Making the health system work for over 25 million births annually

Drivers of the notable decline in maternal and newborn mortality in India

Bibliographic Data

ID21881264
AuthorsHimanshu Bhushan (National Health Systems Resource Centre), Usha Ram (0000-0001-6722-7347, International Institute for Population Sciences), Kerry Scott (0000-0003-3597-9637, Manitoba Health), Andrea Katryn Blanchard (0000-0002-5118-8942, University of Manitoba), Prakash Kumar (0000-0002-1376-5745, International Institute for Population Sciences), Ritu Agarwal (0000-0002-8907-5652, India Health Action Trust), Reynold Washington (0000-0003-1245-8425, India Health Action Trust), Banadakoppa M Ramesh (0000-0003-3038-4415, University of Manitoba)
Year2024
Volume9
IssueSuppl 2
Pagese011411
Publication date2024-05-01
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueBMJ Global Health (JOURNAL)
Journal identifiersISSN: 2059-7908 • E-ISSN: 2059-7908
PublisherBMJ (PUBLISHER • GB)
DOI10.1136/bmjgh-2022-011411
PMID38770806
OpenAlexW4396661673
LanguageEN
Citations received4
References cited60

INTRODUCTION: India's progress in reducing maternal and neonatal mortality since the 1990s was faster than the regional average. We systematically analysed how national health policies, services for maternal and newborn health, and socioeconomic contextual changes, drove these mortality reductions. METHODS: The study's mixed-methods design integrated quantitative trend analyses of mortality, intervention coverage and equity since the 1990s, using the sample registration system and national surveys, with interpretive understandings from policy documents and 13 key informant interviews. RESULTS: India's maternal mortality ratio (MMR) declined from 412 to 103 maternal deaths per 100 000 live births between 1997-1998 and 2017-2019. The neonatal mortality rate (NMR) declined from 46 to 22 per 1000 live births between 1997 and 2019. The average annual rate of mortality reduction increased over time. During this period, coverage of any antenatal care (57%-94%), quality antenatal care (37%-85%) and institutional delivery (34%-90%) increased, as did caesarean section rates among the poorest tertile (2%-9%); these coverage gains occurred primarily in the government (public) sector. The fastest rates for increasing coverage occurred during 2005-2012.The 2005-2012 National Rural Health Mission (which became the National Health Mission in 2012) catalysed bureaucratic innovations, additional resources, pro-poor commitments and accountability. These efforts occurred alongside smaller family sizes and improvements in macroeconomic growth, mobile and road networks, women's empowerment, and nutrition. These together reduced high-risk births and improved healthcare access, particularly among the poor. CONCLUSION: Rapid reduction in NMR and MMR in India was accompanied by increased coverage of maternal and newborn health interventions. Government programmes strengthened public sector services, thereby expanding the reach of these interventions. Simultaneously, socioeconomic and demographic shifts led to fewer high-risk births. The study's integrated methodology is relevant for generating comprehensive knowledge to advance universal health coverage

Accountability · Economic growth · Economics · Empowerment · Environmental health · Health care · Infant mortality · Live birth · Political science · Population · Pregnancy · Public health · Socioeconomic status · Standardized mortality ratio · Demography · Global Health and Epidemiology · Global Maternal and Child Health · Healthcare Systems and Reforms · Medicine · Nursing