This article was originally published on The News Minute and has been republished with permission.
By Nimeshika Jayachandran
“Adilabad used to have a high rate of maternal mortality, especially among the tribal women. So many of them were just young girls really. They get married young and when they became pregnant, it was difficult for them to get proper medical attention,” says Swami, a BPO from the National Health Mission who works in the district of Adilabad, in Telangana “It really is astonishing to see how drastically the maternal mortality rates have come down, in a short time,” he says.
Swami is one of many people whose efforts collectively have helped to bring down Telangana state’s maternal mortality rate, in a span of hardly 3 years.
Maternal mortality refers to the number of maternal deaths which occur due to pregnancy or as a result of a complication of the same. Maternal mortality rate (MMR) is taken as the number of recorded maternal deaths, for every 1 lakh live births.
According to data released by the Sample Registration System (SRS), Telangana state went from an MMR of 92 in the 2011 to 2013 period to a rate of 81 between 2014 and 2016. The efforts of the state government to reduce its MMR has resulted in the entire nation’s MMR reducing to 130 from 167. In fact, Telangana is now close to the 70 mark, the Sustainable Development Goal (SDG) set for the country.
“One of the biggest challenges we faced was in putting together a system wherein women in even remote parts of the state can also easily access medical facilities during pregnancy,” said Swami.
The infrastructure which was implemented, largely focused on making healthcare accessible to all women and also incentivized institutional deliveries which helped attract more women to institutional deliveries.
“Take a place like Adilabad itself for example, there are 32 mandals which fall under Adilabad. In many of the interior areas, women would not get regular antenatal check-ups or would have home deliveries due to lack of proper medical facilities. All of these things contributed to high maternal mortality rate,” said Jeyvanth Rao, a Health Department worker.
In order to tackle this problem, the government undertook the gargantuan task of improving public health care facilities, starting with the Public Health Centres (PHCs). “The state implemented a 24-hour call centre as part of a government initiative. The PHCs worked with Accredited Social Health Activists (ASHAs) and collected the expected delivery dates of women in a particular locality and passed it on through the call centres. In this way we had a registry of all the pregnant women along with their due dates,” said Swami.
The call centres were set up in conjecture with the government’s ‘Amma Vodi’ (Mother’s Lap) programme.
Under ‘Amma Vodi’ a few initiatives were taken to ensure that pregnant women were getting regular antenatal check-ups as well as institutional deliveries.
The call centres helped authorities to keep track of pregnant women and were able to make sure that they were getting regular check-ups.
The government also introduced the 102 number for women who required transport to and from their check-ups. Those who require transport can call 102 and request for an ambulance to come pick them up and drop them off after their medical visits. The ambulances are also available to take them to the nearest hospital for delivery as well.
“We have such a tight-knit system in place, the ASHA workers are on the field and know which women are high-risk pregnancies and also know whose delivery date is near, so they can keep someone informed through the call centre whether an ambulance is required. This has allowed us to make sure that all pregnant women are getting the medical care which is required before, during and after delivery,” said another Health Department worker.
In addition to the above, under ‘Amma Vodi’ the government has sought to incentive institutional deliveries by providing them with financial incentives. Women are given Rs 13,000 for girl children and Rs 12,000 for boys which are given in installments.
“They are given base of 4 to 5 thousand rupees at the time of delivery and the rest is given at subsequent follow-up visits,” said Dr Sruthi Krishnan, a medical officer from Hyderabad, “It’s a way to ensure that they and the child come for regular check-ups.”
Along with the ‘Amma Vodi’ programme, the government also introduced the KCR Kit Scheme.
“KCR Kit Scheme was introduced by Chief Minister Kalvakuntla Chandrashekar Rao to provide new mothers with some essential items to care for their babies. Upon delivery, they are given a kit which includes things like clothes, baby soaps, powder, and oil, mosquito nets, napkins and diapers and others which will last for three months. All these things are given free of cost under the scheme and takes care of the basic neonate needs,” said Dr Sravya Potluri, an Obstetrician from Hyderabad, “It is essentially a starter pack for new mothers and has everything they would need for the newborn.”
While Telangana state has shown an overall decrease in the maternal mortality rate, there are pockets of the state which still have a long way to go. Districts such as Medak, Rangareddy, and Mehbubnagar are showing an MMR almost twice as high as that of Adilabad at rates of 38,30, and 31 respectively, which have been attributed to the need for improving the public healthcare centre (PHC) infrastructure in the locality.