New Delhi, April 3: India's maternal mortality is high due to a lack of political will and administrative and managerial failures rather than absence of expertise, an article published in WHO magazine said.

India has the largest number of births per year (27 million) in the world. With its high maternal mortality of about 300-500 per 100,000 births, about 75,000 to 150,000 women die every year in India after giving birth.

"This is about 20 percent of the global burden. Hence India's progress in reducing maternal deaths is crucial to the global achievement of Millennium Development Goal 5," Dileep Mavalankar, Kranti Vora and M. Prakasamma have said in an article in the April issue of WHO magazine.

They also pulled up the central government's flagship National Rural Health Mission, which aims to provide quality healthcare to the rural populace, for not making any difference in villages.

The article, titled "Achieving Millennium Development Goal 5: Is India serious?", said: "We feel strongly that without a clear strategic focus on skilled birth attendants, emergency obstetric care (EmOC) and referral services, India will not be able to reduce maternal mortality rapidly."

While both Mavalankar and Vora are from the Centre for Management of Health System at the Indian Institute of Management, Ahmedabad, Prakasamma works for the Academy for Nursing Studies in Hyderabad.

"Why is India's maternal mortality high in spite of rapid economic growth? We believe the key reasons are political, administrative and managerial rather than a lack of technical knowledge."

For politicians, health is a low priority, they noted.

"Government expenditure on health has been a mere 0.9 percent of GDP, while a large percentage of the budget is spent on defence, un-targeted subsidies and non-vital infrastructure. No political party has maternal health on its priority agenda."

In 1992, India launched the Child Survival and Safe Motherhood programme (at a cost of about $300 million) followed by a five-year programme ($250 million) called Reproductive and Child Health-I in 1997.

"Although EmOC was one of the strategies, it was not implemented due to lack of focus and limited management capacity. Even today the government does not systematically monitor how many EmOC facilities are fully functional," the WHO magazine said.

"In spite of rhetoric from the National Rural Health Mission, changes on the ground to improve maternal health care are slow and lack focus."

In the 1960s, India created a cadre of two-year trained rural midwives called "auxiliary nurse midwives" (ANMs) to provide maternal and child health services.

But the report said their designation as 'auxiliary' undermined their status and function as midwives, leading to the lack of professional or skilled midwives in the country.

"Lack of qualified midwives is a major human resource constraint for providing locally accessible skilled delivery care for rural women. India ignored the development of a midwifery cadre, which has led to persistent dependence on traditional birth attendants for deliveries and a high maternal mortality rate," it said.

India has only three technical officers for maternal health at the national level. Almost no state in India has a maternal health director, the WHO report said.

"This explains why maternal health strategies are not implemented effectively, and maternal deaths and pregnancy outcomes are not monitored. Lack of management capacity in the health system has led to poor quality services and slow progress."

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