Maternal / Neo-Natal Health

Lancet Report on Maternal Health

Nearly 1/4^th of babies worldwide are still delivered in the absence of a skilled birth attendant. 1/3^rd of the total maternal deaths in 2015 happened in two countries: India and Nigeria. WHO, India’s MMR stands at 178 presently but as per MDG mandate India needs to further reduce it to 103.

Reasons for High MMR in India

Low Institutional delivery rate – lack of facilities, will, awareness & orthodoxial stigmas attached
Women not getting Antenatal Care – 34 % did not receive an ante-natal check- up for births
Postnatal care is grossly deficient
Teenage pregnancy and their risk of dying – 34 % married under the age of 18 despite the Child Marriage Restraint Act, which multiplies the risk of dying
Women lack awareness of the importance of pregnancy care and delivery in healthcare facilities
Women’s lack of making decision- Patriarchal mindset + Lack of awareness of location of health services
Cost factor – direct fees as well as the cost of transportation, drugs and supplies
The poor quality of services, including poor treatment by health providers

Solutions

An improved, accountable health care system at primary level
Make the antenatal, intra-natal & postnatal services available to women located close to them
Ensure delivery by skilled attendant nurses or doctors

Janani Suraksha Yojana – world’s biggest conditional cash-transfer scheme, aimed to promote institutional delivery. The cash incentive reduces financial barriers to accessing institutional delivery.

22% increase in women delivering in government hospitals between 2004 and 2014 – NSSO Data

It led to increase in utilisation of all three maternal healthcare services – (antenatal care, Safe Delivery, Postnatal Care)

Pradhan Mantri Surakshit Matritva Abhiyan – assured & quality antenatal care, free of cost, universally to all pregnant women

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Medical Termination of Pregnancy (Amendment) Bill 2014

Recently, Supreme Court of India declined the plea of a woman to abort her foetus detected with Down syndrome. The whole issue set a debate about a woman’s right to choice over her body and termination of foetus, which is considered as a life after a certain period of pregnancy in Medical Termination of Pregnancy Act 1971.

Medical Termination of Pregnancy Act 1971, allows a woman to terminate her foetus till 20^th week of pregnancy. To detect any abnormality in foetus, a pregnant woman can undergo the medical test only after 18-week period of her pregnancy. However, the report of the test itself can take 2-3 weeks to arrive; meanwhile, the pregnant women would have crossed the time limit allowed to opt for abortion.

However, in certain exceptional circumstances, court relaxes the aforesaid time period and allows termination of pregnancy only if the foetus poses danger to the woman’s life or is detected with an abnormal deformity.

Due to rigid framework of the Act and myriad aspects of social stigma attached to the issue, around 10 women every minute in India die due to pregnancy-related complications.

Medical Termination of Pregnancy (MTP) (Amendment) Bill 2014

intended to extend the legal limit for abortion from the present 20 weeks to 24 weeks
will also allow for abortions-on-demand up to 12 weeks
Takes into account a woman’s choice and autonomy over her body
would cut the role of judiciary in case of any abnormality found in the foetus after the 20 week time period and would authorise the health care provider to terminate pregnancy
amended the definition of ‘termination of pregnancy’ by differentiating the medical and surgical methods – would allow women to use and procure abortion-related medicines

In the proposed amendment, all the stakeholders must be consulted so that sex selective abortion and high mortality rate can be curtailed. Also need of the hour is to look at the proposed law through a broader lens, where the right to choice of women over her body and the right of the foetus to be born, would be justified.