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India will win if it cares for its women and mothers

India has made considerable gains over the past decade to address the issue of maternal mortality ratio, but concerns over the health of the mother and child remain

Marcus Ranney
Published: 15, Jun 2016

Dr. Marcus Ranney completed his Bachelors of Science and Medical degrees from University College Medical School in London. His passion for sports and extreme medicine and physiology has stemmed for more a decade, conducting field research across the planet. His expeditions have led him climbing the sides of Everest, skiing across the Arctic and traversing the European Alps. He has served as a medical officer in the Royal Air Force fueling his desire for flight and also at NASA’s Kennedy Space Center for one of the space shuttle’s missions to the International Space station. After practicing clinical medicine in London he made the transition to Mumbai where he now works within the Healthcare and Life-sciences industry as a Strategic advisor and Venture Capitalist, blending together his experiences from both the scientific and business worlds. Leveraging his extensive network within the region and strong domain expertise, Marcus has advised and developed strategies for a variety of healthcare organisations and continues to support entrepreneurs and startups in fulfilling their business visions. With a vast set of interests that span from the basic sciences right through to application of clinical medicine and its service delivery, Marcus has a strong ambition to shape the global healthcare landscape. Marcus has always been a person of many interests and continues to expand his spheres of influence across different verticals through strategic mentorship and advisory roles. In his own time he works with a number of NGO's in his capacity as a World Economic Forum's Global Shaper. He is a keen athlete and regularly participates in Half Marathons and Triathlons and has recently been signed to publish his first book in the field of popular science!

A key government intervention known as the Janani Shishu Suraksha Karyakaram (JSSK) scheme encompasses free maternity services for women and children, a nationwide scale-up of emergency referral systems and maternal death audits, and improvements in the governance and management of health services at all levels (Photo: Karves / Shutterstock.com)
A key government intervention known as the Janani Shishu Suraksha Karyakaram (JSSK) scheme encompasses free maternity services for women and children, a nationwide scale-up of emergency referral systems and maternal death audits, and improvements in the governance and management of health services at all levels (Photo: Karves / Shutterstock.com)

A child is added to India's burgeoning population roughly every two seconds. Taking into account that almost 300 million people in India still live below the poverty line, the vast majority of our country struggles with even basic health care cover during this incredible life-changing event. A large number of global maternal and neonatal deaths are unfortunately from India. According to the State of the World’s Mothers report, published in May 2013, by Save the Children, India ranked 142nd out of 176 countries. The index for this ranking was developed on the basis of five indicators — maternal health, children’s well being, educational status, economic and political status of women in the country.

Maternal mortality ratio (MMR), the number of women who die from pregnancy-related causes while pregnant or within 42 days of pregnancy termination per 100,000 live births, is a strong indicator of the status of a country's health care system and unfortunately, India still performs poorly. Data from the World Bank has measured India's MMR to have fallen from 206 per 100,000 in 2011 to 174 in 2015. Unfortunately, almost 70 percent of these cases can be prevented; the main causes being heavy bleeding (haemorrhage) and eclampsia (high blood pressure). The silver lining is that although she still compares among one of the worst culprits in the world, the overall trend is downward and India has made considerable gains over the past decade.

The sad unknown is that for every woman that dies in childbirth, there are about 20 women who end up suffering long-lasting and debilitating illnesses, having massive implications on the overall health and well-being of her family. Societal determinants customary in India such as early age of marriage and early and repeated child-bearing are major factors contributing to this public health burden. Even today, more than 40 percent of girls marry before they are 18. These traditions have serious repercussions, as girls are more likely to become pregnant at younger and riskier ages. The 2015 Global Hunger Index (GHI) Report ranked India 20th among leading countries with a serious hunger situation, behind only Afghanistan and Pakistan in South Asia. With around a third of women being malnourished and half suffering from anaemia, a large minority of women are physiologically ill-prepared to handle childbirth.

Another indicator to keep track of is the infant mortality rate (IMR). This is the number of infants dying before reaching their first birthday, per 1,000 live births in a given year. In this regard, India scores slightly better than before and has seen its number drop from 44 per 1000 in 2011 to 38 in 2015. Once again, the trend is downward, but we are a far cry from China's story, which in the same period of time reduced its IMR from 13 to 9 births per 1000.

I have painted a bleak picture, but perhaps things are not as bad as they seem. The good news is that the Indian government, together with global unilateral agencies, has been investing to counteract this challenge and improve the lives of millions of women and neonates across India. A key government intervention known as the Janani Shishu Suraksha Karyakaram (JSSK) scheme encompasses free maternity services for women and children, a nationwide scale-up of emergency referral systems and maternal death audits, and improvements in the governance and management of health services at all levels. In 2013 and 2014, in addition to supporting courses for skilled birth attendants, UNICEF supported the ministry of health and family welfare to pioneer a short-term training for midwives and doctors on maternal health using models and dummies. Programmes such as these have helped reduce the MMR towards the targets India set itself through the Millennial Development Goals.

That being said, the Indian private sector is motoring along in overdrive too. Expected to touch an annualised growth rate of 38 percent, the maternity and childcare hospital market in India is expected to be worth $27 billion by 2020. While birthing services compose the overall majority within this market segment, encouragingly it is the pre-natal services care segment that will drive most of this growth, expected to increase by 42 percent year on year. A simple Google search will reveal more than 20 private chains of maternity hospitals around the country, offering packaged services from anywhere between $7000 in some of the more luxurious and high-end hospitals to as low as $70 in the rapidly growing chains of affordable birthing centres across India.

The most exciting changes, however, are being led by the increasingly digitised world in which we all live. Last quarter, a total of 24 million smartphones were sold in India. It is now the second largest smartphone market in terms of active unique smartphone users, with the total base crossing 220 million users, says a new report from Counterpoint Research. The power of this technology, residing in an increasing number of kurta pockets is allowing more of its women to have access to good quality information and care services at their fingertips. Consumer research carried out by Google highlighted that baby care and services were among the top five internet searches carried out by women. As the internet infrastructure evolves through the rollout of 4G services, more women will have access to high quality medical information and care through dedicated websites, mobile applications and chatbots residing in traditional mass communication platforms.

Whether it be chatting with other parents around them to find out inside tips for the best schools in the area, communicating with their paediatric nurse or doctor through chat or video consults, tracking their child’s immunisation schedule and growth or just buying another box of diapers, digital technology is helping parents become more informed, connected and efficient. Provided these tools are equally accessible in regional languages and platforms suitable for the various market segments within India’s large socio-demographic divisions, this is great news for its women and children.

Ultimately India will win if it cares for its women and mothers.

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