Maternal Health and Child Mortality: Condition, Vision and Challenges

Email

Whatsapp

Facebook

Pinterest

Twitter

Copy link

This volume containing articles on mother and child gives a fragment of a total vision on the prevailing situation of the health status of mother and child in India. The present volume brings together scholars and academicians from various disciplines and health professionals, policy makers and social scientists under the same umbrella for discussion and critical evaluation of current health situation and efficacy and role of healthcare programme related to maternal and child health in India. The present volume focuses to identify the major socio-economic, demographic and cultural factors affecting the maternal and child health issues especially among the vulnerable segments living in rural India. In order to control the maternal and child deaths in India, concentrated efforts need to be put to identify the major determinants of the population, better health education, women's empowerment, and strengthening health care system to provide timely and quality services, including emergency and obstetric care were also discussed in this edited volume.

Dr. Nitish Mondal (b. 1984) received his M.Sc. (First Class First) (2007) and the Ph.D. degree in Anthropology (2014) from the University of North Bengal, West Bengal. Currently, Dr. Mondal is working as Associate Professor & Head in the Department of Anthropology, Sikkim University, Gangtok, Sikkim India. He is the recipient of UGC-NET Junior (2008) and Senior Research Fellowship (2010) for the Doctoral Research and Gold Medal (in Anthropology, 2007) from the University of North Bengal. He has published number of research papers in different peer-reviewed international and national journals of repute and two edited books.

Prof. Kh. Narendra Singh (b. 1966) is currently the Professor and Head of the Department of Anthropology, Assam University: Silchar (Diphu Campus), Assam. He did his Master's and Doctoral degrees in Anthropology from the Sabitribai Phule Pune University (formerly University of Pune), Pune. Besides anthropological field studies, Prof. Singh has vast experience of conducting various large-scale national level health survey including, DLHS-RCH, NFHS and GATS India. Professor Singh has authored several edited volumes and published numerous articles/research papers in international journals of repute.

During the past few decades there has been a growing recognition that addressing of the appropriate maternal and child health issues requires organising services in a continuum of health care that encompasses these health problems. Most of the health problems encountered in mothers and children of the developing countries could be prevented either by immunization or health education. Maternal health is one of the most crucial elements, has long been ignored in public health care and the maternal mortality rate (MMR) remains quite high in our country and contributes almost a quarter of the global estimates of maternal morbidity and mortality, however, a slight declining trend over two decades has been observed.

The World Health Organization (WHO) estimates that of 5,36,000 maternal deaths occurring globally each year, out of which 1,36,000 deaths take place in India. India's MMR has been reduced from 212 deaths per 1,00,000 live births in 2007 to 167 deaths per 1,00,000 live births in 2013. Improvement in the maternal and child health care, reducing the burden of maternal and child mortality, and working towards universal access to health care are the utmost priorities of the governments and several civil society organizations. The adolescent and illiterate mothers and those living in hard to reach areas still have a much greater chance of dying during childbirth. Adolescent girls living in rural areas of the country are vulnerable to teenage marriage and pregnancies. India has the highest number of child marriages in the world.

The National Census (2011) estimated that 41.3 per cent of the girls in India are married before 19 years of age. In rural India, 47.3 per cent of 19-year-old girls got married and in the urban areas, the corresponding figure was 29.2 per cent. Available data suggested that for every 1,000 girls aged 15 to 19 years, there were 76 adolescent births in India in 2010 compared to 49 worldwide and 53 in less developed regions. There is little evidence that maternity has become safer in India over the last 20 years despite the safe motherhood policies and programmatic initiatives at the national level. The status of women is being low in India, except in the southern and eastern states. The female literacy rate is observed to be unsatisfactory and women lack the empowerment to decide, including the decision to use reproductive health services and childcare.

Malnutrition among children is a major public health problem in India and it has been estimated that more than half of the Indian children are undernourished. Maternal and child mortality are being recognised as a human rights issue due to its vulnerability and preventability. Integration of a human rights perspective in maternal and child health programmes could contribute to eliminating avertable maternal and child deaths. The maternal and child health issues are much higher in the rural areas and attributed to lack of adequate health care facilities, lack of knowledge about health, hygiene and lack of awareness about health care services, institutional delivery and acute shortage of doctors and medical staff in the hospitals. The health system's conscious effort to improve maternal and child health, normative elements of human rights approach to maternal health (i.e. availability, accessibility, acceptability, and quality of maternal health services) were not upheld. The Government of India has made significant advancements to improve the maternal and health and show an increase in institutional delivery and immunization coverage but the desired target is yet to be achieved. Given the multiple efforts of the Government to improve maternal health why have the maternal health indicators not improved in the past decade? Due to lack of the managerial capacity, clear overall programme objectives, and evidence-based strategies, the schemes were implemented as an unconnected patchwork of efforts and, hence, did not lead to the desired improvement in the performance and achievement of objectives of the health system.

It gives me great pleasure to write a Foreword for the book Maternal Health and Child Mortality: Condition, Vision and Challenges, a volume edited by two young anthropologists of Diphu Campus of Assam University.

Freedom from hunger is basic human right. Nutrition is a state of health conditioned by the ecology of food, and of all factors influencing the health status of the individual members of the society, nutrition exerts the greatest influence. In a country like ours, malnutrition with a high incidence of infection is a major health problem. India shows the highest occurrence of childhood undernutrition in the world and it has been estimated that nearly half of the Indian children are undernourished. Malnutrition is the significant underlying factor for high incidence of infant and child mortality, growth retardation and reduced mental efficiency. The worst victims of malnutrition are not only the economically vulnerable segments of the society but more particularly, the biologically vulnerable groups like infants, pre-school children, expectant mothers and lactating mothers. The Census of India (2011) has recorded that 41.3 per cent of the girls in India get married before attaining 19 years of age. In rural India, 47.3 per cent of girls get married before attaining the age of 19 year, while in urban areas, the corresponding figure was found to be 29.2 per cent. Marriage at adolescent age has an adverse effect on the health status of the girl. All these proximate causes are ultimately linked to a host of underlying factors, specifically poverty and ignorance being the most significant determinants. Culture plays a great role on the mother-child health in India.

India is now committed to achieving universal health coverage, and that the Government of India launched the Ayushman Bharat Yojana on September 23, 2018, which rest on the twin pillars of health and wellness centres, and the National Health Protection Mission (AB-NHPM) has a target for 100 million families covering 500 million individuals. It is not impossible to achieve the target within a reasonable period of time with concerted efforts, but the problem we are facing is shortage of: medical practitioners particularly in the villages, that puts a strain on the public health facilities, and coupled with it is the poor infrastructure development programmes at the village/block level. There also lies lack of desired specific training programmes for health care workers at the village level. Hope in near future the prevailing situations will change greatly towards providing a much better all-round health care facilities to the rural people of the villages in India.

In rural areas of India, the greatest need is of the primary health care facilities and the supporting infrastructure facilities in the region for running the primary health centres. Health centres must be supported with regular communication and transportj facilities will all weather roads connectivity with villages and remote rural areas. Communication and road connectivity is in a very poor shape in rural areas that I have seen and experienced while conducting fieldworks in interior villages among the tribals of Ranchi and Hazaribagh districts when Jharkhand was not yet formed. However, health care facilities and connectivity have improved to some extent in rural areas only after the formation of the state of Jharkhand.

Apart from nutrition and health studies of the tribes and castes in India, the anthropologists in India are now more inclined in working on medical anthropology and medical economics, and other related parameters in rural and urban areas to understand the health and nutritional status and related aspects of the people in a holistic way.

**Contents and Sample Pages**