Maternal Health - Rau's IAS

Context: In May, a United Nations report showed that India was among the 10 countries that together accounted for 60% of global maternal deaths, stillbirths and new born deaths. India accounted for over 17% of such deaths in 2020.

Reasons for Poor Maternal Health:

Malnutrition: Undernourished girls have a greater likelihood of becoming undernourished mothers who in turn have a greater chance of giving birth to low-birth-weight babies, perpetuating an intergenerational cycle of undernourishment.
Low literacy: According to 2011 census, around 35% of female is illiterate in India. Lack of adequate literacy deprives women awareness about nutrient-rich diet, good feeding practices and personal hygiene which ultimately impacts their maternal health.
Child Marriages: According to NFHS-5, about 25% of women aged 18-29 got married before reaching the minimum legal age of marriage. Increasing incidences of teenage pregnancies due to child marriages and inadequate access to contraceptives impacts their maternal health and one of the leading causes for Maternal mortality in India.
Climate change:

Studies shows that soaring temperatures due to heatwaves severely impact the maternal health of pregnant women. Women suffer more from yeast infections and UTIs (Urinary Tract Infections) in hot summers. Dietary habits that keep changing according to temperatures also impact Menstrual cycle.
Rapid climate changes globally have given rise to climate-driven food insecurities which disproportionately impacts the nutritional health of women in a patriarchal society.

A special bulletin was released by Registrar general of India on Maternal mortality ratio. Key findings of the report are:

Maternal mortality ratio (MMR) of India has declined by 10 points. It has declined from 113 in 2016-18 to 103 in 2017-19, an 8.8% decline.
The country has been witnessing a progressive reduction in the MMR from 130 in 2014-16, 122 in 2015-17 and 113 in 2016-18 to 103 in 2017-19.
With this persistent decline, India is on the verge of achieving the National Health Policy (NHP) target of 100 per lakh live births by 2020 and certainly on the track to achieve the Sustainable Development Goal (SDG) target of 70 per lakh live births by 2030.

This improvement has been possible due to continued efforts of government of India like

Janani suraksha yojana:

Implemented by Ministry of Health and family welfare
It is a safe motherhood intervention under the National Health Mission. It is being implemented with the objective of reducing maternal and neonatal mortality by promoting institutional delivery among poor pregnant women.
Cash incentives are given to beneficiaries for undergoing institutional deliveries.
The scheme focuses on poor pregnant woman with a special dispensation for states that have low institutional delivery rates, namely, the states of Uttar Pradesh, Uttarakhand, Bihar, Jharkhand, Madhya Pradesh, Chhattisgarh, Assam, Rajasthan, Orissa, and Jammu and Kashmir. While these states have been named Low Performing States (LPS), the remaining states have been named High Performing states (HPS).

Janani shishu suraksha karyakram:

A scheme under MoH&FW
It is an initiative to provide completely free and cashless services to pregnant women including normal deliveries and caesarean operations.
Free entitlements to pregnant women under this scheme are

Free and cashless delivery
Free c-section
Free drugs and consumables
Free diagnostics
Free diet during stay in the health institutions
Free transport from home to health institutions

Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA):

launched by the Ministry of Health & Family Welfare (MoHFW)
Under PMSMA, all pregnant women in the country are provided fixed day, free of cost assured and quality Antenatal Care.
As part of the campaign, a minimum package of antenatal care services (including investigations and drugs) is being provided to the beneficiaries on the 9th day of every month.
The Abhiyan also involves Private sector’s health care providers as volunteers to provide specialist care in Government facilities.

LaQshya:

Labour Room & Quality Improvement Initiative (LaQshya) program will benefit every pregnant woman and newborn delivering in public health institutions. Program will improve quality of care for pregnant women in labour room, maternity Operation Theatre and Obstetrics Intensive Care Units (ICUs) & High Dependency Units (HDUs).

National food security act:

Special provisions have been made for pregnant women and lactating mothers by entitling them to receive nutritious meal through a wide network of ICDS centres.
Pregnant women and lactating mothers are further entitled to receive cash maternity benefit of not less than Rs. 6000 to partly complement the wage loss during the period of pregnancy and also to supplement nutrition.

Integrated Child Development Services (ICDS) Scheme:

Under Ministry of women and child development
The scheme provides Supplementary nutrition, immunizations and regular health check-ups of pregnant and lactating mothers.

PM Matru Vandana yojana:

Pradhan Mantri Matru Vandana Yojana (PMMVY) is a Maternity Benefit Programme that is implemented in all the districts of the country in accordance with the provision of the National Food Security Act, 2013.
All eligible Pregnant & Lactating Mothers would receive a Cash incentive of Rs 5000 in three instalments for first childbirth. Conditions attached to these instalments are

Early registration of pregnancy at the Anganwadi Centre (AWC)
Receiving at least one ante-natal check-up (ANC)
Registration of childbirth and vaccination of first cycle vaccines (BCG, OPV, DPT and Hepatitis-B).

Maternity Benefit Amendment Act:

Duration of the maternity leave increased to 26 weeks from 12 weeks.
Maternity leaves were extended to adopting and commissioning mothers. A commissioning mother is defined as a biological mother who uses her egg to create an embryo implanted in another woman.
The act provided that the employer may permit a nursing woman (after 26 weeks of maternity leave) to work from home if the nature of work permits.
All organizations with 50 or more employees are required to provide a Creche facility and during working hours, the concerned female employee must be allowed four visits to the crèche.