With recent data released by the Registrar General of India showing a 22 per cent decline in the country’s maternal mortality ratio (MMR) since 2013, the World Health Organization (WHO) has commended India for its “groundbreaking progress”.

The MMR declined to 130 in 2014-16 from 167 per 100 000 live births in 2011-13, and 556 in 1990.

India’s present maternal mortality ratio is below the Millennium Development Goal (MDG) target and puts the country on track to achieve the Sustainable Development Goal (SDG) target of an MMR below 70 by 2030.  Three states have already achieved the SDG target. Kerala has an MMR of 46, followed by Maharashtra (61) and Tamil Nadu (66).

According to WHO Regional Director for South-East Asia Dr Poonam Khetrapal Singh, four key actions are responsible for India’s remarkable achievement.

“First, India has made a concerted push to increase access to quality maternal health services. Since 2005, coverage of essential maternal health services has doubled, while the proportion of institutional deliveries in public facilities has almost tripled, from 18% in 2005 to 52% in 2016 (including private facilities, institutional deliveries now stand at 79%),” Singh said in a statement.

The second factor, according to Singh, is state-subsidised demand-side financing like the Janani Shishu Suraksha Karyakram — “which allows all pregnant women delivering in public health institutions to free transport and no-expense delivery, including Caesarian section”. She said this particular programme had largely closed the urban-rural divide traditionally seen in institutional births. “Overall, 75% of rural births are now supervised, as compared to 89% of urban deliveries,” said Singh.

Speaking about the third action responsible for reduced maternal mortality ratio, she said India had put significant emphasis on mitigating the social determinants of maternal health. “Women in India are more literate than ever, with 68% now able to read and write. They are also entering marriage at an older age, with just 27% now wedded before the age of 18. These factors alone have enabled Indian women to better control their reproductive lives and make decisions that reflect their own interests and wants,” said Singh.

The senior WHO official also credited the government’s “substantive efforts to facilitate positive engagement between public and private health care providers”.

“Campaigns such as the Pradhan Mantri Surakshit Matritva Abhiyan have been introduced with great impact, allowing women access to antenatal check-ups, obstetric gynecologists and to track high-risk pregnancies,” she said.

The WHO said India’s achievements were of immense inspiration to WHO Member States. As per its South-East Asia’s Flagship Priority of advancing maternal, newborn, child and adolescent health, Singh said in her statement, WHO would continue to provide technical and operational support as and where needed in India and across the region to end preventable deaths due to pregnancy and childbirth and to ensure every woman has full control over her reproductive life.