[Answered] Improving MMR is a multi-sectoral endeavour – encompassing better access to inputs ranging from education and nutrition to contraceptives and institutional delivery. Discuss

MMR is the annual number of maternal deaths per 100,000 live births. As per the WHO, maternal death is the death of a woman while pregnant or within 42 days of termination of pregnancy, from any cause related to or aggravated by the pregnancy or its management. It is a key performance indicator for efforts to improve the health and safety of mothers before, during, and after childbirth.

Factors affecting MMR:

1. literacy and lack of education: An educated and empowered woman is less likely to have multiple unwanted pregnancies. In rural India, many families assume that more children mean more hands to work.
2. Education of girls helps in avoiding early marriage and ensuring gender equality. E.g., Beti Bachao, Beti Padhao.
3. It ensures focus on family planning awareness, increasing marriage age and a wide range of contraceptive options.
4. Patriarchal Society: patriarchal customs make women’s health, nutrition and education unimportant
5. Proper nutrition for pregnant women: The NFHS-4 survey says that only 30.3% of Indian women consumed iron and folic acid tablets for the recommended course of 100 days or more, resulting iron-deficiency and anaemia (a major cause of maternal deaths, pre-term births and infant mortality).
6. Behavioral Change:  eating a healthy diet; limiting or avoiding alcohol consumption; arranging for a skilled birth attendant at labor etc.
7. Health facilities: better infrastructure & facilities at PHCs ensures institutional deliveries and reduces rate of home delivery and delivery by unskilled birth attendant.  It can be achieved through strengthening PHCs through the NRHM and enhancing role of ASHAs & ANMs.

The Centre too needs to assess different schemes like Pradhan Mantri Surakshit Matritva Abhiyan, Janani Surkasha Yojna etc. objectively.

India has well-structured public health system still it lacks high service standards and practices. India’s MMR has seen a decline from 130 (2016) to 122 (2017) but Covid scenario may challenge the future outcomes. Maternal deaths are not only a health issue but also a matter of social injustice so India needs to give a special focus to states with higher maternal mortality ratio.