Editorial

Health profile of mother and child in Assam

The latest Sample Registration System (SRS) bulletin showing a decline in Maternal Mortality Ratio (MMR) and Infant Mortality Rate (IMR) in Assam is good news.

Sentinel Digital Desk

The latest Sample Registration System (SRS) bulletin showing a decline in Maternal Mortality Ratio (MMR) and Infant Mortality Rate (IMR) in Assam is good news. The positive result reinforces the importance of various interventions initiated by the state government with the support of the central government for the improvement of maternal and child health and nutrition. With the World Health Organisation (WHO) launching a year-long campaign on the theme "Healthy Beginnings, Hopeful Futures", which is focused on maternal and newborn health, the improvement in MMR and IMR will encourage the healthcare personnel to leverage it to intensify their efforts to further improve the two crucial health indicators. This brings into focus the key strategy adopted by the central and state governments of taking maximum care of the pregnant women and the newborn, which is guided by the overarching goal of ensuring health equity. IMR in Assam dropped from 38 to 34, and MMR dropped from 195 to 167, but ongoing health interventions staying on the course is critical to touch the national averages (IMR - 27 deaths per thousand; MMR - 98 per lakh live births). The rural-urban break of IMR and MMR shows that both the indicators are dragged down by alarmingly higher IMR and MMR in rural areas of the state compared to urban areas. Improving healthcare access and nutrition support for women and children in rural Assam is crucial to ensure a faster decline in IMR and MMR. The Sustainable Development Goal (SDG) of MMR is 70 per lakh live births by 2030, while there is no SDG target set for IMR. SDG target 3.2 aims to end preventable deaths of newborns and children under 5 years of age by 2030. A key flagship scheme aimed at improving MMR is Janani Suraksha Yojana for promoting institutional delivery among poor pregnant women. It is a 100% centrally sponsored scheme for ensuring safe motherhood through distribution of cash incentives for institutional deliveries in which an Accredited Social Health Activist (ASHA) plays the most crucial role to motivate pregnant women to deliver in a health institution and also arrange to immunise the newborn till the age of 14 weeks. Two other key health interventions aimed at improving MMR under the National Health Mission include Janani Shishu Suraksha Karyakram (JSSK), which entitles every pregnant woman to free delivery, including caesarean section, in public health institutions along with the provision of free transport, diagnostics, medicines, blood, other consumables and diet; and Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA), which provides pregnant women a fixed day, free of cost, assured and quality antenatal checkup by an obstetrician/specialist/medical officer on the 9th day of every month. Bringing more rural women in the state under the umbrella of these health interventions will significantly reduce maternal mortality. Apart from ensuring adequate health care for the newborn, institutional deliveries also provide healthcare professionals the opportunity to motivate the mothers to adopt family planning practices and adequate spacing between two pregnancies. Under JSSK sick infants up to one year of age are entitled to free treatment in public health institutions along with the provision of free transport, diagnostics, medicines, blood and consumables and building awareness among people, more among rural people in the state to avail these benefits can go a long way in bringing down IMR in the state. Breaking the cycle of child marriage and teenage pregnancy remaining a priority is essential to the state achieving the IMR and MMR targets. Teenage pregnancy puts mothers at higher mortality risks, and due to poor access to healthcare and nutritional deficiencies, the children born to them also suffer from poor nutritional status. Access to better education and preventing school dropout of girls, enforcement of the Child Marriage Prohibition Act, and preventing young girls from becoming mothers at a young age are essential to prevent child marriage. Building community awareness about the social evil of teenage pregnancy facilitates a better ecosystem for the implementation of the government schemes and makes the task easier for ASHA and healthcare professionals towards achieving the goal of a healthy society with healthy mothers and children. Improved sanitation facilities; access to safe drinking water through the provision of functional household tap connections under Jal Jeevan Mission (JJM); and an increase in the number of delivery points at primary health centres have laid a solid foundation for improved care for the mother and newborn. Accelerating the implementation of the JJM to cover every village in the state is crucial; providing more incentives to ASHAs will go a long way in realising optimal benefits of the schemes aimed at reducing IMR and MMR. Assam shedding the tag of the state with the highest MMR and improving its MMR is reflective of the interventions already made. Sustaining the momentum is critical to the state achieving the SDG goal. Focused intervention among marginalised sections backed by efficient implementation of relevant schemes will help the state achieve the desired transformation.