[Answered] “According to a recent report, maternal death rate in India is declining.” Discuss what led to such a decline? Also suggest some measures needed to further reduce the Maternal Mortality rate towards Sustainable development goal.

India’s Maternal Mortality Ratio (MMR) has seen a decline from 167 per 1 lakh live births in 2013 to 130 2016 and to 122 per 1 lakh live births in 2017, according to the latest Sample Registration System (SRS) 2015-2017 bulletin for MMR. This is good news for India as nearly 2,000 maternal deaths have been averted per year. The decline is important for India as 11 States have achieved the National Health Policy target of MMR 100 per lakh live births well ahead of 2020. This has been made possible through institutional deliveries and focused approach towards aspirational districts with benefits reaching the most marginalised and vulnerable mothers.

Reasons for decline in maternal mortality:

1. Focus on quality and coverage of health services through public health initiatives have contributed majorly to the decline. Some of these initiatives are:
   • LaQshya,
   • Poshan Abhiyan,
   • Janani Suraksha Yojana,
   • Pradhan Mantri Surakshit Matritva Abhiyan,
   • Pradhan Mantri Matru Vandana Yojana.
2. The implementation of the Aspirational District Programme and inter-sectoral action has helped to reach the most marginalized and vulnerable population.
3. Recently launched Surakshit Matritva Aashwasan Initiative (SUMAN) especially focusses on zero preventable maternal and newborn deaths.
4. The continuous progress in reducing the MMR will help the country to achieve the SDG 3 target of MMR below 70 by 2030.
5. With Janani Suraksh Yojna (JSY) under National Rural Health Mission, institutional births nearly doubled. It increased from around 38% to 78% between National Family Health Survey III (2005-06) and NFHS IV.
6. The web-based Mother and Tracking System tracked every pregnancy in the country since 2010. It sends messages to health workers and expectant mothers about ante-natal checkups, vaccinations etc.
7. NRHM also allowed auxiliary nurse midwives (ANMs). They administer antibiotics, intravenous fluids and drugs during emergencies under supervision.

Steps to further reduce the maternal mortality:

1. Every woman should  know about the  crisis (problem) that may come to her life from pre-reproductive period to post reproductive period.
2. Care  and prevention should be instituted at early stage:
   • To protect against child hood and adolescent health issue.
   • To prevent complications of pregnancy through early detection and treatment.
   • To provide clean and safe delivery.
   • To promote the implementation of family planning programme.
   • Predicting the early diagnosis of post reproductive disease.
   • Encouragement fo Institutional delivery.
3. To ensure success it is important to involve obstetrician, midwife and paramedical staff– to find out any complications of pregnancy and prompt treatment.
4. To Involve government, NGOs, IMA- for Awareness Programme at schools, college, religious places regarding Reproductive Health Care and bad effects of drugs, smoking, alcohol etc.
5. To involve health care staff to perform community studies, household surveys and other measures and reproductive age mortality surveys.

Strategies to improve coverage of effective interventions during pre-reproductive  period by involving  doctor and govt and others manpower could reduce the incidence of health related complications or mortality and morbidity in India. Early intensive efforts to improve family planning, to control of fertility choices, to provide safe abortion and integrated maternal health services are important interventions to reduce pregnancy related mortality.