Lok Sabha Question No. 2952 (UNSTARRED), answered on 2016-12-02
Subject: Maternal Deaths
Ministry: HEALTH AND FAMILY WELFARE
Asked by: HARISH DWIVEDI, G. HARI, SUSHMITA DEV, JYOTIRADITYA MADHAVRAO SCINDIA

## GOVERNMENT OF INDIA MINISTRY OF HEALTH AND FAMILY WELFARE DEPARTMENT OF HEALTH AND FAMILY WELFARE

## LOK SABHA UNSTARRED QUESTION NO. 2952 TO BE ANSWERED ON 2 ND DECEMBER, 2016

## MATERNAL DEATHS

## 2952. SHRI HARISH CHANDRA ALIAS HARISH DWIVEDI:

SHRI G. HARI:

KUMARI SUSHMITA DEV:

SHRI JYOTIRADITYA M. SCINDIA:

Will the Minister of HEALTH AND FAMILY WELFARE be pleased to state:

- (a) whether the Government is aware of latest Lancet report on maternal health which reveals that one - third of the total maternal deaths in 2015 happened in India where 45000 mothers died during pregnancy or childbirth, if so, the reasons therefor;
- (b)  whether  there  has  been  any  rise  in the  maternal  mortality  rate  in  the  tribal  areas of  the country, if so, the details in th sregard; and
- (c) the steps taken by the Government to bring down maternal deaths across the country?

## ANSWER THE MINISTER OF STATE IN THE MINISTRY OF HEALTH AND FAMILY WELFARE (SHRI FAGGAN SINGH KULASTE)

(a): As  per  trends  in    Maternal  Mortality  1990 to  2015  estimates    released  by  WHO, UNICEF, UNFPA, World Bank and the United Nations Population Division,  Nigeria and India accounts    for      over  one  third  of  all  estimated    global  maternal  deaths    in  2015 approximately  58000  maternal  deaths(19%)  c ontributed  by  Nigeria  and  45000  maternal deaths(15%) contributed by India.

The latest report of Registrar General of India - Sample Registration System ( RGI - SRS 2011- 13)also estimates  that the Maternal Mortality ratio (MMR) of India has declined from 212 in 2007 - 09 to 167 per 100,000 live births in 2011 -13 which translates into a reduction of absolute numbers of maternal deaths from approximately 56000 to 44,000 per year.

Besides  medical  causes,  there  are  social  determinants  of  health  which  also  indi tly contributes to maternal mortality. These  are Illiteracy, low socio -e onomic status, early age of marriage, poor knowledge on nutritional care during pregnancy & preference for home deliv through family members or village dais (untrained), poor ac cess to health facilities etc. which are important social factors contributing to higher maternal mortality.

(b): Registrar  General  of  India,  Sample  Registration  System  (RGI - SRS),  do  not  provide disaggregated data based on rural and urban, Scheduled Caste(SC), Scheduled Tribes(ST),other backward classes(OBCs) and others; category wise.

(c): To further accelerate reduction of Maternal Mortality Ratio (MMR)  the key steps taken under the National Health Mission (NHM) are :

-  Promotion of institutional deliveries through Janani Suraksha Yojana.
-  Janani Shishu Suraksha Karyakaram (JSSK) has been launched on 1 st June, 2011, which entitles all pregnant women delivering in public health institutions to absolutely no  expense  delivery  including  Caesa rean  section.    The  initiative  stipulates  free  drugs diagnostics,  blood  and  diet,  besides  free  transport  from  home  to  institution,  b facilities in case of a referral and drop back home.  Similar entitlements have bee place for ante - natal and post -natal complications during pregnancy and all sick infants accessing public health institutions for treatment.
-  The Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA) has been launched by the Ministry of Health & Family Welfare (MoHFW), Government of In dia to provide fixed -day assured, comprehensive and quality antenatal care universally to all pregnant w on the 9th of every month. As part of the Abhiyan, a minimum package of antenatal c services would be provided to pregnant women in their 2nd / 3rd trimesters, by OBGY specialists/  Radiologist/  Physicians  at  government  health  facilities,  with  suppo private sector doctors to supplement the efforts of the government
-  Capacity building of MBBS doctors in Anaesthesia (LSAS) and Obstetric Care i ncluding C - section  (EmOC)  skills  to  overcome  the  shortage  of  specialists  in  these  discip particularly in rural areas.
-  Capacity buildings of SNs & ANMs in Skilled Birth Attendant (SBA) and DAKSHATA programme  to  equip  them  for  managing  normal deliveries,  identify  complications,  do basic management and then refer at the earliest to higher facilities.
-  To strengthen the quality of training, a new initiative has been taken for setti Skill Labs with earmarked skill stations for different tr aining programs in the states for which necessary allocation of funds is made under NHM.
-  Operationalization of adequate number of Primary Health Centres for providing 24 basic emergency obstetric care services.
-  Operationalization  of  adequate  number  o f  FRUs  to  provide  24  X  7  comprehensive emergency obstetric care services.
-  Establishing  Maternal  and  Child  Health  (MCH)  Wings  at  high  caseload  facilities improve the quality of care provided to mothers and children.
-  Name Based Web enabled Tracking of Pregnant Women and New born babies so that provision of regular and complete services to them can be ensured.
-  Mother  and  Child  Protection  Card  in  collaboration  with  the  Ministry  of  Women  an Child Development to monitor service delivery for mothers and ch ildren.
-  Engagement of more than 9.15 lakhs Accredited Social Health Activists (ASHAs) t generate demand and facilitate accessing of health care services by the community.
-  Village Health and Nutrition Days in rural areas as an outreach activity, for pr ovision of maternal and child health services.
-  Operationalization  of  Comprehensive  Abortion  Care  Services  and  Reproductive  Trac Infections and Sexually Transmitted Infections (RTI/STI) at health facilities with on 'Delivery Points.
-  Over 21,000 am bulances are being supported under NHM to interalia transport pregnan women to institution for delivery and also for referral.
-  Newer  operational  guidelines  have  been  prepared  and  disseminated  to  the  States Screening for Diagnosis & management of Gesta tional Diabetes Mellitus, Hypothyroidism  during  pregnancy,  Calcium  supplementation  during  pregnancy  and lactation,  De - worming  during  pregnancy,  Maternal  Near  Miss  Review,  Screening  for Syphilis  during  pregnancy,  Guidance  note  on  use  of  uterotonic  during  la bor  and Guidance note on prevention and management of PPH.
-  Reproductive Maternal Newborn Child Health + Adolescent (RMNCH+A) interventions for achieving improved maternal and child health outcomes through continuum of ca across life cycle.
-  Further to sharpen the focus on the low performing districts, 184 High Priority Dist (HPDs)  have  been  identified.  These  districts  would  receive  higher  per  capita  fun relaxed norms, enhanced monitoring and focussed supportive supervision, an encouraged to a dopt innovative approaches to address their peculiar health challenges.