Maternal Health and Care in India: Why a Major Public Health Strategy Is Essential

Abstract

India has large inequalities in maternal health and high maternal mortality and morbidity rates. A social model of maternal health was used as a framework for a broad review of online published literature to appraise the approaches used by India to address these issues and to examine the potential for reducing the country’s maternal health inequalities.The review found the following:• An apparent lack of coordinated economic, social, and health strategy and policies focused on improving maternal health• No acknowledgment in national health policy of the limitations of the medical model of maternal health and little apparent mention of the social model• No evident national frameworks for quality assurance in maternity care• Lack of recognition of the importance of woman-centered care• No evident comprehensive maternal health needs assessment to underpin coordinated multisector working• An apparent lack of reliable national data collection for setting inequality targets and monitoring progress• No apparent performance-focused management system for improving maternity care nationally.Although India has made large increases in maternal health care provision over recent decades, a pragmatic review of government policies, the reports of international agencies, and the findings of published research studies indicate that major barriers exist to reducing maternal health inequalities and to achieving good quality care for disadvantaged women. The main barrier appears to be the widespread use at all levels, including government, of the medical model of maternal health, which focuses mostly on obstetric interventions and fails to address the wider economic and social determinants of maternal health or to use a woman-centered approach to maternity care.We recommend that Indian governments adopt instead a “social model” approach to maternal health improvement and urgently employ a public health strategy led by a national multisector task force to reduce inequalities in maternal health.