Neha Nouman

Maternal and child health (MCH) is a critical aspect of global health as it affects more than half of the world’s population and can create complications in pregnancy which can have severe impacts on both mother and child such as excessive blood loss, infections, and high blood pressures, with some cases being fatal. MCH can reflect the health status within the population and serve as an indicator of a nation’s development. The more developed a nation, the better MCH care they will have. Although it appears as though deaths from complications during childbirth, or due to complications during pregnancy have decreased by 38% over the last two decades, the vast inequalities that are present are not shown. More than half of the deaths that are related to MCH are found to happen in Sub-Saharan Africa and Southern Asia, with them shouldering the burden of 86% of the global total in 2017 (Who/Yoshi Shimizu, 2024). India presents a unique case study to explore MCH, as there have been significant advancements in their healthcare system, but also notable challenges thus far.

Understanding Maternal and Child Health:

Maternal and child health focuses on the well-being of women during pregnancy, childbirth, and the postnatal period. It also focuses on the health of the child from birth onwards. MCH is a vital area of healthcare that needs to be focused on as it is pivotal in the area of global health because it aims to reduce both maternal and infant mortality whilst enhancing the health outcomes that can be produced to provide a nurturing environment for mothers and children. MCH encompasses access to relevant health services, nutritional guidance, disease prevention, and management of conditions. MCH can act as a key indicator of the health infrastructure that is in place in a country, as the better it is in a country the lower the complications that are associated with MCH. The health infrastructure therefore also can reflect the socio-economic developments and conditions in a nation. On an international level, the importance of MCH is underscored by its inclusion in global health objectives and initiatives, such as the Sustainable Development Goals (SDGs), which have been set by the United Nations to transform the world that we live in and fight systemic issues such as poverty and inequality. These goals emphasise the importance of universal access to quality maternal and child healthcare services which is essential for reducing healthcare disparities that are present within nations and overall improving health outcomes (Bhatia et al, 2021: Dhanwal & Choudhury, 2021).

Successes in India’s MCH Landscape

One of the most important goals that MCH targets aims to achieve is a reduction in both maternal and child mortality rates. India has successfully been able to achieve this goal and this has been a significant victory in their MCH landscape. The maternal mortality ratio saw a decline from 212 deaths per 100,000 live births in 2007 to 113 in 2016-2018 (Meh et al, 2021). Within 10 years, there was a 46.6% decrease in the mortality rate in India and this behaves as an indicator notifying us of the improving health conditions in the country. A reduction of almost half is a testament to the improved MCH healthcare services in India and the increased awareness and importance it is receiving as a healthcare unit. The reduction in mortality rates in India can be attributed to various initiatives and reforms that were implemented by the government over several years. One of the most influential programs has been the Janani Suraksha Yojana (JSY) scheme which offers cash incentives to women to give birth in hospitals, in the hopes that by increasing institutional deliveries where there is medical attention and facilities, material mortality will reduce (NMH, 2024). The JSY has been able to provide a lens to explore inequality in healthcare in India. When focusing on different states in the country, there were varying degrees of success in maternal mortality reduction, which has highlighted the importance of regional strategies, but also addressed the issue in different states with specific solutions (Randive et al, 2014). This specific focus has allowed for an overall decrease in mortality rates as individual states have solutions that are tailored to them.

Another success in India’s MCH landscape is the technical innovations that they have implemented into their healthcare services. The use of mobile health technologies and telemedicine has been able to expand healthcare accessibility across the country in rural and urban areas alike, and this has had a significant impact on the enhancement of MCH care in India. The integration of technology in health care was part of a wider campaign namely ‘Digital India’ which has improved the efficiency of services in the nation (Joshi et al, 2020).

A third success that is seen in the MCH landscape in India, is the increased policy and community initiatives that have been implemented such as the National Rural Health mission. This has aimed to strengthen healthcare infrastructure all around the country, not only just in cities, to improve MCH outcomes. Rural areas tend to have weaker health infrastructure and the NRMH has attempted to focus on these states to improve the access they have to healthcare and reduce any disparities. It has had an emphasis on capacity building, and enhancing the skills of healthcare providers in an attempt to increase the quality of healthcare that is provided in remote areas (Sharma & Kamra, 2020; Geetha, 2020).

Failures in India’s MCH Landscape

Although there have been some successes in the work that India has been doing in improving the MCH care that is provided, it is arguably not enough with most reforms having occurred almost 20 years ago. One of the main failures remains arguable the disparities in health care access that still exist and are very much prevalent today. Although work has been done to combat this issue, not enough has been done in the context of an ever-growing population in a post-pandemic era. The rural-urban divide in healthcare access is very prominent in society in India and is often compounded by a lack of awareness and cultural barriers, leading to lower utilisation of maternal health services in rural areas compared to urban ones (Chauhan et al., 2022) directly lending to the fact that there are more MCH related health complications in rural areas. This issue is also seen from state to state and is not only limited to a rural-urban divide. Healthcare disparities are also present in different regions of the country, reflecting inequality amongst different states in terms of infrastructure and services provided (Bango & Gosh, 2022). Other socio-economic factors also play a role in access to MCH, with one of the most significant ones being the caste system that is present in India. Members of lower castes face challenges in accessing quality healthcare, and this is reflected by the lower utilisation of MCH services amongst disadvantaged social groups (Pakrashi et al, 2022). The government in India must implement improved policies that aim to reduce the overall inequality that is present within different areas of society.

Targeted interventions need to be implemented within India to ensure that women are gaining access to the healthcare that they need. Many women, especially in rural areas, face barriers to accessing healthcare due to financial constraints, transportation issues and limited healthcare infrastructure (Dhami et al, 2021), all of which significantly hinder their accessibility to healthcare. Societal norms have influenced women’s ability to seek healthcare independently, and gender disparities in the matter are evident from a young age and continue into adulthood (Jahangir & Sekker, 2023), meaning that more work needs to be done at the root of the problem to ensure that this unequal access does not continue to widen over time.

Takeaways

It is very clear to see that as a nation India has made advancements within the MCH they provide within their healthcare systems, with there being a significant decrease in maternal and child mortality rates in addition to an increase in the number of people using resources that are in place. Government schemes have proven to be effective over time however are now outdated and no longer apply to the modern world in which we live. There are still many issues that exist in India regarding MCH, and these include but are not limited to disparities in accessing healthcare within the rural-urban divide, or on a state-to-state basis. More work needs to be done to overcome socio-economic barriers and ensure that all mothers and children have access to the care that they need and deserve.

Bibliography

Bango, Madhumita and Soumitra Ghosh. “Social and Regional Disparities in Utilization of Maternal and Child Healthcare Services in India: A Study of the Post-National Health Mission Period.” Frontiers in Pediatrics 10 (2022): n. pag.

Bhatia, Mrigesh, Laxmi Kant Dwivedi, Kajori Banerjee, Alok Bansal, Misra Sib Ranjan and Priyanka Dixit. “Pro-poor policies and improvements in maternal health outcomes in India.” BMC Pregnancy and Childbirth 21 (2021)

Chauhan, Nelia Lois, Devendra Raj Singh and Bharat Kumar. “Detriments and Utilisation of Maternal Health Care Services in Urban slums of Agra City.” Revista Review Index Journal of Multidisciplinary (2022): n. pag.

Dhami, Mansi Vijaybhai, Felix Akpojene Ogbo, Blessing Jaka Akombi-Inyang, Raphael Torome, Kingsley Emwinyore Agho and On Behalf Of The Global Maternal And Child Health. “Understanding the Enablers and Barriers to Appropriate Infants and Young Child Feeding Practices in India: A Systematic Review.” Nutrients 13 (2021): n. pag.

Dhanwal, Dr. Ashok Kumar and Maitri Chaudhuri. “A Comparative Study between Knowledge and Practice of New-Borne Care and Child Health Care by the Rural Mothers and to Seek its Relationship with the Selected Demographic Variables in Tripura, India.” Scholars Journal of Applied Medical Sciences (2021)

Geetha S, Dr.P.LOGANATHAN. “A Study on Maternal Health Care through Janani Suraksha Yojana (JSY) Namakkal District.” (2020).

Jahangir, Selim and T. V. Sekher. “Gender disparities in self-perceived health and subjective well-being among older adults in India: evidences from a large-scale survey.” SN Social Sciences 3 (2023): n. pag.

Joshi, Vinayak Vijay, N. A. Pawar and Swapna Acharya. “Digitalisation of Health Care in India: Initiatives and Challenges.” (2020).

Meh, Catherine, Abha Sharma, Usha Ram, Shaza A Fadel, Natasha Correa, John W. Snelgrove, Prakash Shah, Rehana Begum, Manoranjana Shah, Tommy Hana, Sze Hang Fu, Lucshman

Pakrashi, Debayan, Surya Nath Maiti and Sarani Saha. “Caste, Awareness and Inequality in Access to Maternal and Child Health Programs: Evidence From India.” Social Indicators Research163 (2022): 1301 – 1321.

Raveendran, Bhaskar Mishra and Prabhat Jha. “Trends in maternal mortality in India over two decades in nationally representative surveys.” Bjog 129 (2021): 550 – 561.

Randive, Bharat, Miguel San Sebastiån, Ayesha De Costa and Lars Lindholm. “Inequalities in institutional delivery uptake and maternal mortality reduction in the context of cash incentive program, Janani Suraksha Yojana: results from nine states in India.” Social science & medicine 123 (2014): 1-6 .

Sharma, Vijayetta and Pawan K. Kamra. “ACHIEVING MATERNAL HEALTH THROUGH JANANI SURAKSHA YOJANA UNDER NRHM:A QUALITATIVE STUDY OF CONDITIONAL CASH TRANSFER SCHEME IN PUNJAB, NORTH INDIA.” International Journal of Advanced Research(2020): n. pag.