Maternal and reproductive health services include curative and preventative health services for women of reproductive age. The challenges of reproductive health are large, and free public services are advised, given their positive impacts on women's health, infant and toddler health, and fertility regulation. Reproductive health is not only about mortality/morbidity, it is about the recognition of women's rights to control their fertility and sexuality, and empowering women to avoid sexual violence. Maternal health is the urgent need of the state as they contribute to the overall progress of the country. Jharkhand state has strived hard to improve on the maternal health indicators but the progress is slow and steady. There are many causes hampering the smooth progress of maternal health status. The medical causes (direct & indirect) which include Severe Bleeding Hemorrhage, hypertensive diseases (Eclamsia),unsafe abortion, Obstructed Labor, Ectopic Pregnancy and infections are direct causes, whereas the indirect causes include Anemia, Malaria, Heart Disease and Tuberculosis and HIV. Whereas the social determinants of maternal mortality are poor educational levels, early age of marriage, early pregnancy, decreased spacing and large family size that contributes to the existing situation of maternal health status in Jharkhand. The sex ratio of women is 941 to 1000 males. The literacy rate of women is only 35.1% as against 64.9% literacy rate of men. About 36% of the women get married by 18 years and the total fertility rate is 3.31% according to the NFHS 3 data. 51.4% of women age 20-24 have a birth of order 2 & above. The DLHS 3 data also states that only 19.1 % of mothers consumed 100 IFA Tablets. Maternal mortality in Jharkhand though is in the decreasing trend there are lot of risks due to pregnancy related causes. So it is of utmost urgency to look into women’s health holistically to understand their health problems.
Strategies and Activities for Maternal Health
- Core skill training of Health workers to address ANC, perinatal and PNC situations. Trainings for Medical Officers for BEmNOC, EmOC & LASAS will continue.
- Strengthening MCH tracking system – status of the tracking will be reviewed from the block to the district level
- Scaling up of the Labor room in Tribal Area and formation of Waiting Room to be functional 24X7
- Micro birth preparedness plan for the JSY beneficiaries.
- HIV/AIDS Screening
- Promoting house-visits by Sahiyyas, AWWS and ANMs within 48 hours of delivery and if in hospital promoting 48 hours of post-delivery stay in the hospital to ensure PNC.
- Focusing 19 districts of Jharkhand where maximum maternal & child deaths take place and having high TFR and strengthening the supportive supervision and capacity building in these districts.
- Intensive focus on low performing divisions especially the Santhal Paraganas and North Chotanagpur.
- Strengthening of Mukya Mantri Janani Sishu Swasthya Abhiyan (MMJSSA) and setting up of grievance redressal cells to monitor the progress and implementation of JSY.
- Strengthening Village Health Nutrition Day- the State has finalized 26 out of 57 basket of services
- To enhance awareness, generate demand and facilitate behaviour change in specific target population for health services related to FP, MH, CH and Adolescent reproductive and sexual health (ARSH) by promoting IEC/BCC.
- Functioning of the Newborn Care corner.
- Increase in number of Accredited Health Facilities in the poor performing districts.
- Strengthening infrastructural facilities along with FRUs and Blood storage units & provision of additional human resource.
- Strengthening RTI / STI clinic of the District Hospitals, through facility development, community clinics at PHCs, training, apex clinics at district hospitals, improved lab services, linkage with AIDS control programme.164 CHCs are proposed for ICTC
- Strengthening the Medical Colleges as Regional Resource Centers for providing better care and capacity building of the Medical Officers & Health Workers on SBA & BEmNOC
- Formation of the Core Committee to monitor the critical indicators of the Maternal Health.
- Establishment of call centres in 20 blocks in 10 districts to establish and provide quality referral services especially related to obstetric and infant health care in all the Districts of Jharkhand
Training and Capacity building
- Enhance the technical skill among the doctors especially who are posted at PHCs to be trained on Comprehensive Abortion Care.
- Strengthening of VHC.
Intervention in anemia, malaria and abortion related complications
- To promote safe abortion practices and provide comprehensive abortion care, through training, facility enhancement, provision of equipments, social mobilization, with a proper monitoring of private facilities by the district level appropriate authorities to avoid sex selective abortions.
- Strengthening the capacity of service providers in maternal anemia intervention to reduce maternal mortality in the state.
- Slide collection and reporting through Sahiyya in malaria prone areas like the Santhal paraganas and Palamu division.