Women's health: women's health is a global issueBMJ 1997; 315 doi: https://doi.org/10.1136/bmj.315.7116.1154 (Published 01 November 1997) Cite this as: BMJ 1997;315:1154
All rapid responses
WHO defines reproductive health as the one that addresses the reproductive processes, functions and systems at all stages of life so that people are able to have a responsible, satisfying and safe sex life. It is well recognized fact that reproductive ill health could be prevented by following safe sex practices such as avoiding unprotected intercourse, prevention and treatment of RTI/STIs and improving maternal health by preventing unsafe abortions, prevention and early treatment of pregnancy related complication through early registration of pregnancy and provision of intra-natal and post natal care to avoid risky labour and post natal complications which contribute to major chunk of reproductive mortality.
Improving maternal health is one of the eight goals of Millennium Development Goals. Maternal mortality is the indicator of maternal health. India contributes one-fifth of the global burden of absolute maternal deaths; however, it has experienced an estimated 4.7% annual decline in maternal mortality ratio (MMR), and 3.5% annual increase in skilled birth attendance since 1990 1. While not on track to meet Millennium Development Goal number 5, India is making progress in reducing maternal mortality.
Maternal mortality now accounts for 0.55% of all deaths and 4% of all female deaths in the 15 to 49 year age group2.
Mahesh Devnani and colleagues 3 discuss (in their rapid response in the BMJ) the following:
According to World Health Organization (WHO)4 and Ministry of Health and Family Welfare, Government of India (MoHFW)5 the MMR in India in 1990 was 560 per 100,000 live births whereas as per United Nations Development Programme (UNDP)6 and Ministry of Statistics and Programme Implementation, Government of India (MoSPI)7 it was 437 per 100,000 live births. Accordingly, as per WHO/MoHFW the MDG target of MMR for India to achieve by 2015 is 140 per 100,000 live births whereas as per UNDP/MoSPI it’s 109 per 100,000 live births4,5,6,7.
The MDG target for Maternal Mortality Ratio (MMR) is 109 per 100,000 live births. From a baseline of 560 or 437 in 1990, the nation had achieved 178 by 2010-12 (SRS), and 167 till 2013 (SRS) at this rate of decline is estimated to have reached an MMR of 141 by 2015. Maternal mortality and poor access to healthcare is disproportionately higher in rural populations of the poorer states of India. The draft National Health Policy, 2015 proposes to underpin the quality of care and facilities in the health care for further attaining the stipulated goals.
Provision of family planning and institutional deliveries are two key strategies for reducing Maternal deaths and improving women’s health. The irony is that most causes of maternal mortality are preventable causes (Haemorrhage, Anaemia, Sepsis, Obstructed Labour, Abortions, Toxaemia). The research should address the causes of maternal deaths and translate into the easy and feasible interventions for prevention and management of these causes.
Unmet need for Family planning is percentage of currently married women who either want to space their next birth or stop childbearing entirely but are not using contraception. Women have unmet need for family planning, down from 20 percent in NFHS-1 and 16 percent in NFHS-2. Currently, 82 percent of the demand for family planning is being met, up from 67 percent in NFHS-1 and 75 percent in NFHS-2.
Low acceptance of family planning methods not only leads to reproductive ill-health consequences including high MMR but also increases Total Fertility Rates. India aims at reducing the TFR to 2.1 (replacement level fertility) which would now only be achieved by 2020. The TFR for country in 2012 was 2.4.
Thus we need to intensify our research in women’s health which will address the issues of improving maternal health and enhancing contraceptive prevalence which will in turn contribute to health, productivity and overall development of the nation. Analysis of various causes of maternal mortality and morbidity have shown that early marriage, pregnancy at an early age, low acceptance of family planning methods, lack of awareness of safe motherhood practices and safe abortion services, low access to health facilities and poor quality of health services, delivery by unskilled providers, low socio-economic status and low decision making power of woman for her own health are some of the contributing factors for maternal illhealth. Also, such unsafe practices have made women vulnerable to RTI/STIs thus making them predisposed to HIV/AIDS. Such additional spacing methods as injectables are being explored and tested to be considered to expand the basket of family planning choices in the NFWP and reduce unmet need.
1. Montgomery AL, Ram U, Kumar R, Jha P; Million Death Study Collaborators. Maternal mortality in India: causes and healthcare service use based on a nationally representative survey. PLoS One. 2014 Jan 15;9(1):e83331. doi: 10.1371/journal.pone.0083331. eCollection 2014
2. http://www.thehinducentre.com/multimedia/archive/02263/Draft_National_He... (as accessed on 10/07/2015 at 1.39 PM)
4. World Health Organization. Trends in maternal mortality: 1990 to 2013. 2014.http://apps.who.int/iris/bitstream/10665/112697/1/WHO_RHR_14.13_eng.pdf.
5. Ministry of Health and Family Welfare, Government of India. National Health Policy 2015 Draft, December 2014. http://mohfw.nic.in/showfile.php?lid=3014.
6. United Nations Development Programme. India - Millennium development Goals - Overview - Improve Maternal Health.http://www.in.undp.org/content/india/en/home/mdgoverview/overview/mdg5/.
7. Ministry of Statistics and Programme Implementation, Government of India. Millennium Development Goals: India Country report 2014.http://www.in.undp.org/content/dam/india/docs/MDG%20-%20India%20Report%2....
Competing interests: No competing interests