India Sees Shift to Institutional Births
Recent data from India indicates that institutional deliveries have risen to 96.1% of all births, up from 73.7% in previous years. Consequently, births attended by traditional midwives have fallen to just 0.9%. While this marks progress in maternal health, care gaps reportedly remain for marginalized communities.
- The drive to increase institutional births is largely underpinned by government programs like *Janani Suraksha Yojana* (JSY), a conditional cash transfer scheme, and *Janani Shishu Suraksha Karyakram* (JSSK), which provides free services to pregnant women and sick newborns. - This policy shift has correlated with a significant drop in India's Maternal Mortality Ratio (MMR), which declined to 88 deaths per 100,000 live births by 2022, on track to meet the UN's Sustainable Development Goal target of 70. - In 2018, the Indian government released the "Guidelines on Midwifery Services in India," establishing a new cadre of formally trained Nurse Practitioners in Midwifery (NPMs) to provide respectful, evidence-based care. This initiative aims to create dedicated Midwifery Led Care Units (MLCUs) within existing health facilities to promote natural birthing and reduce unnecessary medical interventions. - Despite progress, significant barriers remain for marginalized groups, particularly tribal women, who may face geographical isolation, transportation issues, cultural insensitivity from healthcare staff, and a preference for traditional birthing practices. - Community-level care is facilitated by Accredited Social Health Activists (ASHAs), who play a crucial role in counseling women on institutional delivery and connecting them to the healthcare system. Studies have shown that women who use ASHA services are significantly more likely to have an institutional birth. - The role of traditional birth attendants, or *dais*, has been significantly diminished by these policies, and they are often not integrated into the formal healthcare system despite still attending a notable percentage of rural births. - India is increasingly leveraging digital health tools to bridge care gaps. Mobile health (mHealth) initiatives like the *Kilkari* mobile messaging service provide timely health information to families from pregnancy through the child's first year. - Digital platforms like ANCHAL are being used in some regions to create a connected ecosystem between frontline health workers, health facilities, and ambulances to track high-risk pregnancies and ensure timely access to care. Telemedicine services, such as the government's eSanjeevani platform, are also expanding access to prenatal and postnatal consultations in underserved areas.
