1. MATERNAL MORTALITY IN RURAL INDIA
A Case Study:by
Dr. R.P.Acharya, Director,
Department of Atomic Energy,
India
Expectations of a mother from Society..

2. RATIONALE CONSTITUTIONAL PROVISIONS
Art.38-State to secure a social order for the promotion of welfare of the people.
Art.42-Provision of just and humane condition of work and maternity relief.
Introduction of Janani Suraksha Yojana (JSY).
No reduction of Maternal Mortality rate (MMR).
More than about 1.36 lakh women die every year and one woman dies every 5 min.
The maternal mortality ratio in India is 540 maternal deaths per 100,000 live births, rising to 619 in rural areas-a great concern for the Indian society in general and for the public below poverty line in specific.
States with high maternal mortality include Rajasthan, Madhya Pradesh, Jharkhand, Orissa, Uttar Pradesh and Bihar

3. Maternal Mortality Means:
Death of a woman
during pregnancy or
delivery, or
within 42 days of
the end of pregnancy
from a pregnancy-
related cause.

4. SITUATION ANALYSIS SITUATION
“JANANI SURAKSHA YOJANA” (JSY) was launched by the Prime Minister in April 2005.
Aim of the scheme: To protect the interest of maternal rights of the woman and to reduce the unacceptable MMR level in India to bring it down to 100 per 1,00,000 live births (GoI 2005).
The scheme integrates the cash assistance (Rs. 1300/-) with antenatal care during the pregnancy period, institutional care during delivery and immediate post-partum period in a health centre by establishing a system of coordinated care by field level health worker.
As per GoI 2005(a) the MMR ranged from 28 in Gujarat to 707 in UP.

5. SITUATION ANALYSIS SITUATION (Contd.)
MMR were lowest in the north western zone comprising of states of Punjab, Haryana and Himachal Pradesh, while it is the highest in the eastern zone.
MMR was found to be high among SC / ST communities as compared to other communities.
MMR is high among illiterates (574).
For international comparability as per UNFPA’s latest state of World Population 2006, the MMR of Sweden is 2, Japan is 10, Korea is 20, Singapore is 30, China is 36, Thailand is 44, Sri Lanka is 92, while in India it is 540.

6. SITUATION ANALYSIS SITUATION (Contd.)
Several states in India are having identical schemes like Janani Kalyan Bima Yojana in MP, Delivery hut scheme in Haryana and several such scheme in other states.
The scheme is for distribution of incentives and conveyance money to the below poverty line (BPL) families.
JSY is the modified version of existing National Maternal Benefit Scheme, which was linked to provision of better diet for pregnant women from BPL families. (GoI 2005 (b).
Under JSY, Cash assistance is given after delivery through community health centre.

7. SITUATION ANALYSIS LIMITATIONS Resources are limited.
Scarcity of health care facilities in rural India.
Lack of infrastructure.
Distance of Primary Health Centres from the villages.
Street level Bureaucratic hurdles managing funds.
Fixing of unrealistic targets.
Lack of nutritional care during pregnancy.
Poor anti natal care.
Illiteracy and lack of awareness.
Lack of political will at local level.

8. SITUATION ANALYSIS ASSUMPTIONS MMR data available is reliable.
Benefits of various schemes are not actually reaching the intended target group.

9. PROBLEM ANALYSIS OBJECTIVE
Reduce MMR in Rural India to a minimum possible level and
To recommend suitable means for achieving the same.

10. PROBLEM ANALYSIS POSSIBLE ALTERNATIVES
By giving cash benefit directly to the expectant mother to take care of herself as well as the infant.
Creation of comprehensive health package .
Arrangement of nutritional diet and periodic health check ups during pregnenancy till delivery.
Insurance of expectant mother so that insurance companies will take care of her.
Provision of health care facilities at rural level with adequate infrastructure.

11. PROBLEM ANALYSIS CRITERIA Requirement of resources.
Whether the scheme is exhaustive taking care of all socio-economic aspects.
Whether the implementation and monitoring mechanism exists under the scheme.
Whether participation of all levels is possible.

12. Criterion (Low=1, Medium=2, High=3
PROBLEM ANALYSIS EVALUATION OF ALTERNATIVES
S. No
Alternative
Criterion (Low=1, Medium=2, High=3
Total
Resources
Exhaustiveness
Ease of
Implementation
Possibility of
participation
at all levels 1.
By giving cash benefit directly to the expectant mother to take care of herself as well as the infant. L M 6 2.
Creation of comprehensive health package. H 10 3
Arrangement of nutritional diet and periodic health check ups during pregnenancy till delivery.

13. PROBLEM ANALYSIS EVALUATION OF ALTERNATIVES
S. No
Alternative
Criterion
Total
Resources
Exhaustiveness
Ease of
Implementation
Possibility of
participation
at all levels 4.
Insurance of expectant mother so that insurance company will take care of her. M L H 7 5.
Provision of health care facilities at rural level with adequate infrastructure. 8

14. DECISION ANALYSIS CONCLUSION
Need of the day is to provide a comprehensive Health package to the expectant mothers.
The package should include nutritious diet, medicines and check up at regular intervals.
Wherever the population is concentrated in isolated pockets, trained Mid wifes be appointed and equipments to handle emergent situations be provided to her. The village committees be made responsible to take care of the village people and to administer the comprehensive health package.

15. DECISION ANALYSIS CONCLUSION
Existing CHC/PHC be upgraded and the officials of the centres be made responsible for functioning of the CHC/PHC’s including the functioning of the Midwifes.
Mobile medical units be provided to CHC/PHC so as to take care of the accessible people in the surrounding area.
Present Cash assistance is less. The same need to be increased to Rs 6000/ which is worked out modestly @rs.100/ per day for 60 days.
The midwifes and the village committees be empowered for promoting awareness among the village people.

16. DECISION ANALYSIS Recommendations
An exhaustive and comprehensive health package be provided which include basic medical facilities and nutritious diet.
Cash assistance of Rs 6000/-.
Improved heath care facilities at Health Centres with modern equipment.
Incentives be given to doctors who work in these areas.
Provision of mobile units to CHC/PHC.
Appointment of Midwives and periodical imparting training to her.

17. PLAN OF ACTION Implementation Contingency plan
Monthly review meetings at block/District level to implement the measures more effectively.
Timely allocation of funds.
Contingency plan
More participation of the private sector by introducing tax benefits.
Mandatory service of at least 2 years for fresh doctors in CHC/PHC.

18. References
Bhat,P.N.Mari 2001, Generalised growth balance method as an integral procedure for evaluation of completeness of census: a case study of India
Bhat,P.N.Mari,K Naveentham and I.Rajan1995, Maternal Mortality in India-Studies in Family Planning 26,
Bhat,P.N.Mari -Maternal Mortality in India: an update, p1-15
Revised 1990 Estimates of Maternal Mortality: A new approach by WHO and UNICEF(1996).
Shariff, Abusalesh 1999, Human Development Report, New-Delhi: Oxford University Press.
Rawal Asha: Continuing Medical Education-Trends in Maternal Mortality and some policy concerns.

19. References (contd..):
Population Policy, Ministry of Health and Family Welfare, Govt. of India,2000.
Mavalankar Prof. Dilip- State of Maternal Health in India.
Gulati Anil-High Maternal Mortality in the Heart of India.
Rawal Asha-Trends in Maternal Mortality and some policy concerns43-46
Health for all,WHOGeneva,1977
UNICEF Annual Report for the year

20. there is much more we can do
(not) THE END
there is much more we can do
Add a smile to the Janani in need….