Women and Child Development: Where Policy Meets The Personal
By Dr. Smita Vats
Science and technological advancements have revolutionised the field of modern medicine, however, It is sad to see that in today’s day and age, approximately 800 mothers die each day and majority of these deaths are reported from low and middle income countries.
Even in this, the decline has been variable across the country based on the region – with Southern states performing better
Recent data indicates that in India, the MMR is still > 70 / 100000 live births in 90% districts, with about 128 districts having a MMR of > 200. Whereas, the United Nations Sustainable Development Goals (UN SDG)aim to reduce it to < 70/100000 live births.
Similarly, for child-health also, the Southern states are performing better than the Northeastern, Central or Northern states with regards to lesser children showing stunted growth, low birthweight, anaemia, infections, Immunization status etc.
The geographical variation in access and performance of healthcare is attributable to the huge land area, population density and variation, socio-cultural practices, level of education etc . Moreover, in the North-Eastern states, the healthcare system is more fragile due to the difficult geographical terrain and climate peculiarities.
Factors affecting Maternal Mortality and Child Health in India
The causes of Maternal mortality across different states in India are variable with Obstetric hemorrhage and Hypertension contributing to > 30% of Maternal Mortality whereas Anemia ( 25 % ) , Pregnancy related infections, Abortions, Malaria, Tuberculosis etc. are responsible for other cases.
States with better socio-economic status have a higher incidence of Hypertension and states with poorer socio-economic status have haemorrhage, anemia and sepsis as leading causes of maternal mortality.
Other important factors that affect maternal mortality include:
The delay by pregnant woman and her family in deciding and reaching the healthcare facility
Transportation delay
Delays at healthcare facility due to lack of infrastructure/ staff / services- including vacancy and absenteeism of health personnel at public health facilities
Shortage of skilled personnel at health centres
Dysfunctional or poorly developed referral systems
Shortage of medical supplies and vaccines
Corruption and poor management of resources
Misinformation / lack of information regarding Govt health schemes and available facilities
Under-reporting of morbidity and mortality data ( only ~ < 50% of maternal deaths are reported)
Apart from geographical and infrastructure factors discussed above, Child health is significantly affected by the age of parents, socio-economic status and level of education of the parents.
In a study, the children of mothers who were < 25 years of age had a higher incidence of anaemia, stunted growth and Nil/ incomplete immunization.
The Socio-economic status is directly related to the intention of the parents to seek healthcare for their child and so parents of poor socio-economic status / backward social classes / tribals etc had lesser probability of seeking timely /regular healthcare for their child.
Similarly, educated parents are more aware of the need and benefits of seeking timely medical intervention and following healthy/ hygienic dietary and lifestyle habits as compared to uneducated parents and this directly impacts child health.
The Government of India has been making consistent effort towards improving Maternal and Child Health in the country and over the years, multiple health schemes have been launched to achieve the targets. Some of the schemes are as follows:
Janani Suraksha Yojana (JSY) ( 2005 )- promotes institutional deliveries through cash incentives to pregnant women and ASHA workers, especially targeting low-income and rural populations. It significantly increased institutional birth rates, though quality of care in facilities remains variable.
Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA)( 2016)- provides assured antenatal care on the 9th of every month, including check-ups, diagnostics, and counselling, supported by voluntary participation of private gynaecologists. It has improved ANC access, especially in urban clusters.
LaQshya ( 2017 ) - focuses on improving labour room and maternity OT quality through infrastructure, training, and certification. It enhances respectful maternity care and reduces complications, but sustainability and post-certification monitoring need reinforcement.
POSHAN Abhiyaan ( 2016)- aims to reduce malnutrition in children and mothers through technology-enabled monitoring, intersectoral convergence, and behaviour change strategies. It has improved nutritional awareness, but regional disparities persist.
Mission Indradhanush ( 2014) -and its intensified version aim for full immunisation among children under 2 and pregnant women, with targeted drives in underserved areas. It has boosted vaccine coverage, though misinformation and hesitancy remain challenges.
Pradhan Mantri Matru Vandana Yojana (PMMVY) provides conditional maternity benefits of ₹5,000 to compensate for wage loss and encourage ANC and child immunisation. Implementation gaps and exclusion criteria affect its reach.
The performance of these schemes is measured by utilisation of Antenatal care facilities, Institutional deliveries, Postnatal care . For child health also , the data for number of immunisations, children showing stunted growth, malnutrition or anaemia is captured and analysed.
Suggestions for improvement
Continuity of care remains a concern in India despite improvements in service uptake between 2015-16 to 2019-20 :—
Many beneficiaries receive incentives for delivery without completing the recommended 4 ANC visits, weakening preventive care. Linking cash benefits to full ANC compliance could improve maternal outcomes.
Key solutions include:
Improving female education (e.g., Beti Bachao, Beti Padhao)
Enhancing the household wealth index
Delaying age at marriage and childbirth
Empowering women’s autonomy and decision-making
Expanding maternal health insurance and public awareness
Incentivising rural deployment of healthcare workers with housing and education support
Improving ambulance services and referral systems
Investing in digital tracking for maternal and neonatal health.
These multi-pronged interventions are vital to ensure every pregnancy is safe, monitored, and well-supported across India.
India has made measurable progress in improving maternal and child health, but the real transformation lies in bridging the last-mile gaps—in continuity of care, informed access, and equitable service delivery. Empowering women through education, economic security, and health autonomy, while strengthening healthcare infrastructure and accountability, is not just a policy goal—it is a national imperative. A healthy mother and child are not only the foundation of a strong family but also the true indicators of a nation’s growth and humanity.
Author: Dr. Smita Vats is Additional Director and Head of Obstetrics & Gynaecology at Fortis Hospital, Manesar
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