The Modi government 2.0 has laid out its vision and plan to give a thrust to the Indian healthcare sector with a focus on accessibility and affordability. That said, there is a need to prioritise critical and avertible health challenges such as maternal mortality. While various socio-economic factors coupled with the government’s efforts have helped India show impressive progress in reducing maternal mortality, the fact is that most maternal deaths are preventable. So, there is potential for a lot more to be done.
Over the years, various government initiatives such as increased access to quality maternal health services, state-subsidised financing for pregnant women under the Janani Shishu Suraksha Karyakram coupled with societal changes of education of girls and avoidance of early marriage, etc. has resulted in significant reduction in the maternal mortality rate (MMR). As per WHO data, India has been successful in reducing MMR by 77% — from 556 per 100,000 live births in 1990 to 130 per 100,000 live births in 2016. However, India has a long road ahead in meeting the Sustainable Development Goal (SDG) target of an MMR below 70 by 2030.
While concerted efforts through various initiatives need to be made to meet the SDG target on MMR, it is crucial to identify and address its fundamental causes in India. One of the most common and preventable cause of maternal death is Postpartum Haemorrhage (PPH), i.e. excessive bleeding after childbirth. PPH accounts for about 35% of all maternal deaths globally and about 30% of maternal deaths in India. Replacement of blood and blood products plays an important role in managing PPH. So, access to timely delivery of care and to safe and adequate blood for transfusion can be a gamechanger in the effort to eradicate maternal casualties.
In the context of MMR, especially in the rural areas, a significant percentage of pregnancy cases (including high-risk cases) are referred to the community health centres too late. This results in a delay in proper care, poor preparedness to handle risks, including managing PPH, and providing access to safe and adequate blood.
Access to safe blood and blood products remains a major area of concern in India. We face a challenge of acute shortage of safe blood, which is a critical life-saving pillar of any healthcare system. The WHO estimates that blood donation by 1% of the population is generally the minimum to meet a nation’s most basic need for blood. As per the data of 2016-17, India had a shortfall of 1.9 million units (or 15%) vis-à-vis the WHO norm.
In the absence of an organised nationwide blood transfusion service in India, there is almost negligible connectivity and communication between blood banks. As a result of which, there is inefficient management of demand and supply both in terms of availability as well as quality of blood. While most of the metro cities are nearly self-sufficient in blood, tier-II and rural areas still face huge life-threatening shortages. Therefore, there is a a compelling need for India to institutionalise a robust blood transfusion service which can support as a network connecting blood-collection centres across regions, enabling them to mitigate demand-supply discrepancies and ensure economic efficiency and viability of blood banks.
Having said that, an effective blood transfusion service is dependent on consistent all-year round availability of safe blood from donors with different blood groups. As of today, a vast majority of blood collection in India is dependent on replacement blood donation. However, this is not a sustainable and safe mode of blood collection as it does not necessarily replace the blood group or quantity used and poses increased risk of transfusion-transmissible infections. In addition, it causes life-endangering delay in case of emergencies like PPH.
It is therefore crucial that India establishes a pool of healthy, voluntary blood donors through an effective voluntary blood donor programme. One of the biggest impediments in achieving this is widespread misinformation and ignorance about the effect, importance and safety of voluntary blood donation. Even the most educated people in India perceive blood donation to be an emergency service, i.e. donate blood when asked. Evidence from around the world shows that establishment of an effective voluntary blood donor programme involves mobilisation at various levels — grassroots, State and national — to increase public awareness.
These two crucial interventions to address the issue of access to safe and adequate supply of blood could save lives of many pregnant women across India, especially in rural areas. In fact, according to WHO, there are several countries such as Cambodia, Nepal, Bangladesh, Zambia and Ethiopia that have successfully reduced maternal deaths by improving access to safe blood.
In view of this, it is critical for the Ministry of Health and Family Welfare and the State Health Departments to collaborate with relevant stakeholders to take concrete steps towards improving access to safe blood as part of a comprehensive approach to reduce maternal mortality in India. This will also present opportunities to align maternal health programmes with blood transfusion services to not only improve MMR indicators in line with India’s SDG targets, but also support strengthening of India’s vision of expanding universal health coverage. – The Hindu