India is the first country in the world to have officially declared a National Safe Motherhood Day on 11 April. Securing institutional delivery, reducing anemia risk among women by providing them Iron-Folic Acid supplements and ensuing better pre and postnatal health care are essential for mothers. 

Globally, every day, approximately 830 women die from preventable causes related to pregnancy and childbirth. 99% of all maternal deaths occur in developing countries and 20 per cent of these women are from India. Maternal mortality is higher in women living in rural areas and among poorer communities. Young adolescents face a higher risk of complications and death as a result of pregnancy than other women. National safe motherhood day also promotes the prevention of child marriages because the child marriage is an indirect cause of maternal deaths.

Burden of maternal mortality in India and Jharkhand 
Maternal Mortality Ratio (MMR) (number of maternal deaths per 1,00,000 live births) has dropped from 167 (2011-2013, SRS) to 130 (SRS 2014-2016) for the country. This 22 per cent drop is arising from reduction in MMR in each of the States. Jharkhand has also shown reduction in maternal mortality from 208/100000 live births (SRS 2011-2013) to 165 (SRS 2014 -2016) with almost 21 per cent decline in maternal mortality.

Why do women die?
Women die as a result of complications during and following pregnancy and childbirth. Majority of these complications are preventable or treatable. Common cause of maternal deaths (>70 per cent of Maternal deaths) are due to severe bleeding (mostly after childbirth), infections (usually after childbirth), high blood pressure during pregnancy (pre-eclampsia and eclampsia), complications from delivery and unsafe abortions.

Status of Maternal health in Jharkhand
However, even with the decline in maternal deaths strengthening of maternal health services is imperative.  As per the NFHS 4 Survey, Jharkhand has 12 per cent prevalence of women age 15-19 years who are already mothers or pregnant; Deoghar has the highest prevalence of 22 per cent followed by Godda (21.7 per cent), Garwa(18.9 per cent), Jamtara (17.5 per cent), Pakur (17.2 per cent).  In the state, 62 per cent pregnant women are anemic in age group of 15-49 years; highest anemia prevalence is in West Singhbhum (74.4 per cent) followed by Bokaro (73.7 per cent), Gumla (70.5 per cent), Ranchi (68.3 per cent). Only 30.3 per cent mothers had at least 4 antenatal care visits; Garwa (11.6 per cent) had the lowest followed by Chatra (11.8 per cent), West Singhbhum (12.6 per cent), Simdega (12.8 per cent), Latehar (15 per cent). As per NFHS 4, state had 61.9 per cent were institutional births; West Singhbhum (37.4 per cent) had lowest institutional deliveries, followed by Sahibganj (48.2 per cent), Simdega (49.2 per cent), Pakur (49.4 per cent), Latehar (51 per cent).

Why do women not get the care they need?
Poor women and young adolescents in remote areas are the least likely to receive adequate health care and face a higher risk of complications and death. The impact of risk is amplified with poor nutritional status. Factors that prevent women from receiving or seeking care during pregnancy and childbirth are poverty, distance from health facility, non-availability of transport, lack of information, inadequate / quality of services and the cultural practices.

How can women’s lives be saved?
Most maternal deaths are preventable, as the health-care solutions to prevent or manage complications are well known. All women need access to quality antenatal care during pregnancy with availability & provision of all required drugs and logistic, identification & management of anemia, skilled care during childbirth preferably institutional birth, efficient referral and transport system focusing on time to care approach, health facilities to tackle complicated/ high-risk cases and care and support in the weeks after childbirth. To avoid maternal deaths, it is also important to prevent unwanted and teenage pregnancies. All women, including adolescents, need access to contraception, safe abortion services to the full extent of the law, and quality post-abortion care.

Initiatives to ensure safe motherhood
•    Janani Suraksha Yojana (JSY) is a safe motherhood intervention under the NHM with the objective of reducing maternal and neo-natal mortality by promoting institutional delivery among the poor pregnant women it integrates cash assistance with delivery and post-delivery care.
•    Pradhan Mantri Matru Vandana Yojana (PMMVY) is available to all pregnant Women & lactating mothers (PW&LM) for first living child of the family with the objectives of providing partial compensation for the wage loss in terms of cash incentives which would lead to improved health seeking behavior amongst the Pregnant and Lactating Mothers (PW&LM). Eligible beneficiaries get INR 5,000/- under PMMVY and remaining under Janani Suraksha Yojana (JSY) after institutional delivery. 
•    Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA) provides fixed day assured, comprehensive and quality antenatal care to pregnant women on the 9th of every month.  Antenatal checkup is provided by specialists/ physicians with support from private sector doctors. Services include ultrasound, blood and urine tests along with routine antenatal check-ups at the identified health facility/outreach in both rural and urban areas.
•    108 Ambulance services for carrying pregnant women to health facility for delivery free of cost.
•    Janani Shishu Suraksha Karyakram (JSSK) provides completely free and cashless services to pregnant women including normal deliveries and caesarean operations and sick new born (up to 30 days after birth) in Government health institutions in both rural & urban areas.
 

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