EDITORIALS & ARTICLES
What are the determinants of poor maternal health?. Do you think successful Implementation of PMMVY would be a Game Changer in this regard?.
The very first target for SDG 3 - ensuring healthy lives it to Reduce maternal mortality to less than 70 per 100,000 live births by 2030. India had been reducing Maternal mortality at a steep pace and is highly likely to have achieved our own MMR target of 100 by 2020. Despite this, due to the recent disruption in the women’s welfare programs due to COVID-19, achieving desired MMR by 2030 shall be challenging.
In this context, The Pradhan Mantri Matru Vandana Yojana (PMMVY) has been rolled out, where a ‘cash incentive of ₹5,000 is provided directly to the bank/post office account of pregnant women and lactating mothers for the first living child of the family (subject to fulfilling specific conditions relating to maternal and child health)’.
Determinants of poor maternal health performance
- Reduced access to medical facilities: women are dependent on their male counterparts even for visiting the nearest medical facility. Complications from delivery & unsafe abortions are one of the major reasons for Maternal mortality.
- Financial dependence: Prevents women from seeking adequate medical and nutritional support.
- Nutrition Gap: National Family Health Survey(NFHS-5) shows various health challenges faced by women in India. For example incidence of anemia in women has increased from 53.1 to 57%.
- Poor Sanitation and Hygiene: It includes poor menstrual hygiene and problems related to defecation in open.
- Early Marriage: It increases the risk of early pregnancy among women. Early pregnancy is associated with increased child mortality rates and affects the health of the mother.
- Powerless in making decisions regarding reproduction: They don’t have power to decide the limit on the number of children. Often girls are forced into early marriage that increases the power gap.
Importance of such Maternity benefit programmes in this regard:
- Covers medical and nutritional expenses to a certain extent.
- Cash incentives leads to improved health seeking behaviour amongst Pregnant women and lactating mothers. This is of vital importance as timely health advice is critical to save mothers from developing complications during the course of pregnancy.
- Reduces Financial dependence: It provides partial compensation for the wage loss in terms of cash incentives so that the woman can take adequate rest before & after delivery of the first living child.
- Access to contraceptives and products of menstrual hygiene: Attending the medical facilities allows access to health workers' and ASHA workers' advice.
- Post-natal advice: access to medical advice also allows access to vaccination and inputs about post-natal child health services.
Therefore, strengthening maternity benefit program is of critical importance in improving child mortality. Because -
- Too small amount: ₹5000 is a small amount given the nine month of pregnancy. Whereas women earn more in a month through MGNREGA labour (at a wage rate of ₹202/day).
- It covers only first child: Of the total live births in India, 49.5% comprises first-order births and 29.9% are second-order births, as per Sample Registration Survey 2018. It is imperative to include second live birth under the maternity benefit cover particularly for women in the unorganised sector who are more vulnerable to economic shocks and nutrition loss for all child births.
- There is a lack of awareness within targeted beneficiaries and process-level challenges.
- Reducing implementation rigidities: The current registration form requires a mother and child protection (MPC) card, husband’s Aadhaar card, bank passbook and registration form for each of the three instalments, resulting in delayed, rejected or pending applications.
However, this alone is not sufficient in this regard. Other measures are required too:
- Empowerment of women: So that she has a say in reproduction related decisions.
- Education: which improves financial status of the women and delays the age of marriage.
- Prevention of early and child marriage: Which has a huge adverse effect on the health of women.
- Food fortification and enrichment: To reduce the prevalence of health conditions like Anaemia, lack of Calcium and Folic acid.
- Focused approach in key areas: In the rural areas of Bihar, Jharkhand, UP, Assam, West Bengal and Chhattisgarh. The incidence of Maternal mortality is higher which needs to be addressed.
India has made great strides in reducing the maternal mortality, with the help of various programs such as PMMVY which needs to be strengthened further. However, beyond this social and economic empowerment of women on a greater scale is required to reduce avoidable adverse health impacts.
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