National Health mission logo

National Health Mission

Ministry of Health and Family Welfare, Government of India

Maternal Health

Introduction

Government of India adopted the Reproductive, Maternal, New-born, Child and Adolescent Health (RMNCH+A) framework in 2013, It essentially aims to address the major causes of mortality and morbidity among women and children. This framework also helps to understand the delays in accessing and utilizing health care services

Based on the framework, comprehensive care is provided to women and children through five pillars or thematic areas of reproductive, maternal, neonatal, child, and adolescent health. The programmes and strategies developed by various divisions are guided by central tenets of equity, universal care, entitlement, and accountability to provide ‘continuum of care’ ensuring equal focus on various life stages.

Following this strategy, the Maternal Health Division strives to provide quality services to pregnant women and their newborns through various interventions and programmes, building capacity of health personnel and routine health systems strengthening activities

 
Significant Achievements
 

MMR: India’s MMR at 130 (SRS 2014-16) has improved significantly from 167(SRS 2011-13);

GOAL 
INDICATOR
ALL INDIA STATUS
(Source of data)

NHM Goal (2017)
Maternal Mortality Ratio (MMR) 254 (SRS 2004-06) 212 (SRS 2007-09) 178 (SRS 2010-12) 167 (SRS 2011-13) 130 (SRS 2014-16) 100

According to the latest figure released by Registrar General of India - Sample Registration System (RGI-SRS)Maternal Mortality Ratio (MMR) for the period 2014-16 is 130maternal deaths per 100,000 live births.  With this, India has achieved the Millennium Development Goal (MDG) 5 i.e. India have achieved a reduction in MMR by three quarters between 1990 to 2015. The target was to achieve 139 maternal deaths per 100,000 live births.  The table displays the trend in MMR over the years.  The average decline in MMR between 2007-09 and 2011-13 had been 11.3 points per year, i.e. compound rate of annual decline was5.8% whereas average compound rate of decline is 8% between 2011-13 and 2014-16.

 
 Maternal Health Indicators (NFHS3, NFHS4)
 

Sr.NoIndicatorNFHS 3 NFHS 4 
1 Mothers who had antenatal check-up in the first trimester (%) 43.9 58.6
2 Mothers who had at least 4 antenatal care visits (%) 37.0 51.2
3 Mothers who had full Antenatal care(%) 11.6 21
4 Mothers who received postnatal care from a doctor/nurse/LHV/ANM/midwife/otherhealth personnel within 2 days of delivery (%) 34.6 62.4
5 Institutional births (%) 38.7 78.9
 
Areas of work
 

 
Quality Service Provision
 

Quality Ante Natal care: Quality and comprehensive ANC incorporates minimum of atleast four ANCs including early registration and first ANC with first trimester. The ANC package includes physical and abdominal examinations, Hb estimation, screening for Gestational Diabetes Mellitus, Thyroid disorders, HIV/Syphilis and urine investigation, T.T/Td, Immunization, distribution of IFA tablets & Calcium (6 months during Antenatal period & 6 months during postnatal period) and counselling for nutrition etc.  Early detection of high-risk pregnancies, follow up and management are important component of Antenatal care.

Essential Obstetric Care during Delivery : Government of India provide free institutional delivery at its network of health facilities including Sub-centre, primary health centres, community health centres, sub-district hospital, districts hospital etc, to reduce maternal &neonatal morbidity and mortality. In order to provide essential obstetric care services, Government of India is operationalizing the 24 X 7 PHCs services andproviding training to SNs/LHVs/ANMs under Skilled Attendance at Birth.

Post natal care for Mother and New born:-Ensuring post-natal care within first 24 hours of delivery and subsequent home visits on 3rd, 7th, 14th and 42nd day is the important components for identification and management of emergencies occurring during post-natal period.  The ANMs, LHVs, and staff nurses are being oriented and trained for tackling emergencies identified during these visits

Provision of Emergency Obstetric and Neonatal Care at FRUs:Provision of Emergency Obstetric and Neonatal Care at FRUs is been done by operationalizing all FRUs in the country. While operationalizing, the thrust is on the critical components such as manpower, blood storage units and referral linkages etc. Availability of trained manpower (Skill Based Training for health care providers) is linked with operationalization of FRUs. The initiatives being undertaken in this regard are:

Augmentation of skilled human resources for Maternal Health:

  • To overcome the shortage of skilled manpower particularly Anaesthetists and Gynaecologists, the following key skill based training programs are being implemented:
  • 18 Weeks Training Programme of MBBS Doctors in Life Saving Anaesthesia Skills (LSAS) for Emergency Obstetric Care.
  • 16 weeks Training programme of MBBS Doctors in Obstetric Management Skills including C-Section, in collaboration with Federation of Obstetric and Gynaecological Society of India.(EmOC).
  • 10 days Training Programme in Basic Emergency Obstetric Care for Medical Officers (BEmOC)
  •  3 weeks Training Programme for ANMs/SNs/LHVs as Skilled Birth Attendants (SBA) Referral 
  • Skills Labs (Daksh training)– For improving the skills of healthcare providers and to enhance their capacity for providing quality RMNCH +A services, Government of India established National and State Skills Lab.

 

  • Referral Services at both Community and Institutional level

Government of India has a thrust to establish a network for Basic patient care transportation through ambulances with an aim to reach to the  beneficiary in rural area for quick service delivery.

Presently, the states have given the flexibility to establish assured referral systems to transport pregnant mothers and sick Infants, which includes  different models including public, private partnership models.

 
Technical Guidelines and Service Delivery Guidelines:
 

MH Division develops and disseminates standard technical guidelines & service delivery posters for standardizing the quality of service delivery during Antenatal care, intra-natal care, postnatal care etc. from primary to tertiary level of institutions.
 
 
Training
 
Capacity building programme for various categories of health, works through various training programme is as follows:
 
Skilled Attendance at Birth: Government of India has a commitment to provide skilled attendance at every birth both at community and Institution level. To manage and handle some common obstetric emergencies at the time of birth, Staff Nurses (SNs) and ANMs have been permitted to give certain injections and also perform certain interventions under specific emergency situations to save the life of the mother.
 
DAKSHATA: Maternal Mortality and morbidity and perinatal mortality are major public health problems Majority have an intra partum origin and are a consequence of interventions carried out around the time of delivery. In light of this, the Government of India, in 2015, developed ‘Dakshata’ for rapidly improving the quality of care during intrapartum and immediate postpartum period across delivery points in the country.Currently, Dakshata is being implemented in more than 1500 facilities in seven states of the country.

The package provides the complete set of resources to assist the States in planning and implementing the Dakshata programmes. For the realization of this, operational guidelines, learning resource package, assessment tools, planning and budgeting tools are included in the package.

 
 
Strategies and Interventions
 

 
Flagship Programmes
 

JananiSurakshaYojana (JSY): JananiSurakshaYojana (JSY), a demand promotion and conditional cash transfer scheme was launched in April 2005 with the objective of reducing Maternal and Infant Mortality. It is being implemented with the objective of reducing maternal and neonatal mortality by promoting institutional delivery among poor pregnant women.

Janani Shishu Suraksha Karyakram(JSSK): Government of India has launched JananiShishuSurakshaKaryakaram (JSSK) on 1st June, 2011, which entitles all pregnant women delivering in public health institutions to absolutely free and no expense delivery including Caesarean section. The initiative stipulates free drugs, diagnostics, blood and diet, besides free transport from home to institution, between facilities in case of a referral and drop back home. Similar entitlements have been put in place for all sick new-born accessing public health institutions for treatment till 30 days after birth. In 2013, this has been expanded to sick infants and antenatal and postnatal complications.

Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA): Carrying forward the vision of our Hon’ble Prime Minister, the Pradhan Mantri Surakshit Matritva Abhiyan was launched in 2016 to ensure quality antenatal care and high risk pregnancy detection in pregnant women on 9th of every month.

LaQshya: In order to further accelerate decline in MMR in the coming years, MoFHWhas recently launched 'LaQshya - Labour room Quality improvement Initiative. LaQshya program is a focused and targeted approach to strengthen key processes related to the labour rooms and maternity operation theatres which aims at improving quality of care around birth and ensuring Respectful Maternity Care.

 
Other Programmes
 

Comprehensive Abortion Care Services: Comprehensive and safe abortion services are provided at public health facilities including 24*7 PHCs/ FRUs (DHs/ SDHs /CHCs) including the Delivery Points.Supply of Nischay Pregnancy detection kits to sub centres for early detection of pregnancy is undertaken .

Capacity Building of Medical officers is being carried out routinely in safe MTP Techniques. ANMs, ASHAs and other field functionaries are trained to provide confidential counselling for MTP and promote post-abortion care including adoption of contraception.Routine orientation and training of ASHAs to equip them with skills to create awareness on abortion issues in the community and facilitation of women's access to services.

District Level Committees (DLCs) have been framed and empowered for accreditation the facilities for conducting safe abortion services under MTP Act including approval of private and NGO sector facilities for conducting MTPs.

Regular monitoring and evaluation of the services are being conducted.

Provision of RTI/STI services: Under NHM, provision of STI/RTI care services is animportant strategy to prevent HIV transmission and to promote sexual and reproductive health services in all the FRUs, CHCs and at 24 X 7 PHCs.

Village Health and Nutrition Day: Village Health & Nutrition Day (VHNDs) are being organized at Anganwadi center atleast once every month. It is a platform to provide ante natal/ post partum care for pregnant women, promote institutional delivery, immunization, Family Planning & nutritional counseling.

Newer Interventions: 

Midwifery - Government of India has initiated midwifery services throughout the country in 2018, with an objective to provide access to quality maternal and neonatal health services, to promote natural birthing, to ensure respectful care and to reduce over medicalization. The Midwifery services initiatives aim to create a cadre for Nurse Practitioners in Midwifery who are skilled in accordance to ICM competencies, knowledge and capable of providing compassionate women – centric pregnancy care.

 
Infrastructure
 

Delivery Points: All the States & Union Territories have identified DPs with certain minimum benchmark of performance in order to prioritize and direct resources in a focused manner to these facilities. All delivery points are strengthened withtrained and skilled human resources, infrastructure, equipment, drugs and supplies, referral transport etc. for providing quality & comprehensive RMNCH (Reproductive, Maternal, and Neonatal& Child Health) services.

Obstetric HDU/ICU: Operationalization of Obstetric ICU/HDU in a high case load tertiary care facilities is being conducted across countryto handle complicated pregnancies.

MCH Wings - State of the art Maternal and Child Health Wings (MCH wings) have been sanctioned at District Hospitals/District Women’s Hospitals and other high case load facilities at sub-district level, as integrated facilities for providing quality obstetric and neonatal care.

 
 
Information systems for Maternal Health
 

Maternal Death Surveillance and Response(MDSR): The process of maternal death review (MDSR) has been implemented & institutionalized by all the States since 2017. Guidelines and tools for conducting community based MDSR and Facility based MDSR have been provided to the States. The States are reporting deaths along with its analysis for causes of death.Maternal near miss review is also being conducted at premier institutions.

RCH portal / MCTS Portal: Name Based Tracking of Pregnant Women and Children has been initiated by Government of India as a policy decision to track every pregnant woman , infant & child upto 5years of age by name for provision of timely ANC, Institutional Delivery, and PNC along-with immunization & other related services.

MCP Card: Ministry of Health & Family Welfare and Ministry of Women and Child Development (MOWCD) has been launched as a tool for documenting and monitoring services for antenatal, intranatal and postnatal care to pregnant women, immunization and growth monitoring of infants.