According to the World Health Organisation, maternal mortality is the death of a woman while she is pregnant; or death occurring 42 days after delivery or termination of pregnancy. In 2017, approximately 295,000 women died from pregnancy and pregnancy-related complications. Four major medical complications have been attributed to this high mortality rate, and they include haemorrhage after childbirth, infections after delivery, hypertension during pregnancy, complications from delivery and unsafe abortion. Most of these deaths were reported to be preventable if adequate healthcare was provided and made affordable for pregnant women.
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Maternal mortality has a significant negative impact on children and the family, and since the family is the smallest unit of the community, anything that impacts it directly or indirectly affects the entire community. Some of the impacts on children include increased risk of death, poor nutrition and school involvement. In the family, maternal mortality contributes to poverty and poor household management and these translate to the community they belong to.
Because of its massive impact on the society, the United Nations General assembly included it as a health priority while developing the global goals, also known as the Sustainable Development Goals (SDGs). Different countries have agreed on a global scale that in order to achieve the SDGs and to continue the positive impacts that women bring to the economy, priority should be given to women empowerment and gender equality. Statistics show a 38 per cent decrease in maternal mortality ratio from the year 2000 to 2017. Globally, 342 deaths per 100,00 live births reduced to 211. That signifies that in 100,000 births, 211 women die. However, goal 3.1 of the SDGs aims to reduce this ratio to less than 70 deaths per 100,000 live births by the year 2030. Goal 3.1 is a target goal, and a key performance indicator of the SDGs found under goal 3 of the 17 global goals. Goal 3 aims to promote wellbeing and ensure good health amongst people of all ages by the year 2030.
This essay will critically reflect on the progress or lack of progress in achieving the SDGs using goal 3.1 as a key performance index. India is my choice of country for this analysis. I chose India for this essay because it occupies a more substantial part of South Asia and has one-sixth of the world’s total population hence making it the second-most populous country in the world. Although WHO also reported that south Asia of which India belong to have made a significant effort since 2000 to reduce their maternal mortality ratio by 59%, South Asia and Sub Saharan Africa were reported to account for 86% of 295,000 global maternal death reported in 2017.
India has been commended for their progress in significantly reducing maternal mortality ratio in their nation. According to a 2018 baseline report which highlighted the progress made by India in actualising the SDGs, India had a maternal mortality ratio of 130 per 100,00 live births. This figure reveals a 77% decrease when compared to the 556 deaths per 100,000 live births recorded in the 1990s. It is important to note that some states in India have been able to achieve less than 70 deaths per 100,000 live births.
This progress could be attributed to India’s heavy involvement in global development since the era of the Millennium development goals (MDGs). The year 2015 marked the deadline for reaching the MDGs, and before adopting the SDGs, India had a maternal mortality ratio of 174 deaths per 100, 000 live births. Also, they were fully involved and played a significant role in developing and shaping the SDGs, and their commitment is shown in how their national standards mirror the SDGs.
Research has demonstrated that in order to achieve progress in saving lives and improving the health of women, adolescent and children health; each country or organisation needs to achieve progress across a set of over lapping areas. Based on this evidence, key action areas were identified by the WHO in the document titled “Global health strategy for women, children and adolescent health guide (2016 – 2030). These action areas involve financing health, increasing women’s access to adequate healthcare and lifesaving commodities; accountability in all levels of leadership; use of multisectoral approach to address health issues and utilisation of principles that aid in universality, equity, human rights and developmental effectiveness.
India implemented vital actions that are believed to have contributed to the progress of achieving the SDGs, especially in reducing the maternal mortality ratio. These action areas include increased access to quality maternal care and health services with programmes like Pradhan mantri awos yojana and the national health mission; provision of funds to help subsidise or eliminate the cost associated with pregnancy and delivery including free transport with programmes like the Pradhan Mantri Jan Arogya Yojana; empowering women with knowledge necessary to make decisions about their reproductive health thus reducing the social determinants of maternal health; and finally, India has utilised the multi-sectoral approach in combating maternal mortality by facilitating positive collaboration between the public and private health sectors. Some of the important action areas suggested by WHO in the global strategy can be identified in actions taken by India and this has proven to improve women’s health.
Furthermore, it has been noted that there are still large disparities in numbers among states. This has been attributed to poor management, insufficient funds, poor health intertwined with other social determinants of health. India still aims to have less than 70 deaths in 100,000 live births by improving systems in place and working with the frameworks adapted by the WHO in monitoring health system performance in the various states. Also, NITI Aayog (the body responsible for coordinating efforts to ensure that India achieves the SDGs) have recently mapped out government schemes that will help to achieve the SDGs. The mapping will assist to improve systems already in place and develop new systems that will work with the frameworks adapted by the WHO in monitoring health system performance for maximum result.
In conclusion, India has been identified as marking remarkable progress in achieving the SDGs and this is evidenced in their steady decline of maternal mortality ratio. Although they have shown evidence of incorporating some of the key action areas of the global strategy for women, children’s and adolescent health (2016 – 2030). However, they agree that more work still needs to be done in that area and in the area of using the WHO health system framework for better health result.
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REFERENCES
Molla M, Mitiku I, Worku A, Yamin AE. Impacts of maternal mortality on living children and families: A qualitative study from Butajira, Ethiopia. 2015 Reprodhealth 12 (s6) accessed online https://reproductive-health-journal.biomedcentral.com/track/pdf/10.1186/1742-4755-12-S1-S6
Bazile J, Rigodon J, Berman L, Boulanger VM, Maistrellis E, Kausiwa P Yamin AE. Intergenerational impacts of maternal mortality: qualitative findings from rural Malawi 2015 Reprodhealth 12 (s1) accessed online https://reproductive-health-journal.biomedcentral.com/articles/10.1186/1742-4755-12-S1-S1
SDG India Index 2018: A baseline report Pg 38 – 45 accessed online https://in.one.un.org/wp-content/uploads/2018/12/SDX-Index-India-21-12-2018.pdf
Centres for Disease Control and Prevention, National Center for Health Statistics. Underlying Cause of Death 1999-2016 on CDC WONDER Online Database, released December 2017. Data are from the Multiple Cause of Death Files, 1999-2016, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. Accessed at http://wonder.cdc.gov/ucd-icd10.html on May 30, 2018, 9:11:06 AM
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