By Dr. Gyan Pathak 

 

DECREASING investment in maternal and newborn health has stagnated the progress in preventing premature deaths of pregnant women, mothers and babies globally, due to which death befalls on one every 7 seconds. Indian mothers and babies remain most unsafe both in number and its share in global deaths. Based on the current trends, more than 60 countries are not set to meet the maternal, newborn and stillborn mortality reduction targets in UN Sustainable Development Goals by 2030. India may also miss its target of reducing the maternal mortality rate (MMR) to a ‘single digit’ by 2030, as committed in the India Newborn Action Plan (INAP) launched in response to the Global Every Newborn Action Plan (ENAP) in June 2014 at the 67th World Health Assembly organised to advance the Global Strategy for Women’s and Children’s Health. During 2018-20, MMR in India was still 97 as against 130 during 2014-16.

The new joint report of World Health Organisation (WHO), UNICEF, and UNFPA, titled “Improving Maternal and Newborn Health and Survival and Reducing Stillbirths: Progress Report 2023” shows that the progress has stagnated since 2015, with around 2,90,000 maternal deaths each year, 1.9 million stillbirths – babies who die after 28 weeks of pregnancy – and a staggering 2.3 million newborn deaths, during the first month of life. This new publication was launched at a major global conference in Cape Town, South Africa. The report shows that over 4.5 million women and babies die every year during pregnancy, childbirth or the first weeks after birth, equivalent to one death happening every 7 seconds, mostly from preventable or treatable causes if proper care was available.

India is a country with largest number of deaths in 2020, the year for which the latest data was available and accessed by the report. Total maternal deaths, stillbirths and neonatal deaths were about 7,88,000 which is the largest in the world. Nigeria, with 5,40,000 deaths was the second worst and Pakistan with 4,75,000 was the third worst. In percentage term also, these countries with 17, 12 and 10 per cent of global deaths were worst. Even Bangladesh and Afghanistan fared better than India with only 3 and 2 per cent share in global deaths. India needs to be most concerned on this since its share in the global births is highest at 17 per cent, with 24,000 maternal deaths, 2,97,000 stillbirths, and 4,68,000 neonatal deaths. Nigeria has more maternal deaths which was about 82,000 in 2020, and thus it was worst country in the word in number of maternal deaths. The latest WHO survey have found the health systems under great stress which has been exacerbated by the COVID-19 pandemic, rising poverty, and worsening humanitarian crises. Just one in 10 countries of more than 100 surveyed were found to have sufficient funds to implement their current plans. Essential health services have been impacted by the pandemic and around 25 per cent of countries still report ongoing disruptions to vital pregnancy and postnatal care and services for sick children.

Funding losses and underinvestment are the chief causes of premature death of all under-five deaths globally, which is evident from the fact that less than a third of countries report having sufficient newborn care units to treat small and sick babies. Worst affected countries are in Sub-Saharan Africa and Central and Southern Asia, the regions with the greatest burden of newborn and maternal deaths, where fewer than 60 per cent of women receive even 4 out of 8 antenatal checks recommended by WHO. Increasing survival rate would depend on availability of quality, affordable healthcare to women and babies during and after child birth, as well as access to family planning services. The report stresses on availability of more skilled and motivated health workers, especially midwives, alongside essential medicines and supplies, safe water, and reliable electricity. Moreover, interventions should especially target poorest women and those in vulnerable situations who are the most likely to miss out on lifesaving care, including through better planning and investments. Improving maternal and newborn health further requires addressing harmful gender norms, biases, and inequalities, the report emphasised. Recent data show that only about 60 per cent of women aged 15-49 years make their own decisions regarding sexual and reproductive health and rights.

“Pregnant women and newborns continue to dies at unacceptably high rates worldwide,” says Dr Anshu Banerjee, Director of Maternal, Newborn, Child and Adolescent Health and Ageing at WHO, adding, “If we wish to see different results, we must do things differently. More and smarter investments in primary healthcare are needed now so that every woman and baby – no matter where they live – has the best chance of health and survival.” “The death of any woman or young girl during pregnancy or childbirth is a serious violation of their human rights,” says Dr Julitta Onabanjo, Director of the Technical Division at the United Nations Population Fund (UNFPA), adding, “We must take a human rights and gender transformative approach to address maternal and newborn mortality, and its is vital that we stamp out the underlying factors which give rise to poor maternal health outcomes like socio-economic inequalities, discrimination, poverty, and injustice.”