The end of 2015, which marks the conclusion of the 25-year period (1990-2015) for reaching the millennium development goals (MDG), is in sight and a recent World Health Organisation (WHO) study looks at how well the world, particularly those parts of it at medium and low human development levels, has fared in the key area of maternal mortality two years before (1990-2013) the closing bell rings. Picking out the maternal mortality rate (MMR) benchmark (the number of mothers dying within six weeks of child birth per 100,000 live births) makes sense as it gives an idea of the state of mother and child care - which is a good proxy for the level of human development achieved. One of the goals set was to bring down the MMR by 75 per cent from its 1990 levels. Countries which had some distance to go in 1990 have been categorised as being "on track", "making progress" and "making insufficient progress".
By these measures, two small South Asian countries, Nepal and Bhutan, the former is particular far poorer than India, have made outstanding progress and are classified as being "on track". In comparison, India is "making progress", as are Bangladesh and Pakistan. What is remarkable is that both Nepal and Bhutan were far behind India in 1990 (Nepal at 790 and Bhutan at 900, compared to India's 560). But now, Bhutan (at 120) has overtaken India (at 190) by miles, so to speak. Bangladesh which was slightly ahead of India remains so, as does Pakistan. The same story is told by the figure of the average annual percentage change in the indices: Bhutan leading the fall at -8.4 per cent, followed by Nepal at -6 per cent and Bangladesh at -5 per cent, with India in the second lowest position at -4.5 per cent, ahead of only Pakistan which clocked -3.6 per cent. These figures are a severe indictment of the regimes (they cut across the entire political spectrum) and policies that India has experienced in the past decades. India's rapid economic growth in the period has taken it to the second place in the region in terms of per capita income, but Nepal and Bangladesh with lower incomes have done better on maternal mortality.
There is, therefore, an urgent need to look at policies to do better in the future. Since it is the poor who cannot afford better private care and so contribute the most to India's relatively high MMR, there is an urgent need to raise the level of public spending on health care. Higher pay for government doctors and nurses, which a new pay commission award is likely to bring, will be a move in the right direction. This must go with vastly better administration. The various current schemes under the National Health Mission dealing with postnatal care must be reviewed at the highest level.
