India's maternal mortality rate declined significantly because of rise in institutional deliveries: J.P. Nadda

The announcement by J.P. Nadda regarding a significant decline in India's Maternal Mortality Rate (MMR), primarily attributed to the rise in institutional deliveries, marks a crucial milestone in India's public health journey. This positive trend reflects years of concerted efforts and policy interventions aimed at improving maternal healthcare access and quality across the nation.

**Background Context and What Happened:**

India has historically faced substantial challenges in maternal and child health, with high MMR being a persistent concern. Maternal Mortality Rate is defined as the number of maternal deaths per 100,000 live births due to pregnancy or childbirth-related complications. A high MMR indicates systemic weaknesses in healthcare infrastructure, access to skilled birth attendants, and emergency obstetric care. For decades, a significant portion of deliveries occurred at home, often without skilled medical supervision, leading to preventable complications and deaths. The recent announcement by J.P. Nadda, made during the foundation stone laying ceremony for a new medical college in Dhar district, underscores the success of various government initiatives in shifting this paradigm. The emphasis on a Public-Private Partnership (PPP) model for the medical college also highlights a broader strategy to leverage private sector efficiency and investment in bolstering healthcare infrastructure.

**Key Stakeholders Involved:**

Several key stakeholders have been instrumental in this achievement. The **Government of India**, particularly the **Ministry of Health & Family Welfare**, has been the primary architect of policies and funding mechanisms. **State Governments** play a critical role in the implementation of these policies, managing healthcare facilities, and mobilizing resources at the ground level. **Healthcare Workers**, including doctors, nurses, Auxiliary Nurse Midwives (ANMs), and especially **Accredited Social Health Activists (ASHAs)**, form the backbone of the system, providing frontline care, counseling, and facilitating access to institutional deliveries. The **private sector**, through PPP models like the one for the Dhar medical college, contributes to infrastructure development and service delivery. **International organizations** like WHO and UNICEF also provide technical support, guidelines, and financial assistance, while **Non-Governmental Organizations (NGOs)** often work at the community level to raise awareness and improve access.

**Why This Matters for India:**

This decline in MMR is profoundly significant for India. Socially, it indicates improved health outcomes for women, a reduction in gender disparity in health, and overall human development. Healthier mothers contribute to healthier families and communities. Economically, a healthier female workforce can participate more effectively in economic activities, reducing the burden of disease and healthcare costs in the long run. Politically, it showcases the effectiveness of public health policies and strengthens India's commitment to achieving international development goals. Furthermore, it enhances India's global standing as a nation making substantial progress in public health, particularly in achieving **Sustainable Development Goal (SDG) 3.1**, which aims to reduce the global maternal mortality ratio to less than 70 per 100,000 live births by 2030.

**Historical Context and Policy Interventions:**

India's journey towards reducing MMR has been propelled by a series of targeted interventions. A pivotal moment was the launch of the **National Rural Health Mission (NRHM)** in 2005 (later subsumed under the **National Health Mission – NHM** in 2013). NRHM focused on strengthening primary healthcare, increasing access to public health facilities, and deploying community health workers like ASHAs. A cornerstone scheme, **Janani Suraksha Yojana (JSY)**, launched in 2005, provided conditional cash transfers to pregnant women for giving birth in health facilities, significantly incentivizing institutional deliveries. This was complemented by the **Janani Shishu Suraksha Karyakram (JSSK)**, launched in 2011, which guaranteed free and cashless services, including free transport, diagnostics, blood, and diet, for pregnant women and sick neonates in public health institutions. More recently, the **Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA)**, launched in 2016, provides free antenatal check-ups to pregnant women on the 9th of every month. These schemes, combined with infrastructure development and increased awareness, have collectively led to the rise in institutional deliveries.

**Related Constitutional Articles, Acts, or Policies:**

Several constitutional provisions underpin the state's responsibility in public health. The **Directive Principles of State Policy (DPSP)** are particularly relevant: **Article 39(e)** calls for protecting the health and strength of workers, men and women; **Article 42** mandates the state to make provision for just and humane conditions of work and maternity relief; and **Article 47** places a duty on the State to raise the level of nutrition and the standard of living and to improve public health. While not a fundamental right explicitly, the **Right to Life (Article 21)** has been interpreted by the judiciary to include the right to health, thereby making health services a state obligation. The **73rd and 74th Constitutional Amendments** (1992) also empower Panchayati Raj Institutions and Urban Local Bodies to plan and implement schemes for public health, bringing governance closer to the people.

**Future Implications:**

While the decline in MMR is commendable, significant challenges remain. There are still regional disparities, with some states lagging behind. The quality of care in institutional settings, especially in remote areas, needs continuous improvement. Ensuring equitable access, particularly for marginalized communities, remains paramount. Future efforts must focus on strengthening the entire continuum of care, from antenatal to postnatal services, addressing nutritional deficiencies, and improving adolescent health. The success of PPP models in healthcare infrastructure, as seen with the Dhar medical college, will be crucial for sustained progress. India's ability to achieve the SDG 3.1 target by 2030 hinges on continued political will, sustained investment, and innovative approaches to healthcare delivery.