Improving maternal health and reducing the Maternal Mortality Ratio (MMR) has been a persistent goal for India due to the prolonged distress over maternal mortality. The MMR refers to the rate of maternal fatalities in a specific timeframe for every 100,000 live births that occurred in the same timeframe.

The maternal mortality rate can be utilized to gauge the reproductive well-being of females residing in a particular region. A considerable number of women who are of childbearing age pass away as a result of issues that arise during or after giving birth, or from undergoing an abortion.

As per World Health Organization, "Maternal death is the death of a woman during pregnancy or within 42 days from the date of termination of pregnancy, regardless of the time and location of pregnancy, related to or aggravated by pregnancy or management, but not accidental or accidental; ".

Reasons for women's death

Complications occurring before and after childbirth are responsible for women's deaths. The majority of these complications arise during pregnancy and can be avoided or remedied. Pre-existing complications that a woman may have can become aggravated during pregnancy if they are not properly addressed as a part of her healthcare.

The major complications that account for nearly 75% of all maternal deaths are:

• severe bleeding (mostly bleeding after childbirth);
• infections (usually after childbirth);
• high blood pressure during pregnancy (pre-eclampsia and eclampsia);
• complications from delivery; and
• unsafe abortion.

Measures to save women's lives?

Preventing unintended pregnancies is crucial in order to prevent maternal deaths. It is necessary for females of all ages, including teenagers, to have the ability to obtain contraception, safe abortion procedures that comply with legal regulations, and high-quality post-abortion medical care.

The prevention or management of complications that lead to maternal deaths are widely known within the healthcare industry, making them avoidable. It is necessary to provide all women with excellent healthcare services during pregnancy, as well as before and after giving birth. The health of the mother and the health of the newborn are intricately connected.

The presence of experienced healthcare professionals during childbirth is crucial since prompt medical intervention could determine whether both the mother and the baby survive or not.

• If left unattended, a healthy woman can die within a few hours due to excessive bleeding after delivery. Administering oxytocics promptly after giving birth significantly decreases the likelihood of postpartum hemorrhage.
   
• By practicing good hygiene and promptly recognizing and treating early signs of infection, it is possible to prevent infection following childbirth.
   
• It is important to identify and manage pre-eclampsia before it progresses to the point of causing seizures (eclampsia) or other serious, potentially fatal issues. The risk of a woman developing eclampsia can be reduced by administering drugs like magnesium sulphate for pre-eclampsia.

Maternal Mortality Rate in India

Over the years, India has experienced a high number of deaths resulting from pregnancy and childbirth, however, recent data indicates that there has been a reduction in India's maternal mortality rate. The precise measurement of maternal mortality is challenging unless detailed data on deaths and their causes are accessible. Surveys and census are utilized for approximating the rates of maternal mortality.

At present, RAMOS is regarded as the most effective method to estimate maternal mortality ratio (MMR). Analysing various sources and records is done to collect information about the mortality of women who are capable of reproduction. Additionally, a verbal autopsy is used to estimate the number of deaths. A regression model is utilized to calculate the MMR every five years, both on a global and regional scale.

The maternal mortality rate in India is estimated using the Sample Registration Survey (SRS). In March 2022, a specific bulletin regarding the maternal mortality rates in India was published by the Sample Registration System (SRS) under the Office of the Registrar General.

Policies Of Government

There are various policies being introduced by the government of India. Some of them are as follows:
Janani Suraksha Yojana (JSY)
JSY, which falls under the umbrella of NHM, is a program designed to encourage pregnant women to give birth in a healthcare facility, as it aims to decrease maternal and newborn mortality rates. JSY is a scheme sponsored by the central government that combines financial support with both pre and post-natal services. The Yojana has recognized that the Accredited Social Health Activist (ASHA) serves as a valuable connection between the Government and expectant mothers.

Surakshit Matratva Ashwasan (SUMAN)

In 2019, the Ministry of Health and Family Welfare initiated the Surakshit Matritva Aashwasan (SUMAN) program.

The goal is to offer reliable, respectful, and high-quality healthcare services without charge to women and newborns who go to a public healthcare facility, with a strict policy against refusal of service. This objective is aimed towards eliminating any preventable deaths or sicknesses during childbirth and ensuring a pleasant delivery experience.

The program offers a range of complimentary healthcare services to pregnant women, mothers within six months after delivery, and new-borns, which include up to four prenatal examinations and six home-based evaluations of new-born care.

Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA)

In June 2016, the Ministry of Health & Family Welfare (MOHFW) initiated the Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA). Pregnant women across the nation are offered a guaranteed, high-quality Antenatal Care on a designated day at no expense through the PMSMA program. As a component of the campaign, the recipients are given a basic set of antenatal care amenities which feature examinations and medications on the 9th day of each month.

Laqshya -Labour Room Quality Improvement

The main objective of this program is to provide assistance to Public Health establishments. Their maternity operation theatres will be improved to assist them, and the quality of care in labour rooms will be enhanced.

The implementation of this program will span across all CHCs, FRUs, District Hospitals, and Medical College Hospitals.

Anmol app:
The MOHFW has created a complex android application for mobile tablets that serves various functions including identifying and keeping track of individual beneficiaries at an early stage.

The app would facilitate the monitoring of recipients to ensure they receive adequate healthcare and encourage them to adopt family planning practices. The system aids in timely delivery of complete antenatal, postnatal, and delivery services, as well as tracking children to ensure they receive full immunization services.

Conclusion
The government's commitment to 'Surakshit Matritva Aashwasan' for the women by developing a responsive healthcare system that aspires to achieve zero preventable maternal and newborn deaths is strengthened by India's success in reducing MMR. The goal is to lower MMR below the target of 70 per lakh live births when India celebrates its "Amrit Kaal" and to sustain a steady drop going ahead. India is concentrating on improving the standard of in-facility maternity care and increasing awareness of the importance of reproductive health in order to meet this goal.