2014年-世界发展银行全球_India___Maternal_and_Reproductive_Health_at_a_Glance_4页_1mb

India: Maternal and Reproductive Health at a Glance Summary

Core Content

India is the second most populous country and the third largest economy in the world by purchasing power parity. Despite achieving the Millennium Development Goal (MDG) 1 on poverty reduction, gender inequality persists. The country has made significant progress in maternal health, with a 65 percent decline in maternal mortality rate (MMR) from 1990 to 2013, reducing it to 190 deaths per 100,000 live births. Fertility rates have also decreased, from 3.9 to 2.5 between 1990 and 2012, while contraceptive prevalence rate (CPR) increased to nearly 55 percent.

Key Indicators

• Maternal Mortality Rate (MMR): 190 deaths per 100,000 live births (65% decline since 1990)
• Contraceptive Prevalence Rate (CPR): 54.8% (any method)
• Skilled Birth Attendance (SBA): 52.3%
• Antenatal Care (ANC) with qualified providers: 74.2%
• Adolescent Fertility Rate: 32.8 births per 1,000 women aged 15–19
• Unmet Need for Family Planning: 12.8%

Main Viewpoints

Progress in Maternal Health

India has made notable progress in reducing maternal mortality and increasing access to reproductive health services. The MMR has dropped significantly, and there has been an increase in the use of contraceptives and skilled birth attendance. However, these gains are not evenly distributed across the population.

Fertility and Contraception Trends

The total fertility rate (TFR) has declined over the past two decades, reflecting broader societal and economic changes. The CPR has also increased, but disparities remain, particularly between urban and rural areas and across different wealth groups.

Access Inequities

There are significant disparities in access to maternal health services based on geography and wealth. Rural areas and the poorest wealth quintiles have lower CPR and SBA rates compared to urban and richer areas. These inequities hinder the achievement of MDG 5 and require targeted interventions.

Adolescent Health

Adolescent fertility remains a concern, with 16% of women aged 15–19 having begun childbearing. Preventing unwanted pregnancies among adolescents is a key focus, with strategies including safe abortion services, family planning (FP) counseling, and creating adolescent-friendly clinics.

HIV/AIDS Context

India has an estimated 2.4 million people living with HIV as of 2012, with an adult prevalence rate of 0.3%. Women account for 39% of infections, and transmission is mainly through unprotected heterosexual intercourse, often involving sex workers and their clients.

Key Strategies

• Preventing Unwanted Pregnancies: Focus on adolescents through safe abortion and FP services, doorstep delivery of FP products, delaying age at marriage and first pregnancy.
• Demand-Side Strategies: Enhance financing and behavior change communication to improve contraceptive use and access to services.
• Supply-Side Strengthening: Expand access and quality in both public and private sectors by increasing delivery points, mapping facilities for comprehensive emergency obstetric and neonatal care (EmONC), and ensuring effective referral systems.
• Improving Care Services: Enhance antenatal, intranatal, and postnatal care through early complication detection, screening for non-communicable diseases (NCDs), and ensuring timely treatment and postnatal visits.
• Strengthening Monitoring and Evaluation (M&E): Focus on equity by registering all pregnant women early and conducting maternal death audits.
• Improving Nutrition: Address maternal and child nutrition through iron-folic acid (IFA) supplementation and postpartum counseling for child nutrition.

Conclusion

India has made substantial progress in maternal and reproductive health, but challenges remain in achieving equitable access and reducing disparities. The country's large youth population offers potential for a demographic dividend, but this requires continued investment in health and education. Key strategies include improving access to services, enhancing quality of care, and addressing gender inequality to ensure sustainable improvements in maternal and reproductive health outcomes.