Still a long road ahead to single digit MMR and IMR

To ensure India is a developed country by 2047, we need to act now, and make Maternal & Infant health a top priority, similar to the IT sector. Panels will need to be formed with senior experienced members leading the initiative.

India hopes to become a developed country by 2047 according to Prime Minister Narendra Modi’s latest 77th Indian Independence Speech on August 15, 2023.

But can we say the same thing with Maternal and Child Health (MCH)? We still have one of the highest maternal mortality rates (MMR) in the world with 93/100,000 deliveries and unacceptably high infant mortality rates (IMR) with 45/1000 live births. These have come down drastically over the last few years, but it is not enough. Declining numbers from this level will be much tougher. We need to reach single digit for both these indices. Especially as IMR does not include Neonatal Mortality Rates (NMR) of babies born less than 28 weeks in India.

Cloudnine, a leading chain of maternity and baby hospitals, established in 2006, in the last 16 years has achieved nothing short of miraculous results, a Maternal Mortality of 3/150,000 deliveries, one of the lowest in the world and IMR less than 0.3 per 1000 live births despite delivering babies less than 28 weeks in its centres.

This was achieved by taking multiple steps, including:

• Buying standard equipment from reputed international companies, despite it more expensive, purely for the guarantee of the quality and not much maintenance issues.
• Compulsory antenatal classes by obstetrician, neonatologist, anesthetist, physiotherapist, alongwith the lactation consultants or dieticians for all couples undergoing pregnancy and childbirth.
• Educating and making all mothers aware regarding the changes their body goes through in pregnancy, how to nurture the body, nutritional requirements, pelvic floor exercises and preparation for breast feeding.
• Identifying and educating the support person for the new mother, usually a partner or a close relative.
• Having on board senior doctors with MD qualification as obstetricians, pediatricians, and anesthetists.
• Sensitizing the entire team at each hospital to handling emergencies.
• Screening every new born baby for standard medical disorders, as specified by the American Academy of Pediatrics before declaring them normal.

To achieve this on a national level, and improve MMR, the problems need to be addressed at the grassroot level. Education, elimination of myths, enforcement and enlightenment are some serious issues. Ignorance, illiteracy and belief in age old practices can only be eliminated through mass education. Education on pregnancy, childbirth and safe motherhood should become compulsory in high schools.

These include measures as encouraging rural practicing doctors for fellowships and trainings in obstetrics and women’s health; enforcing accountability for each and every infant death; infrastructure improvement in rural areas, through Private Public Partnership and amendment in current governmental policies by suitably rewarding and extending tax concessions, encouraging indigenously manufactured equipment manufacturers to follow international standards.

A recent judgement on Indraprastha Apollo case is a disgrace on government facilities. The judgement says, private facilities should provide better facilities than government ones. Does that imply, it is acceptable for government facilities to lag behind? How much compromise is acceptable? How poor can the government facilities be compared to private hospitals? How can we suggest that the Indian citizens who cannot afford medical care be treated at government hospitals with higher death rate. This not only insults the poor, but also compromises the position of the government authorities. And in no way helps achieve the desired MMR by 2030!

Currently the private sector pays nearly 28 percent GST for equipment procured versus the public hospitals that do not pay any taxes, nor rent or lease for their buildings, thus bringing their costs much lower than private hospitals. Administrators in the public hospitals need to be selected on merit rather than because of their personal connections with senior government officials.

To ensure India is a developed country by 2047, we need to act now, and make Maternal & Infant health a top priority, similar to the IT sector. Panels will need to be formed with senior experienced members leading the initiative.

The neonatal and prenatal devices market share in India is expected to increase by USD 4 billion from 2021 to 2026, and the market’s growth momentum will accelerate at a CAGR of 5.21 percent. This offers a huge potential for the equipment sellers and the hospitals, and can be one of the biggest drivers of economy too.

The author is also Sr Consultant Neonatologist, Cloudine Hospital & Professor (Adjunct) of Neonatology, Notre Dame University, Perth, Australia.