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Maternal Health

Under the Millennium Development Goal (MDG) 5, the target is to reduce Maternal Mortality Ratio (MMR) by three quarters between 1990 & 2015. Based on the UN Inter–Agency Expert Group’s MMR estimates in the publication “Trends in Maternal Mortality: 1990 to 2013", the target for MMR is estimated to be 140 per 1,00,000 live births by the year 2015 taking a baseline of 560 per 100,000 live births in 1990.

As per the latest report of the Registrar General of India, Sample Registration System (RGI-SRS), Maternal Mortality Ratio (MMR) of India has shown a decline from 178 per 100,000 live births in the period 2010-12 to 167 per 100,000 live births in the period 2011-13. Average decline in MMR between 2007-09 and 2011-13 has been 11.3 points per year, i.e. 5.8% compound rate of annual decline. Assuming that the annual compound rate of decline observed during 2007-09 and 2011-13 continues, India’s MMR is likely to reduce from 167 during 2011-13 to 140 in 2015.

Under National Rural Health Mission (NHM), several initiatives are under implementation to achieve the goal for reduction in Maternal Mortality. These interventions are as follows:

Essential Obstetric Care Quality Ante Natal Care
This includes quality antenatal care including prevention and treatment of anemia, institutional / safe delivery services and post natal care. To provide essential obstetric care services GoI is operationalizing the PHCs for 24 X 7 services and also training the SNs/LHVs/ANMs in Skilled Attendance at Birth. Quality ANC includes minimum of at least 4 ANCs including early registration and 1st ANC in first trimester along with physical and abdominal examinations, Hb estimation and urine investigation , 2 doses of T.T Immunization and consumption of IFA tablets (6 months during ANC & 6 months during PNC).
Post natal care for mother and newborn Skilled Attendance at Birth
Ensuring post natal care within first 24 hours of delivery and subsequent home visits on 3rd, 7th 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. Govt. 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, a policy decision has been taken permitting Staff Nurses (SNs) and ANMs to give certain injections and also perform certain interventions under specific emergency situations to save the life of the mother.
Provision of Emergency Obstetric and Neonatal Care at FRUs Referral Services at both Community and Institutional level
Provision of Emergency Obstetric and Neonatal Care at FRUs is being done by operationalziing all FRUs in the country. While operationalising, 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 MBBS doctors) is linked with operationalization of FRUs. GoI has a thrust to establish a network of Basic patient care transportation ambulances with aim to reach the beneficiary in rural area within 30 minutes of the call for quick service delivery.
Presently states have been given the flexibility to establish assured referral systems to transport pregnant mothers and sick Infants, etc which includes different models including public, private partnership models.


Other Major Interventions are:
Safe Abortion Services/ Medical termination of Pregnancy (MTP):

  • Provision of comprehensive safe abortion services at public health facilities including 24*7 PHCs/ FRUs (DHs/ SDHs /CHCs) with a focus on "Delivery Points".
  • Capacity Building of Medical officers in safe MTP Techniques and of ANMs, ASHAs and other field functionaries to provide confidential counselling for MTP and promote post-abortion care including adoption of contraception.
  • District Level Committees have been framed and empowered to accreditate the facilities for conducting safe abortion services under MTP Act including approval of private and NGO sector facilities for conducting MTPs.
  • A tool (format) to facilitate monitoring of Comprehensive Abortion Services and implementation of the MTP Act has been implemented all levels by GoI.
  • Supply of Nischay Pregnancy detection kits to sub centres for early detection of pregnancy so that safe abortion services can be provided to intended pregnancies covered under the MTP Act.
  • Development of standard IEC/BCC material on Safe Abortion.
  • Orientation/Training of ASHAs to equip them with skills to create awareness on abortion issues in women and the community and facilitate women in accessing services.

New Initiatives:

  • Janani Shishu Suraksha Karyakaram (JSSK)
  • Maternal Death Review
  • Delivery Points (DPs)
  • Web Enabled Mother and Child Tracking System
  • A Joint MCP Card