The story of India in the 21st century has been one of extraordinary growth and innovation. In the health scape, we have eliminated polio under incredibly challenging circumstances, and have been validated for maternal and neonatal tetanus elimination before the global date-two very significant achievements. A crucial pillar of our growth story has been the contribution of women, who have shaped our society and our productivity in immensurable ways. They are a priority for the Government which is ensuring through its policies and initiatives a progressive future for them.
The programs, schemes and initiatives that are implemented by the Ministry of Health and Family Welfare (MoHFW) care for women right from birth to adolescent and adulthood, what it’s called as the ‘life cycle’ approach. Vaccines, home-visits by frontline health workers, nutrition (across the lifecycle) are provisioned to ensure a healthy childhood, from whereon the adolescent health programs – Menstrual Hygiene program, Weekly Iron & Folic Acid Scheme (WIFS) and the Saathiya (Peer Educators), take on. Thereon married women are provided with family planning services and an enhanced basket of choice for contraceptives and ultimately specialized care is provided around pregnancy and child birth through dedicated programs of Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA), Surakshit Matritva Aashwashan (SUMAN), LaQshya (labor room quality improvement initiative), mid-wifery services etc. With the Ministry’s commitment for providing universal healthcare, cancer screening for breast and cervical cancers is made available to women, free of cost, through Ayushman Bharat – Health & Wellness Centers (AB-HWCs).
PMSMA launched in June, 2016 aims to provide assured comprehensive and quality antenatal care – a minimum package of antenatal care services (including investigations and drugs), free of cost, universally to all pregnant women on the 9th day of every month. The Abhiyan also involves private sector’s health care providers as volunteers for specialist care at the Government facilities. Till date more than 2.38 crore pregnant women have received antenatal care under PMSMA and more than 12.55 lakh high risk pregnancies have been identified.
To improve the quality of care in labor rooms and maternity operation theatres, LaQshya, was launched in December 2017 with an aim to reduce preventable maternal and newborn mortality, morbidity and stillbirths associated with the care around delivery in labor room and Maternity Operation Theatre (OT) and ensure that pregnant women receive respectful and the best quality of care during delivery and immediate post-partum. Till date, 506 labor rooms and 449 maternity operation theatres are State certified; 188 labor rooms and 160 maternity operation theatres are LaQshya certified at the national Level. Not just labor rooms, state-of-the-art Maternal and Child Health (MCH) wings have been sanctioned at District Hospitals/District Women’s Hospitals and other high case load facilities at sub-district level, as integrated facilities for providing quality obstetric and neonatal care. As on date, 650 dedicated MCH Wings with more than 42,000 additional beds have been sanctioned.
The latest program for women has been the SUMAN Initiative, launched on 10th October 2019. This initiative aims to provide assured, dignified, respectful and quality healthcare, at no cost and zero tolerance for denial of services to every woman and newborn visiting the public health facility in order to end all preventable maternal and newborn deaths and morbidities, and provides a positive birth experience. Under SUMAN, all existing schemes for maternal and neonatal health have been brought under one umbrella in order to createa comprehensive and cohesive initiative, which goes beyond entitlements and provides a service guarantee for the entitlements.
Moving onto universal healthcare,
AB-HWCs screen all 30+ population for non-communicable diseases (NCDs) i.e. diabetes, hypertension and three types of common cancers (oral, breast and cervical). Women are being screened for breast cancer and cervical cancer, and till date more than 1.03 crore women have been screened for the former and more than 69 lakhs women for the latter.
Programs and facilities need skilled human resource and thus a national training programme named ‘Dakshata’ was launched in 2015. It is a strategic 3-day training capsule for building the skills of health care providers, including doctors, staff nurses and ANMs, for providing quality intrapartum care. Till date, 16,400 health care providers have received Dakshata trainings.
More recently, the Health Ministry took the policy decision to roll out ‘Midwifery Services Initiative’ in the country in order to improve the quality of care and ensure respectful care to pregnant women and newborns,. This aims to create a cadre of Nurse Practitioners in Midwifery who are skilled in accordance to competencies prescribed by the International Confederation of Midwives (ICM) and are knowledgeable and capable of providing compassionate women-centered, reproductive, maternal and newborn health care services. To give a boost to these training programs, the Government of India has established five National Skill Labs – ‘’Daksh’’ functioning at National Institute of Health and Family Welfare (NIHFW), Lady Hardinge, Safdarjung, Jamia Hamdard and Trained Nurse Association of India institute in 2014 in Delhi and NCR region and 104 stand-alone skills labs established in different States such as Gujarat, Haryana, Maharashtra, Madhya Pradesh, West Bengal, Odisha, Tamil Nadu, Tripura, Jammu & Kashmir etc. for capacity building and skill enhancement of healthcare providers to offer quality RMNCH+A services. Till date around 3375 (1238 in FY 2018-19) health personnel have been trained at National skills lab and around 33751(7750 in FY 2018-19) at State skills lab from different cadre including nursing tutors, skills lab trainers, professors, medical officers etc.
The collective efforts of the Ministry have borne fruits: The Maternal Mortality Ratio (MMR) of India has declined by eight points in one year as per the latest Special Bulletin on MMR released by the Registrar General of India. This decline is important as it translates to nearly 2000 additional pregnant women saved annually. MMR has declined from 130/ lakh live births in 2014-16 to 122/ lakh live births in 2015-17 (6.2% decline); with this persistent decline, India is on track to achieving the Sustainable Development Goal (SDG) target for reducing MMR by 2025, five years ahead of timeline of 2030.
This has been possible with sharp rise in institutional deliveries in India – from 47% in 2007-08 to over 78.9% in 2015-16 based on the National Family Health Survey (NFHS-4) while safe delivery has simultaneously climbed from 52.7% to 81.4% in the same period. Schemes such as JSY and JSSK have contributed towards meeting this goal. Under JSY, pregnant women going to a public health institution for delivery are provided cash entitlement in one go at the health institution. Janani Shishu Suraksha Karyakaram (JSSK) entitles all pregnant women delivering in public health institutions to have absolutely free and no expense delivery, including caesarean section. The entitlements include free drugs, consumables, free diet during stay, free diagnostics and free blood transfusion, if required. This initiative also provides free transport from home to institution, between facilities in case of a referral and drop back home. The scheme was expanded to cover complications during ante-natal and post-natal period and also sick infants up to 1 year of age.
Also, Maternal Death Surveillance and Response (MDSR) including Maternal Death Reviews that have been institutionalized across the country both at facilities and in the community have played a significant role in reducing maternal mortality. The States are being closely monitored under this to identify not just the medical causes but also some of the socio-economic, cultural determinants as well as the gaps in the system, which contribute to these deaths.
Besides these programs, laws have been passed to empower and protect the rights of women viz. Pre-Conception and Pre-Natal Diagnostic Techniques Act, 1994 which was enacted by the Parliament of India to stop female foeticide and arrest the declining sex ratio in India.
Also, women are not only the beneficiaries of the healthcare programmes, but are in fact an important part of the team delivering healthcare services to society. This army of frontline health workers includes Accredited Social Health Activists (ASHAs), Auxiliary Nurse Midwives (ANMs), staff nurses and women doctors who form the foundation of our healthcare system. The same is also true for services delivered by other Ministries eg: Aaganwadi workers are the backbone of the services delivered by the Ministry of Women and Child Development. The government initiatives thus provide employment opportunities for women and foster women empowerment.