As the UNICEF Representative in India, Dr Yasmin Ali Haque feels every child deserves a safe and healthy start in life. Prior to joining her India posting in July 2017, she was Deputy Director of UNICEF’s Office of Emergency Operations where she played a lead role in programming and policies for an effective UNICEF response for children in humanitarian crises.

A Bangladesh national, she joined UNICEF in Bangladesh in 1996 as Project Officer for Health and Nutrition. During this tenure, Dr Haque contributed significantly to national policy analysis and strategic planning for maternal health and maternal mortality reduction in the context of a human rights-based approach.

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In an interview with AJITA SINGH, Dr Haque said even one maternal death is one too many and it is everyone’s shared responsibility to end these preventable maternal and newborn deaths. Excerpts:.

Q: What is your opinion on the Union Health ministry’s claim of improved healthcare indices in India?

A: We see improvements in most indices in India but we need more services in decentralised facilities for a growing population.

Q: What is your take on India’s recent achievements in improving MMR?

A: India has shown impressive progress in reducing maternal deaths. Now, nearly 1,000 fewer women die of pregnancy-related complications each month in India as compared to 2013. The MMR report talks of big gains and trends.

Q: What big gains?

A: In terms of absolute numbers, nearly 12,000 fewer maternal deaths in 2016 as compared to 2013, with total number of maternal deaths for the first time reducing to 32,000.

Every day 30 more pregnant women are now being saved in India as compared to 2013.

Every state has progressed though Bihar and Uttar Pradesh were the last to come on board with zero polio as these regions have more marginalised people in remote, tribal or poorer areas.

Q: Name the state that can be called a gainer and also one that is a loser?

A: What is even more heartening to see is that the two states at different ends of spectrum in terms of the burden of maternal mortality have done the best.

The state of Uttar Pradesh with the third highest MMR and one third of the country’s home deliveries, which accounts for the highest share of home deliveries in the country, has led the charts with a near 30 per cent reduction, which is even higher than the national average of 22 per cent. On the other side, Kerala which has the lowest MMR in the country has also shown 25 per cent reduction in MMR.

Q: What about other states?

A: Three states have already met the SDG target for MMR of 70 per 100,000. These are Kerala, Maharashtra and Tamil Nadu, while Andhra Pradesh and Telangana are within striking distance

Q: What role do you envisage for UNICEF in improving health parameters here?

A: As even one maternal death is too many, it is our shared responsibility to end these preventable maternal and newborn deaths.

Q: What is UNICEF’s agenda for India at present?

A: Ensuring every woman delivers with a safe pair of hands in an environment that treats her with respect and dignity. It is crucial that the same timely access and quality of care is afforded to every woman, especially those who live in the remotest and the poorest households of the country. The time for all of us to act is now.

UNICEF is fully committed to working with the Government of India to ensure that each child born in this country gets the best start in life, thrives and develops to his or her full potential.

The focus on aspirational districts is, in a way, trying to challenge administrations to find answers. The crux is demand-­creation and recognition that even the poorest do not make uninformed choices.

Q: What are the challenges before UNICEF in achieving the targets?

A: The Sick Newborn Care Units (SNCUs) are especially important. If help is at hand at the primary facilities, there’s less burden on the secondary ones and fatalities can be prevented. The surveillance system is expected to ring the alert if cases go up. Cases need proper care at the primary level in early stages.

Q: What issues of concern do we need to address for bettering the health of the Indian population?

A: India has progressed with the under-five mortality, but its main challenge is neonatal deaths. Eighty per cent births happen in a facility that can pick up neonatal problems, but 20 per cent of UP’s 225 million children is still a very big number.

So our focus is on how to reach this 20 per cent and examine why they don’t come. Was the woman ever mistreated in a labour room? Was it clean? Did it have privacy? UNICEF’s Every Child Lives programme works in these areas to drive further reductions.

Q: What more is needed to be done on the healthcare front in India?

A: India’s challenge is in its massive numbers: to decrease any metric by one percentage point, a quarter of a million children must be reached! Quality can be provided by private players but public players must make arrangements for quantity.

For improved healthcare indices, malnutrition needs to be tackled. Care of mother’s malnutrition during pregnancy and actual delivery needs to be addressed. While the baby is growing in the womb, the mother needs to be nourished. Child survival is yet another issue, essentially within the first three years of life.

India’s good gains on maternal and child mortality, particularly neonatal and during the first month of delivery, require to be maintained. Safe and yet more safe ways and places have to be ensured. There is an urgent need for much stronger care to mother and newborn child during delivery. Medical equipment is needed to tackle complications.

Q: What do you advocate the government should do to alleviate health woes of people here?

A: Immunisation is the first step towards ensuring health of the children though there is a big challenge of reaching out to some of the remote communities in the country.

Other issues of concern include malaria management, inadequate use of iodised salt and poor sanitation management in the region. Law enforcement agencies and the district assemblies must help the environmental health officers in measuring iodine content in salt at market places.

Potable water is a huge challenge in the Upper West, Upper East and Northern Regions and urging the people to adopt alternative ways of conserving water. We must respect water and its usage and we must also learn to live with it.

Provision of quality education for children must not be gambled with and we appealed to district assemblies to help motivate teachers and monitor them to provide quality education to children.