Maternal and child health care are critical to achieving India’s national health goals. India has made substantial investments to build quality Reproductive and Child Healthcare (RCH) capacity – across infrastructure, services, and skilled human resources. In 2013, to capitalize on these efforts and gains already made, the Government of India (GOI) launched an extensive effort towards Reproductive, Maternal, Newborn, Child, and Adolescent Health (RMNCH+A). What followed were a series of crucial RMNCH+A interventions across 184 high priority districts. The goal was to provide these interventions under a ‘continuum of care’ approach, ensuring focus on women and children’s growth phases. This, in turn, meant the delivery of integrated services across multiple life stages, including adolescence, pre-pregnancy, childbirth and postnatal period, childhood, and through reproductive age. The programs were delivered within a dedicated institutional structure that included National and State RMNCH+A Units and District Level Monitors.
Nearly seven years on, key findings emerging from NFHS- 5 Phase 1 Survey show that investments in RMNCH+A have begun to show positive results across several key indicators. First, there have been substantial improvements in fertility indicators, contraceptive use, and health workers’ reach providing family planning services. Sex Ratio has improved in 14 out of 22 states. Modern contraceptive use has increased shows a favorable shift towards reversible contraceptive methods like Condoms, IUCD, and Injectables. The Antara Program launched by the Ministry of Health and Family Welfare (MoHFW) in 2017 to introduce new contraceptives (injectable contraceptive and pill) in the public health system has contributed to an increase of MCPR within 15 states. Furthermore, the reach of health workers to the female non-users has significantly improved in 15 out of 22 states. Focus on reproductive health and family planning are important markers of a progressive mindset, especially with regards to women. Hence this shift is significant and noteworthy in India’s social and human development journey.
Second, immunization outcomes have improved. Possession of vaccination cards by mothers of young children (below three years) has substantially increased after implementing ‘Mission Indradhanush’ in 2015 and Intensified Mission Indradhanush in 2017. Vaccine coverage among children between ages 12 – 23 months is up, and across states, 70% to 96% of children in this age band have been fully vaccinated, based on information from their vaccination cards. This will go a long way in saving the lives of children and reducing vaccine-preventable diseases.
There are also a host of other indicators that have shown considerable improvement. These include positive trends on early initiation of breastfeeding, increased access, and hygienic protection methods during the menstrual periods. Further, there is clear evidence of expanded health coverage and a substantial increase in the percentage of women who now have bank accounts. These trends are seen as evidence of an increase in women’s economic agency and also a greater probability of making investments in their own health while also supporting families’ health and education needs.
Finally, the survey data has shown that both the number of birth registrations and institutional births have significantly increased. In 14 States/UTs, more than 90 percent of births were delivered in health facilities. These statistics are vital as it means many more women now have access to skilled care during pregnancy and childbirth, which means better prevention, detection, and management of pregnancy related complications. Together, these statistics also directly impact preventable maternal and newborn deaths and are crucial to creating a virtuous cycle of mapping each newborn and providing critical infant-care services. Simultaneously, a mother’s health can be tracked post-partum, and early guidance on breastfeeding and complementary diets for infants can also be provided.
These positive results are encouraging. There is, of course, still much more to be done to improve outcomes across all key indicators as well as all geographies. Indeed, India as a whole, and some states, in particular, still have a high prevalence of stunting, a large population of underweight children, and a prevalence of anemia among pregnant women. Going forward, as further evaluation is carried out, NFHS-5 data will remain key to examining the progress made on all critical national health indicators. On the one hand, this data set will provide evidence for the effectiveness of ongoing programs. Simultaneously, it will also help identify the need for new programs with an area-specific or community-specific focus. Thus, both for intervention design and identification of vulnerable groups, this data is invaluable to building a nationwide practice of rolling out health interventions rooted in granular evidence from the ground.
(The author is Executive Director of International Paediatric Association. Views expressed are personal and do not reflect the official position or policy of the Financial Express Online.)