Breaking the cycle: Addressing maternal and child mortality in Assam

Heramba Nath

(herambanath2222@gmail.com)

The state of Assam, known for its vibrant culture and natural beauty, faces an alarming public health crisis: high maternal and child mortality rates. Despite governmental efforts and several public health initiatives, Assam continues to record the highest maternal mortality rate (MMR) and infant mortality rate (IMR) in India, reflecting deep-rooted challenges in healthcare delivery and socio-economic conditions.

Maternal mortality refers to deaths caused by complications during pregnancy, childbirth, or the postpartum period. Assam’s MMR, standing at 195 per 100,000 live births (SRS 2018–2020), far exceeds the national average and is the highest in the country. These deaths are primarily attributed to preventable causes such as excessive bleeding (post-partum haemorrhage), hypertensive disorders like eclampsia, infections, and unsafe abortions. Similarly, child mortality, particularly among infants and children under five, remains a pressing concern. Neonatal deaths, which occur within the first 28 days of life, are predominantly caused by preterm births, low birth weight, birth asphyxia, and infections. For older children, diseases like pneumonia, diarrhoea, and malnutrition are significant contributors to mortality.

The factors contributing to these high mortality rates are multifaceted, rooted in socio-economic disparities, infrastructural gaps, and cultural practices. Poverty remains a critical barrier, limiting access to quality healthcare, nutritious food, and essential services. Malnutrition among women and children weakens their immunity, making them more susceptible to complications and infections. Assam’s sar areas, remote regions, and riverine communities are particularly affected by high maternal and child mortality rates. The lack of education and family planning in these areas exacerbates the issue. Inadequate access to healthcare facilities, skilled birth attendants, and emergency services further compounds the problem. The challenging terrain and limited connectivity in these regions make it difficult for pregnant women and sick children to reach medical facilities in time, resulting in delayed or inadequate care. Assam’s healthcare infrastructure faces significant shortcomings, particularly in rural and remote areas. Many villages lack adequately equipped healthcare facilities, delivery centres, and paediatric units. The shortage of skilled healthcare professionals, including doctors, nurses, and midwives, further hampers the quality of care. Poor road connectivity and transportation delays exacerbate the situation, often resulting in pregnant women and sick children failing to reach medical facilities in time. Cultural practices and beliefs also play a substantial role in perpetuating this crisis. Many families prefer home deliveries without skilled birth attendants due to traditional customs or mistrust of modern healthcare systems. Societal undervaluation of women’s health often leads to inadequate prioritization of maternal care, compounding the issue. These socio-cultural barriers, coupled with systemic challenges, create a complex web of factors that hinder progress in reducing maternal and child mortality rates.

The consequences of high maternal and child mortality extend beyond the immediate loss of life. Families suffer profound emotional trauma and financial hardship, particularly when the death of a mother disrupts the family structure. Orphaned children face increased risks of malnutrition, poor health, and lack of education, perpetuating cycles of poverty and disadvantage. At the community level, these high mortality rates hinder economic development, strain public health resources, and contribute to broader societal inequities. The government has implemented several initiatives to address this crisis. The Janani Suraksha Yojana (JSY) promotes institutional deliveries through financial incentives for pregnant women, while the Janani Shishu Suraksha Karyakram (JSSK) provides free healthcare services, including delivery and transportation for mothers and newborns. Other schemes, such as the Mamoni Scheme and Mamta Abhiyan, focus on promoting antenatal care and reducing malnutrition among women and children. Despite these efforts, significant gaps remain in the implementation and effectiveness of these programmes. Addressing Assam’s maternal and child mortality crisis requires a multi-pronged approach that tackles both the healthcare system and its underlying social determinants. Strengthening healthcare infrastructure, enhancing emergency services, community engagement, empowering women, addressing malnutrition, and leveraging technology and innovation are critical steps towards reducing preventable deaths.

Empowering women through education and economic opportunities can help delay early marriages and teenage pregnancies, reducing the risks associated with these practices. Community engagement and awareness programmes can promote positive health-seeking behaviour, encouraging women to access antenatal care, institutional deliveries, and postpartum services. Leveraging technology and innovation can help bridge gaps in access to healthcare, particularly in rural and remote areas. Telemedicine platforms, mobile health apps, and digital solutions can facilitate remote consultations, timely health advice, and monitoring for pregnant women and children. Mobile apps can help track antenatal check-ups, vaccination schedules, and nutrition requirements, providing timely reminders to both families and healthcare workers. Telemedicine can connect patients in remote areas with specialists, ensuring that even those in the most underserved regions receive the necessary care. These technological tools can significantly reduce delays in treatment and improve maternal and child health outcomes.

Investing in healthcare infrastructure, particularly in rural areas, is also essential. Establishing well-equipped healthcare centres, enhancing transportation networks, and improving access to skilled medical professionals will make it easier for pregnant women and children to receive timely care. Additionally, improving community-based health services and training local health workers will help extend healthcare services to even the most isolated communities.

By addressing these systemic challenges and implementing comprehensive solutions, Assam can make significant strides in reducing maternal and child mortality. This requires a collective effort from the government, healthcare providers, and communities, with a focus on empowering women, improving healthcare access, and ensuring equitable distribution of resources. Through these combined efforts, Assam can break the cycle of high maternal and child mortality and build a healthier future for its people.