Worrying state of maternal health amid deepening disparities  

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Photo credit Odisha Millet Mission (The Ministry of Women and Child Development celebrated the fifth ‘Poshan Pakhwada' from 20th March to 3rd April 2023 with various activities nationwide. This initiative aims to raise awareness on malnutrition and promote healthy eating habits)

Photo credit Odisha Millet Mission (The Ministry of Women and Child Development celebrated the fifth ‘Poshan Pakhwada' from 20th March to 3rd April 2023 with various activities nationwide. This initiative aims to raise awareness on malnutrition and promote healthy eating habits)

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India has fourth lowest health budget

Pradeep Kumar Panda

Bhubaneswar, March 28: Despite improvements and a multitude of health care initiatives over the years, India continues to grapple with high maternal mortality, limited access to healthcare, nutrition disparities, and mental health concerns. The challenge becomes further compounded when we consider the intersectionalities such as caste or economic status, among others.

India has fourth lowest health budget in the world. Furthermore, the alarming increase in unnecessary c-section deliveries, commercialisation of medical services, lack of timely detection of complications, inadequate training facilities, barriers to maternal education and a lack of awareness of existing government initiatives, all pose concerns for both maternal and infant health.

India continues to face the serious health issue of a high maternal mortality rate, compounded by persistent disparities in maternal healthcare service utilisation and maternal health outcomes across different states. Although the utilisation of Maternal, Newborn, and Child Health (MNCH) services has increased between 2006 and 2016, it still varies widely across states, with considerable inequality persistent between and within states. Poor women in many of the high-focus states have been left behind. The high inequality in the use of antenatal care services across high-focus states is of serious concern.

Despite recent improvements in the maternal health scenario in rural Assam and interventions made by the state, it remains one of the states with the highest number of maternal deaths in the country. She attributes this trend to several factors. Factors of patriarchy affecting reproductive health decisions have not been rightfully addressed and visible incongruences between the knowledge of the people and the services provided by the government machinery remain. These impediments will continue, as long as we continue to narrowly view reproductive health as a mere “pathological challenge.”

Maternal nutrition plays an intricate role in women’s well-being and has far-reaching implications for child development. Budget allocations for nutrition did not meet needs; the deficit created a backlog of requirements; health facilities functioned sub-optimally; and service delivery was poor. Further, a vicious cycle of understaffing and shortage of infrastructure has led to underutilisation of even the limited resources available and, in turn, to fund allocation for the scheme in subsequent financial years.

Tribal women also tend to fare worse in most of the nutritional indicators.  Large-scale surveys and routine monitoring are currently deficient in measuring the nutrition status of women, especially tribal women. The nutrition status of adolescent girls and women is largely worse in tribal regions compared to non-tribal regions in the study states, with the exception of Odisha. The reach of essential nutrition services is lowest in Jharkhand amongst the three study states. Universal schemes like ICDS and Janani Suraksha Yojana have not reached women from all social groups equitably.

In a similar vein, improving access to nutritionally rich foods, biofortification, and a better public distribution system can help improve maternal nutrition outcomes. An overhaul of the preexisting network of agriculture and cooperatives is required, that deeply integrates women into its fold. Accelerating undernutrition reduction in India requires realigning agriculture and rural development policy to empower women in agriculture. Improved maternal nutrition has been shown to have positive intergenerational effects as well.

Those individuals who face more than one vulnerability may be more disadvantaged than those who face a single vulnerability. For example, women from poorer households are more likely to experience adverse health outcomes than those from wealthier households. If those poor women also lack education or if they are from otherwise socially disadvantaged groups, their burden increases.

In case of maternal and reproductive health domain, there is an emerging concern regarding early age at menopause, and the rise in hysterectomies among Indian women. Thus, a common opinion evolving in such a circumstance should ideally collect information on menopausal management rather than a larger module devoted to HIV/AIDS prevalence.

Caste hierarchies in hospitals, which in turn impact infection control and maternal health. Deep caste prejudice against cleaners, who continue to come from marginalised Dalit communities, prevents the professionalisation of their work. This, in turn, leads to a lack of hygiene as casteist notions of what is clean and unclean influence the way that infection is understood and infection control is implemented.

Further, in India, even though there has been a remarkable surge in institutional births, this has been accompanied by a disturbing increase in caesarean section deliveries.  The results expose a concerning prevalence of c-section deliveries in the town, with a significant portion performed without medical indications, leading to adverse effects on women’s health. The government should ensure that c-sections are not carried out for non-medical reasons. This will lead to improved maternal and child health outcomes, empowerment of women, and reduction of expenditure on health. Thus, urgent policy interventions are necessary to monitor and regulate c-section deliveries across the country.

Post-partum depression is emerging as a growing health concern in India, affecting the lives of women residing in both rural as well urban areas. Evidence shows that sociocultural determinants, particularly relating to women’s position within families and society, influence the development of PPD beyond hormonal and psychological factors. To them, interventions and policies concerning women’s maternal health and mental well-being must recognize the significance of these determinants and develop targeted measures that address the underlying structural factors.

Thus, as these examples across India illustrate, better dissemination of holistic knowledge frameworks surrounding can help fill information gaps, enable mothers to make informed choices, and foster equitable outcomes.  Further, there is a pressing need to establish comprehensive programmes for women’s health that adopt an intersectoral approach to effectively address issues related to the development of PPD. Overall, the challenges that persist in improving the state of maternal care in India require that we employ a multidimensional approach.

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