultrasounds, blood and urine tests.
Yet, getting these facilities to women is a challenge, especially in poorer states. No more than 3.3 per cent of pregnant women in Bihar reported receiving full antenatal care, lowest among states. Full ANC refers to at least four antenatal visits, at least one tetanus toxoid (TT) injection and iron folic acid tablets or syrup taken for 100 or more days.
IndiaSpend looked at some of the WHO recommendations and evaluated India’s ability to implement them: