N4S
Mothers are surviving births, yet hidden illnesses still stalk India’s women. UPSC usually turns such “population and health” themes into big GS 1 questions that ask “why” and “how,” much like the 2014 sex‑ratio poser that mixed prosperity with social bias; examiners expect you to go beyond numbers and trace deep causes and policy gaps. Many aspirants slip because they quote the falling MMR but ignore the silent crisis of anaemia or the uneven state data under “The Maternal Health Paradox: Falling MMR vs Rising Hidden Burdens” (Kerala MMR 19 vs Assam 195, anaemia 57%). They also forget to link welfare design flaws shown in “Disconnect Between Policy Success and Ground Realities” (institutional births 88.6% yet only 60% full ANC) and thus miss the continuity‑of‑care angle UPSC loves. This article rescues them by stitching both sides together: it pairs success metrics with unseen gaps, offers ready references like PMSMA coverage figures, and serves real solutions in “Way Forward” that move from delivery counts to healthy‑mother outcomes. Its standout gem is the “Back2Basics: Assessment of Maternal Health Governance” table, which condenses every key scheme—JSY cash support, LaQshya audits, Anaemia Mukt Bharat—into exam‑ready one‑liners you can drop as evidence. Read it once, and you have concept, critique, case studies, and policy toolkit all in one place.
PYQ ANCHORING
GS 1: Why do some of the most prosperous regions of India have an adverse sex ratio for women? Give your arguments. [2014]
MICROTHEME: Population and associated issues
India’s maternal health story today is one of striking contrast. On one hand, the country has made significant progress—its Maternal Mortality Ratio (MMR) dropped from 97 (2018–20) to 93 (2019–21), marking a steady improvement and moving closer to global targets. Yet, beneath this success lies a persistent crisis: over 57% of women of reproductive age suffer from undiagnosed anaemia (NFHS-5), a silent epidemic threatening both mothers and newborns.
This paradox—a falling MMR but a rising burden of hidden illness—raises urgent questions: Is India’s maternal health progress truly inclusive and sustainable? Can policy success coexist with widespread nutritional and diagnostic gaps?
The Maternal Health Paradox: Falling MMR vs Rising Hidden Burdens
| Reason | Explanation | Substantiation |
| Success of Institutional Deliveries | Increased access to hospitals and trained personnel has reduced deaths during childbirth. | Institutional deliveries rose to 88.6% (NFHS-5), contributing to MMR decline. |
| Persisting Undernutrition & Anaemia | Nutritional deficiencies are chronic and underdiagnosed, especially in rural and poor women. | 57% of women suffer from undiagnosed anaemia (NFHS-5); over 30% are underweight during pregnancy. |
| Health System Focused on Delivery, Not Continuum of Care | Focus remains on childbirth; less attention is paid to pre- and postnatal nutrition, diagnostics, and mental health. | Many women don’t receive full 4 antenatal checkups or follow-ups after delivery. |
| Uneven State Performance | National MMR averages hide wide interstate disparities. States like Kerala and Tamil Nadu show high performance, while others lag. | MMR: Kerala (19), Assam (195) – Sample Registration System, 2021. |
| Fragmented Data and Underdetection | Many cases of maternal morbidity (e.g., anaemia, hypertension, infections) remain unreported or poorly diagnosed. | Lack of routine haemoglobin testing in rural PHCs; poor data on postpartum complications. |
| Program Implementation Gaps | Schemes like PMSMA, Janani Suraksha Yojana often face manpower, funding, and awareness issues at the last mile. | Less than 30% of pregnant women covered under PMSMA (as per MoHFW 2022) in some districts. |
This paradox shows that while India has moved the needle on survival, it is still struggling to ensure health, nutrition, and dignity for all mothers.
Here’s the content structured neatly into a table format with broader themes, causes, and examples — perfect for UPSC-style answers:
Disconnect Between Policy Success and Ground Realities in India’s Welfare Schemes
| Broad Issue | Specific Causes | Example / Evidence |
|---|---|---|
| 1. Design–Delivery Gap | a. Output-focused approach over outcome-based evaluation. | Institutional births at 88.6% (NFHS-5), yet 57% of women remain anaemic. |
| b. One-time delivery models with poor continuity of care. | Only ~60% of pregnant women receive full ANC (NFHS-5). | |
| c. Uniform scheme design, poor contextualisation for diverse regions. | MGNREGA assets fail in flood-prone or tribal areas due to inappropriate planning. | |
| 2. Targeting and Access Issues | a. Outdated or flawed databases cause exclusion and inclusion errors. | SECC 2011 errors impact PDS and PM-KISAN targeting; genuine poor left out. |
| b. Digital divide restricts access to benefits. | Aadhaar-linked DBT failures in Jharkhand and Rajasthan disrupt MNREGA and pensions. | |
| c. Socio-cultural barriers inhibit scheme utilisation. | Low hospital births among women in conservative rural belts despite full subsidies under JSY. | |
| 3. Governance & Coordination Gaps | a. Lack of convergence among departments handling linked services. | POSHAN Abhiyaan implementation suffers from poor coordination between WCD, Health, and Rural Development. |
| b. Weak monitoring, auditing, and grievance redressal mechanisms. | CAG flagged irregularities in PMAY: ghost beneficiaries, duplicate payments, incomplete houses. | |
| c. Populist policies prioritised over structural reforms. | Continuation of free ration (PMGKAY) while funding for anganwadis or school meals remains limited. |
Local-level best practices
Several Indian states and districts have bridged the gap between access and quality in maternal health.
- Tamil Nadu, with an MMR of just 54, has built a robust system through 99% institutional deliveries, the 108 ambulance network, HMIS-based risk tracking, and nutrition kits under the Dr. Muthulakshmi Reddy scheme. Its RCH programme ensures seamless care across ANC, delivery, and postnatal phases.
- In Odisha’s tribal Malkangiri district, maternal mortality has halved. ASHAs are trained to test haemoglobin, track high-risk pregnancies digitally, and provide counselling. Localised incentives and cultural adaptation—ASHAs speaking tribal languages and accompanying women—have driven uptake.
- Kerala’s Kudumbashree model leverages women’s self-help groups to deliver ANC, mental health counselling, and 100% immunisation. Community-led monitoring in tribal areas via mobile vans has made care both inclusive and accountable.
- Chhattisgarh’s Janani Shishu Suraksha Yatra (JSSY) and Mitanin model raised institutional deliveries from 40% to 80%. Mitanins provide doorstep ANC, track danger signs, ensure nutrition, and refer mental health cases.
These models show that when delivery systems are community-driven, context-specific, and continuous—not just coverage-focused—India can overcome both mortality and morbidity challenges in maternal health.
Way Forward
- Shift the metric: from “delivery counts” to “healthy mothers.”
Track haemoglobin, BMI and mental-health scores alongside institutional-delivery data. - Localise nutrition action.
Mandatory point-of-care anaemia testing at every ANC visit; millet-based THR (take-home rations); women-led farmer-producer co-operatives for iron-rich crops. - Close the quality loop in facilities.
Kayakalp-style audits for labour rooms and post-natal wards; e-partographs and mandatory second-opinions for C-sections. - Universalise mental-health screening.
Integrate PHQ-9 or EPDS tools into PMSMA; train ASHAs to identify red flags. - Data convergence & accountability.
Link Poshan Tracker, HMIS and civil-registration data to a single dashboard; empower panchayat-level social audits.
#BACK2BASICS: ASSESSMENT OF MATERNAL HEALTH GOVERNANCE
What’s Driving India’s Decline in Maternal Mortality?
| Driver | Key Action & Outcome |
|---|---|
| Incentivized Institutional Deliveries | Janani Suraksha Yojana (JSY) offers cash support for safe births — over 1 crore women benefited annually, with spending touching ₹1,814 crore in FY 2023–24. |
| Zero-Cost Maternal Care | Janani Shishu Suraksha Karyakram (JSSK) covers delivery, transport, diagnostics, and drugs — 1.36 crore women accessed services (Apr–Dec 2024). |
| High-Risk Pregnancy Tracking | PMSMA & e-PMSMA enable monthly ANC and digital tracking — 78.27 lakh high-risk cases identified till Dec 2024. |
| Improved Clinical Quality | LaQshya & SUMAN ensure respectful, high-standard care — 1,110 labour rooms, 808 maternity OTs certified; 47,700+ facilities covered under SUMAN. |
| Emergency & Critical Care Access | Over 400 Obstetric ICUs/HDUs and 650 MCH Wings with 42,000+ beds set up nationwide. |
| Trained Human Resources | Nationwide training of doctors and nurses — 2,518 EmOC doctors, 2,683 LSAS-trained, and 3.3 lakh SBAs deployed. |
| Real-Time Surveillance | MPCDSR & RCH Portal institutionalize digital maternal death reviews, replacing manual reporting for quicker response. |
Key Maternal Health Programmes Under the National Health Mission (NHM)
| Programme / Policy | Objective & Key Features |
|---|---|
| National Health Policy 2017 | Targeted MMR <100 by 2020 — achieved with MMR now at 93 (SRS 2019–21). |
| SDG Target 3.1 | Reduce MMR to ≤70 by 2030 — India on track. |
| JSY (2005) | Cash incentive for institutional deliveries — targeting SC/ST/BPL women. |
| PMMVY 2.0 (2022) | ₹5,000 maternity benefit for first child; extra for second girl child — promoting positive gender norms. |
| JSSK (2011) | Free delivery (including C-section), transport, diagnostics, medicines, and diet in public hospitals. |
| SUMAN (2019) | Assures free, dignified, quality maternity care with zero denial. |
| PMSMA (2016) | Free ANC on 9th of each month; e-PMSMA tracks high-risk pregnancies — 5.9 crore+ women examined by March 2025. |
| LaQshya (2017) | Quality assurance in delivery rooms and OTs to reduce maternal and neonatal complications. |
| Anaemia Mukt Bharat (AMB) | Holistic anaemia reduction via testing, treatment, food fortification, and mass communication. |
Infrastructure & Systems Strengthening
| Initiative | Impact |
|---|---|
| Comprehensive Abortion Care (CAC) | Training + safe abortion access integrated into RMNCAH+N services. |
| Delivery Points & FRUs | Upgraded with equipment, drugs, trained staff, and referral linkages. |
| MCH Wings | Specialized maternal-child units built in high-caseload facilities. |
| Obstetric ICUs/HDUs | Critical care infrastructure scaled in tertiary centers for obstetric emergencies. |
SMASH MAINS MOCK DROP
Despite significant improvements in institutional deliveries and a declining Maternal Mortality Ratio (MMR), India’s maternal health outcomes remain uneven and exclusionary. Critically examine the disconnect between policy achievements and ground-level realities in maternal health, with a focus on nutritional and diagnostic gaps.
