Context

• Despite steady improvement in India's Maternal Mortality Ratio (MMR), stark regional disparities and systemic gaps persist. The editorial emphasizes the urgent need for differential strategies across states, enhanced health infrastructure, and strengthened accountability mechanisms to eliminate preventable maternal deaths.

Background

• Maternal Mortality: Defined as the death of a woman during pregnancy or within 42 days of termination, due to pregnancy-related causes. India's reduction in MMR is notable, but many states lag due to poor infrastructure, delays, and inadequate emergency obstetric care. A need for context-specific, regionally differentiated approaches has emerged.

Government Initiatives

• Janani Suraksha Yojana (JSY)
• Janani Shishu Suraksha Karyakaram (JSSK)
• Surakshit Matritva Aashwasan (SUMAN)
• LaQshya Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA) 
• Mother and Child Protection (MCP) Card 

Challenges Highlighted

• Persisting Regional Disparities: Wide MMR variations between states: Kerala (MMR 20) vs Madhya Pradesh (MMR 175) and Assam (MMR 167). Empowered Action Group (EAG) States continue to suffer from systemic underperformance in maternal healthcare delivery.
• Delay in Seeking and Reaching Care (Three Delays Model): First Delay: Lack of timely recognition of danger signs due to poor education, financial insecurity, and social inertia among families. 
• - Second Delay: Inadequate transport, especially in remote villages, forest areas, or islands. 
• - Third Delay: Lapses at healthcare facilities-delays in treatment, staff unavailability, OT readiness, and lack of blood donors.
•  Shortage of Skilled Human Resources: 66% vacancy in specialist positions (obstetricians, anaesthetists, paediatricians) at Community Health Centres (CHCs).
• Inadequate Emergency Obstetric Infrastructure: Lack of functional blood banks and storage units delays life-saving transfusions.
• Medical Complications Poorly Managed: Postpartum haemorrhage (PPH) remains the leading cause of maternal death, especially in anaemic mothers. Hypertensive disorders of pregnancy, when untreated, lead to seizures and death.
• Unsafe Abortions and Sepsis: Failure of contraceptive access results in unsafe abortions by quacks, leading to infections and maternal death. Late hospital admissions and untrained birth attendants exacerbate sepsis risk.

Way Forward

• Adopt Differential, Cluster-Based Strategies: EAG States: Focus on basic maternal care-early registration, antenatal check-ups, and functional FRUs. Southern States & Developed States: Refine quality of emergency obstetric care.
• Strengthen FRU Infrastructure: Ensure fully functional FRUs with specialist staff, blood storage, OT and emergency equipment.
• Streamline Emergency Response: Expand and strengthen the 108 ambulance network and ensure timely transport, especially in remote areas.
• Improve Community Awareness and Empowerment: Empower SHGs and local women's groups to reduce first delay. Sustain ASHA-ANM networks and financial incentives for institutional deliveries.
• Address Anaemia and Malnutrition Proactively: Strengthen iron-folic acid supplementation and nutrition programmes during pregnancy to prevent haemorrhagic shock.
• Ensure Contraceptive Access and Safe Abortion Services: Reduce deaths from sepsis by expanding access to family planning and safe abortion methods. Integrate Maternal Mental Health: Recognise and treat antenatal depression and post-partum psychosis within public health strategy.