| PYQ Relevance:
[UPSC 2020] In order to enhance the prospects of social development, sound and adequate health care policies are needed particularly in the fields of geriatric and maternal health care. Discuss. Linkage: The article on maternal mortality highlights various deficiencies in healthcare delivery and infrastructure (e.g., lack of specialists, blood banks, operation theatres, and trained personnel) that contribute to maternal deaths, indicating the critical need for sound policies. This question is most directly relevant as it specifically names “maternal health care” as a crucial area for sound and adequate healthcare policies to enhance social development. |
Mentor’s Comment: Despite progress, India still loses 93 mothers for every 1,00,000 births due to problems that could be prevented during childbirth. Although the number has come down from 103 (2017–19) to 93 (2019–21), there are still huge differences between states. For example, Kerala has brought the number down to 20, but in states like Madhya Pradesh (175) and Assam (167), the numbers are very high.
Today’s editorial analyses the issues related to India’s Maternal Mortality Ratio. This topic is important for GS Paper I (Women-related Issues) and GS Paper II (Social Justice and Health) in the UPSC mains exam.
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Let’s learn!
Why in the News?
India’s Maternal Mortality Ratio is going down, but some states still need to work on solving basic problems and improving their healthcare systems.
What do MMR trends reveal about regional disparities in India?
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Why is India’s Maternal Mortality Ratio still high despite better healthcare access?
- Regional Disparities in Healthcare Infrastructure: MMR is significantly higher in Empowered Action Group (EAG) states like Assam (167) and Madhya Pradesh (175), compared to Kerala (20). Eg: States like Bihar and UP face shortages in skilled staff and poor facility access, despite national programmes.
- Inadequate Functioning of FRUs (First Referral Units): Many FRUs lack specialists, blood banks, and operating theatres. Over 66% of specialist posts remain vacant. Eg: In 2,856 designated FRUs, many lack anaesthetists or functional surgical units, risking lives in emergencies.
- Three Delays in Maternal Care: Delays in seeking care, reaching hospitals, and receiving treatment result in avoidable deaths.
How are the three key delays contributing to maternal deaths?
- Delay in Decision-Making at Home: Families often fail to recognise danger signs during pregnancy or childbirth and delay seeking medical help. Eg: A pregnant woman showing signs of excessive bleeding may not be taken to a hospital promptly due to family neglect, financial constraints, or the belief that delivery is natural.
- Delay in Reaching a Healthcare Facility: Lack of timely transportation from remote or rural areas hinders access to skilled birth attendants or emergency care. Eg: A woman in a tribal village may take hours to reach a hospital due to poor roads or lack of ambulances, resulting in delivery en route.
- Delay in Receiving Adequate Care at the Facility: Even after reaching a hospital, care may be delayed due to absence of doctors, operation theatres, or blood supply. Eg: A woman experiencing uterine rupture may not get immediate surgery because the anaesthetist is unavailable or the OT isn’t ready.
| What are First Referral Units (FRUs)?
First Referral Units (FRUs) are designated health facilities equipped to provide comprehensive emergency obstetric and newborn care (CEmONC). These units serve as the first-level referral centres for maternal and child health emergencies, especially in rural and underserved areas. |
How can FRUs be made more effective in reducing maternal deaths?
- Ensure Availability of Specialist Medical Staff: FRUs must be equipped with qualified obstetricians, anaesthetists, and paediatricians to handle maternal emergencies. Eg: In many districts, over 60% vacancies in specialist posts mean pregnant women cannot access timely surgeries like C-sections, leading to avoidable deaths.
- Establish Fully Functional Emergency Infrastructure: FRUs must have operational operation theatres, blood banks, and 24×7 emergency care to address complications like postpartum haemorrhage. Eg: A woman suffering massive bleeding after childbirth can be saved if a blood transfusion and surgery are available within two hours.
- Strengthen Referral and Transport Systems: Ensure robust ambulance networks and clear referral protocols to reduce delays in reaching FRUs from rural or remote areas. Eg: The 108 ambulance service, when linked efficiently with FRUs, can reduce deaths caused by obstructed labour during long-distance travel.
What lessons does the Kerala model offer for reducing MMR nationwide?
- Confidential Review of Maternal Deaths: Kerala uses a systematic review process to study every maternal death to identify medical and systemic gaps. Eg: Led by Dr. V.P. Paily, Kerala’s Confidential Review Committee analyses causes like hemorrhage, embolism, or surgical delay, enabling precise interventions.
- High-Quality Emergency Obstetric Care: Kerala emphasizes emergency preparedness, with trained obstetricians, well-equipped operation theatres, and availability of blood banks.
- Holistic Maternal Health Approach: Kerala addresses not only physical but also mental health aspects of pregnancy, like antenatal depression and postpartum psychosis.
Way forward:
- Strengthen FRUs and Emergency Care Infrastructure: Ensure that all First Referral Units (FRUs) are fully staffed with specialists, equipped with blood banks, operation theatres, and essential medicines to manage obstetric emergencies swiftly.
- Scale Up Kerala’s Model Nationwide: Implement confidential maternal death reviews, train healthcare personnel in advanced obstetric practices, and integrate mental health support into maternal care programs across all States.
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