[Answered] Examine the significance of the One Health approach in the context of India’s public health system and how it can be incorporated effectively to address the risk of Pandemics.

Introduction

The professional midwife has transitioned from a supporting role to a central pillar of India’s maternal health reform. This shift addresses the birthing paradox: a scenario where the urban elite faces over-medicalization (with C-section rates exceeding 27% to 50% in some states), while rural and tribal populations struggle with under-resourcing and a lack of skilled attendance.

Historical and Policy Context of Midwifery Reform

1. Shift from Doctor-Centric Model: India’s maternal healthcare has historically been doctor-centric, leading to over-medicalisation. The 2018 Guidelines on Midwifery Services marked a shift toward midwifery-led care. The Midwifery Services Initiative (2018) aims to create NPMs trained to global standards.
2. Institutional Policy Support: The reform aligns with recommendations of the NITI Aayog and global agencies such as United Nations Population Fund promoting Midwife-Led Care Units (MLCUs).

The Natural Pillar and Countering the Scalpel Culture

The professionalization of midwifery, specifically through the Nurse Practitioner in Midwifery (NPM) cadre, is the primary tool to restore physiological birth as the norm.

1. Clinical Gatekeeping: They support continuous labour care, lowering C-section rates (currently 21.5% nationally, higher in private sectors). This aligns with the WHO target of 10–15% for C-sections, which India has significantly overshot in recent years.
2. Respectful Maternity Care (RMC): Unlike the episodic and often impersonal nature of high-volume obstetric wards, midwifery enhances maternal dignity, emotional support, and breastfeeding initiation. This woman-centric model counters the scalpel culture prevalent in high-volume obstetric wards.
3. Restoring Agency: Midwifery shifts the narrative from delivering a patient to supporting a mother, providing her with the autonomy to choose birthing positions and avoid unnecessary episiotomies.

Ensuring Equitable Access

Midwifery acts as a social leveler by democratizing access to high-quality care across India’s diverse geography.

1. The Last Mile Reach: In dark zones (rural, tribal, and low-income areas) where obstetricians are scarce, the NPM cadre provides Skilled Birth Attendance (SBA). They are trained to handle common emergencies like Post-Partum Hemorrhage (PPH) while knowing exactly when to refer a case to a specialist.
2. Integration with SUMAN: They manage 90% of low-risk pregnancies, freeing specialists for high-risk cases and reducing tertiary hospital burden. This democratises access, aligning with SDG-3 (maternal health) and SUMAN (Surakshat Matritva Ashwasan) scheme goals.
3. Economic Viability: Offers a high Return on Investment (ROI). Scaling midwifery can avert up to 83% of maternal and neonatal deaths, saving the healthcare system billions in long-term complication costs and neonatal intensive care.

Regulatory Backbone the NNMC Act, 2023

The success is anchored by the National Nursing and Midwifery Commission (NNMC) Act 2023, which replaced the archaic Indian Nursing Council.

1. Standardization: It ensures that every NPM undergoes a rigorous, 18-month competency-based program aligned with International Confederation of Midwives (ICM) standards.
2. Professional Identity: By creating a separate register for midwives, the Act has helped decouple midwifery from general nursing, granting these professionals the legal and administrative autonomy required to run MLCUs.

Pilot projects in Maharashtra and Telangana demonstrate improved outcomes. UNFPA data indicates professional midwifery can avert up to 83% of maternal and neonatal deaths. Yet, challenges persist: hierarchical resistance from obstetricians, scaling training, and rural retention.

Way Forward

1. Scale NPM training with ICM standards and establish more Midwifery Training Institutes.
2. Integrate midwifery fully into public health systems with dedicated MLCUs in every district hospital.
3. Strengthen regulatory autonomy under NNMC and address inter-professional hierarchy through collaborative protocols.
4. Leverage Ayushman Bharat and digital platforms for community-level midwifery outreach.
5. Conduct periodic outcome audits and incentivise rural postings.

Conclusion

National development begins with healthy mothers and children. Professional midwifery can humanise childbirth while ensuring equitable maternal healthcare across India.