As we approach the 2015 deadline for the Millennium Development Goals, what does the future hold for international maternal mortality targets? The MHTF is pleased to be hosting a blog series on post-2015 maternal mortality goal setting. Over the next several weeks, we will be featuring responses and reactions to proposed targets from around the world. Please share your thoughts with us!
Point 1:
- India has the largest annual birth cohort of 26 million babies. In 1990 our maternal mortality ratio (MMR) was 600 deaths per 100,000 live births which declined to 200 in 2010
- India achieved 66% decline compared to 47% of global decline.
- We have wide variations in the states. Uttar Pradesh in 1997-98 had MMR of 606 while Kerala had 150. UP came down to 309, while Kerala came down to 81 in 2007-09.
- The point decline of UP was 297 while that of Kerala was 69. UP declined by 49% whereas Kerala only 46%.
- Now the point is: targets for UP and Kerala cannot be same.
Point 2:
- The targets and goals for MDGs were set in the year 2000, but its active monitoring by international and national organizations and countries began only after an initial 5-7 years passed. The countries started monitoring the achievement in the past 5-7 years.
While keeping next MDG goals and targets and in view of our experiences with different states/provinces it is suggested that:
- There should be different goals for countries depending upon their present level of achievement since further reduction after achieving a low/very low MMR will not be easy.
- Percentage reduction (differential) for different groups of MMR i.e. MMR between 500 to 400 . . ., 100 to 20. . . can be one of the options.
- Every country can then give a differential target or goal to the States and population within their country.
- For each such group of MMR, the broad strategies should also be decided as a suggestion for the states so that the states having less than 100 or 50 MMR have a clear vision what additional focus is needed
- While preparing strategies, socioeconomic factors should be taken in account along with clinical causes.
- Process indicators for every 5 years and its part for every year should be simultaneously decided so that the countries know and concurrently monitor where they stand if they have to achieve a certain level within the defined time period.
Finally, we need to discuss what should be our ultimate commitment for maternal mortality, whether it should be limited to reduction or should be a commitment like achieving a zero level, at least for preventable deaths – as in the polio programme.
The points raised above are at present not the view policy of the government of India but my thought process based on experiences in the implementation and seeing the ground realities from close.