While India’s maternal mortality rate declined substantially during 2004-2006 to 2014-2016, at an annual rate of 5%, the reduction is still short of what is required to achieve the National Health Policy target.

Jithin Jose proposes a four-pronged strategy to sustain and accelerate the decline, RAFT – review of medical records, death certificates or autopsy reports of mothers; access to quality and respectful healthcare for women; funding for infrastructure, medicines, and interventions in the labour room; and training of personnel. 

As per the Sample Registration System (SRS) data, India has achieved the Millennium Development Goal (MDG) 5A, which stated that all countries should reduce Maternal Mortality Rate MMR by 75% of their respective 1990 figures by 2015. However, other sources seem to put the MMR at a higher figure. Regardless, we have seen a pan-India decline in (MMR), at an annual rate of 5% during 2004-2006 to 2014-2016.

 In March 2017, with the aim of achieving the Sustainable Development Goals (SDGs), Government of India proposed the National Health Policy (NHP), which set an MMR target of 100 to be achieved by 2020. This means that India would have to reduce its MMR at an annual rate of 5.75% in the coming years, which is more than its annual average reduction during 2004-2006 to 2014-2016.

However, achieving this target would be an uphill task, as any further reductions in the MMR at the national level would require ending preventable maternal mortality. Moreover, considerable amount of resources need to be instituted for per unit of count reduction in order to sustain and accelerate India’s successes.

This would require continuous reductions in both mortality and morbidity, with complementary improvements along the continuum of care for women. Within this context, strengthening of health systems and continuous learning; enabling and mobilising individuals and communities; and advancing quality, respectful care have been identified as critical to making progress towards this goal.

The RAFT strategy

In this post, four-pronged strategy were proposed, RAFT, that is, Review of medical records, death certificates or autopsy reports of mothers; Access to quality and respectful healthcare for women, Funding for infrastructure, medicines, interventions in the labour room; and Training for personnel. This strategy encompasses the three goals mentioned above and is to be implemented at the state level with strong backing from the Centre.

In this process, the states could work with these unions to set up a CRMD committee. Such unions could decide on the methodology for the review committees to follow, given the situation in a particular state, that is, review of case sheet, death report or autopsy reports.

Secondly, the Centre should also extend funds to each state for the purchase of necessary equipment, improving infrastructure, and for training labour-related personnel. Presently, LaQshya and Dakshata programmes under the aegis of the National Health Mission are steps in that direction.

Thirdly, an expert panel should be set up at the national level to review the present course structure of the EMoC (Emergency Obstetric Care) initiative  which all the states could follow, thereby ensuring homogeneity in training content across the country.

Fourthly, a separate cadre of obstetric nurses should also be formed. This would ensure that such trainings do not suffer from administrative bottlenecks like staff rotation. This would help in retaining staff trained in such methods within the delivery unit.

Therefore, if the administration is able to adopt the core principles of RAFT and provide necessary support to states for its implementation, we can expect India to achieve its MMR target set by the SDGs.