The Maternal Health Challenge

India suffers from a dehumanised and poor quality maternal healthcare system expressed as :

1. Inadequate Care and Facilities

“Too Little, Too Late” refers to care that is inadequate or delayed, due to insufficient access to well-trained healthcare providers, poor infrastructure, unreliable medicine availability, and a weak referral system.

“Too Little, Too Late” remains widespread, resulting in:

Maternal mortality rate

Pregnancy to 42 days after birthXThe annual number of female deaths from any cause related to or aggravated by pregnancy or its management (excluding accidental or incidental causes) during pregnancy and childbirth or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy.

97
X

SRS, Sample Registration System, Office of the Registrar General, India. 2022. “Special Bulletin on Maternal Mortality in India 2018-2020.” Accessed 4 Jan 2023. https://censusindia.gov.in/nada/index.php/catalog/44379/download/48052/SRS_MMR_Bulletin_2018_2020.pdf

per 100,000 live births
in 2018-2020

v/s
70
X

UN, United Nations. “Ensure healthy lives and promote well-being for all at all ages: Targets and Indicators” Accessed on 4th Jan 2023. https://sdgs.un.org/goals/goal3

Sustainable Development Goal Target 3.1 for 2030

Neonatal mortality rate

Within the first 28 days after birth

24.9
X

MoHFW, Ministry of Health and Family Welfare, Government of India. 2021. “National Family Health Survey (NFHS-5) 2019-2021. Compendium of Fact Sheets: Key Indicators India and 14 States/UTs (Phase-II).” https://main.mohfw.gov.in/sites/default/files/NFHS-5_Phase-II_0.pdf

per 1,000 live births
in 2019-2020

v/s
12
X

UN, United Nations. “Ensure healthy lives and promote well-being for all at all ages: Targets and Indicators” Accessed on 4th Jan 2023. https://sdgs.un.org/goals/goal3

Sustainable Development Goal Target 3.2.2 for 2030

Infant mortality rate

Within the first year after birth

35.2
X

MoHFW, Ministry of Health and Family Welfare, Government of India. 2021. “National Family Health Survey (NFHS-5) 2019-2021. Compendium of Fact Sheets: Key Indicators India and 14 States/UTs (Phase-II).” https://main.mohfw.gov.in/sites/default/files/NFHS-5_Phase-II_0.pdf

per 1,000 live births
in 2019-2020

Under-five mortality rate

Under-five mortality rate

Within the first 5 years after birth

41.9
X

MoHFW, Ministry of Health and Family Welfare, Government of India. 2021. “National Family Health Survey (NFHS-5) 2019-2021. Compendium of Fact Sheets: Key Indicators India and 14 States/UTs (Phase-II).” https://main.mohfw.gov.in/sites/default/files/NFHS-5_Phase-II_0.pdf

per 1,000 live births
in 2019-2020

v/s
25
X

UN, United Nations. “Ensure healthy lives and promote well-being for all at all ages: Targets and Indicators” Accessed on 4th Jan 2023. https://sdgs.un.org/goals/goal3

Sustainable Development Goal Target 3.2.1 for 2030

2. Excessive Medical Intervention

“Too Much, Too Soon” refers to the routine over-medicalisation of pregnancy and childbirth by the unnecessary use of non-evidence-based interventions or the use of interventions that can be life-saving when used appropriately, but harmful when applied routinely or overused.

C-sections, inductions, augmentations, and episiotomy rates are much higher than recommended in most parts of India.

Excessive Medical Intervention

Caesarean Epidemic

Across India

Private sector

47.4%
X

MoHFW, Ministry of Health and Family Welfare, Government of India. 2021. “National Family Health Survey (NFHS-5) 2019-2021. Compendium of Fact Sheets: Key Indicators India and 14 States/UTs (Phase-II).” https://main.mohfw.gov.in/sites/default/files/NFHS-5_Phase-II_0.pdf

Karnataka

Private sector

52.5%
X

MoHFW, Ministry of Health and Family Welfare, Government of India. 2021. “National Family Health Survey (NFHS-5) 2019-2021. Compendium of Fact Sheets: Key Indicators India and 14 States/UTs (Phase-II).” https://main.mohfw.gov.in/sites/default/files/NFHS-5_Phase-II_0.pdf

Know More

Telangana

State-wide

60.7%
X

IIPS, International Institute for Population Sciences. 2020. “Fact Sheets: Key Indicators, National Family Health Survey (NFHS-5) 2019-2020.” https://rchiips.org/NFHS/NFHS-5_FCTS/NFHS-5%20State%20Factsheet%20Compendium_Phase-I.pdf

J&K, Telangana & WB

Private sector

> 80%
X

IIPS, International Institute for Population Sciences. 2020. “Fact Sheets: Key Indicators, National Family Health Survey (NFHS-5) 2019-2020.” https://rchiips.org/NFHS/NFHS-5_FCTS/NFHS-5%20State%20Factsheet%20Compendium_Phase-I.pdf

All data as per NHFS – 5 (2019-2020)*

v/s
10 - 19%
X

Boerma, Ties, Carine Ronsmans, Dessalegn Y Melesse, Aluisio J D Barros, Fernando C Barros, Liang Juan, Ann-Beth Moller, et al. 2018. “Global epidemiology of use of and disparities in caesarean sections.” The Lancet 392 (10155): 1341–48. https://doi.org/10.1016/S0140-6736(18)31928-7. – Molina, George, Thomas G. Weiser, Stuart R. Lipsitz, Micaela M. Esquivel, Tarsicio Uribe-Leitz, Tej Azad, Neel Shah, et al. 2015. “Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality.” JAMA 314 (21): 2263. https://doi.org/10.1001/jama.2015.15553.

Ideal population-level caesarean rates

Episiotomies

In India, episiotomies are the norm and are cut for

85%
X

Singh, Shalini, Tushita Thakur, Nomita Chandhiok, and Balwan Singh Dhillon. 2016. “Pattern of episiotomy use & its immediate complications among vaginal deliveries in 18 tertiary care hospitals in India.” Indian Journal of Medical Research 143 (4): 474–80. https://doi.org/10.4103/0971-5916.184304.

of first time mothers, as per a study in 18 tertiary care Indian hospitals.

This is despite WHO guidelines, which recommend that episiotomies are restricted and used only when medically needed.

A restricted episiotomy policy results in 30% fewer women with severe perineal trauma.

3. Widely Prevalent Disrespect and Abuse

Labouring mothers experiencing physical and verbal abuse, discrimination and coercion, non-consented care, lack of privacy, and lack of confidentiality is an inherent violation of human rights and is widely prevalent in India.

Disrespect during maternity inflicts trauma on birthing mothers and reduces women’s willingness to seek medical help.

Prevalence of disrespectful maternity care in India is :

71.31%
X

Ansari, H., and R. Yeravdekar. 2020. “Respectful maternity care during childbirth in India: A systematic review and meta-analysis.” Journal of Postgraduate Medicine 66, no. 3 (2020): 133. https://www.jpgmonline.com/text.asp?2020/66/3/133/289765

As per the systematic review and meta-analysis conducted by Ansari and Yeravdekar (2020)

4. Lack of Demand for High Quality Care

Poor awareness, low expectations, and a lack of choice and agency accorded to expectant mothers has led to suboptimal care becoming the norm.

Families are conditioned to not expect or demand high quality care. This leads to minimal pressure on healthcare facilities to improve.