Under the Millennium Development Goal (MDG) 5, the target for India was to reduce Maternal Mortality Ratio (MMR) by three quarters between 1990 and 2015.
Based on the UN Inter-Agency Expert Group's MMR estimates in the publication "Trends in Maternal Mortality: 1990 to 2015", the target for MMR was estimated to be 139 per 1,00,000 live births by the year 2015 taking a baseline of 556 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 212 per 100,000 live births in the period 2007-09 to 167 per 100,000 live births in the period 2011-13. India's rate of decline of MMR between 2007-09 and 2011-13 is 5.7%.
At the figure of 139 India has clearly missed the target. SRS data shows that so far only three states - Kerala with an MMR of 66 per 100,000 live births, Tamil Nadu with an MMR of 90 and Maharashtra with an MMR of 87 - have been able to achieve the millennium development goal. Andhra Pradesh was also close to achieving the target with an MMR of 110.
Under National Health Mission, the key steps taken by Government of India to address the issue of maternal deaths and to accelerate the pace of reduction of MMR across all states including SC and ST are as below:
- Promotion of institutional deliveries through Janani Suraksha Yojana (JSY).
- Janani Shishu Suraksha Karyakaram (JSSK) entitles all pregnant women delivering in public health institutions to absolutely free and no expense delivery, including caesarean section. Similar entitlements have been put in place for all sick infants accessing public health institutions for treatment.
- Operationalisation of Sub-Centers, Primary Health Centers, Community Health Centers and District Hospitals for providing 24x7 basic and comprehensive obstetric care.
- Capacity building of health care providers in basic and comprehensive obstetric care with a strategic initiative "Dakshata" to enable service providers in providing high quality services during childbirth at the institutions.
- Mother and Child Protection Card in collaboration with the Ministry of Women and Child Development to monitor service delivery for mothers and children.
- Mother and Child Tracking System is being implemented to ensure antenatal, intranatal and postnatal care along-with immunisation services.
- Engagement of more than 9.15 lakh Accredited Social Health Activists (ASHAs) to 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 provision of maternal and child health services.
- Identifying the severely anemic cases of pregnant women at sub centres and PHCs for their timely management.
- Operationalisation of Safe Abortion Services and Reproductive Tract Infections and Sexually Transmitted Infections (RTI/STI) at health facilities with a focus on "Delivery Points".
- Maternal Death Review (MDR) is being implemented across the country both at facilities and in the community. The purpose is to take corrective action at appropriate levels and improve the quality of obstetric care.
- Establishing Maternal and Child Health (MCH) Wings at high caseload facilities to improve the quality of care provided to mothers and children.
- Under National Iron Plus Initiative (NIPI), through life cycle approach, age and dose specific IFA supplementation programme is being implemented.
- To tackle the problem of anaemia due to malaria particularly in pregnant women and children, Long Lasting Insecticide Nets (LLINs) and Insecticide Treated Bed Nets (ITBNs) are being distributed in endemic areas.
- Setting up of Skill Labs with earmarked skill stations for different training programs to enhance the quality of training in the states.
- A new initiative of "Prevention of Post-Partum Hemorrhage (PPH) through Community based advance distribution of Misoprostol" by ASHAs or ANMs for high home delivery districts.
- Newer interventions to reduce maternal mortality and morbidity- Diagnosis & management of Gestational Diabetes Mellitus, Hypothyroidism during pregnancy, Training of General Surgeons for performing Caesarean Section, Calcium supplementation during pregnancy and lactation, De-worming during pregnancy, Maternal Near Miss Review, Screening for Syphilis during pregnancy and Dakshata guidelines for strengthening intra-partum care.