Exemplars in Global Health: Learning from India's Progress in Improving Maternal and Neonatal Health at the National, Cluster, and State Levels, with Ramesh Banadakoppa Manjappa

In the last two decades, India has achieved remarkable strides in improving maternal and newborn health outcomes, surpassing global declines in mortality rates. This transformative progress is evident as India’s share of global maternal deaths decreased from approximately 23% in 2000 to 12% in 2017, and neonatal deaths reduced from 31% to 22% during the same period. What has enabled India’s exemplary progress in maternal and newborn survival over the past two decades? To answer this question, the India Exemplars in Maternal and Newborn Health (MNH) study conducted a national level analysis, including an analysis of two clusters of states (one with higher mortality and lower per capita income and the other with lower mortality and higher per capita income), which both made exemplary progress since 2000. We further conducted analyses of exemplary states (Maharashtra, Tamil Nadu, Rajasthan, Odisha, Uttar Pradesh, and Madhya Pradesh). The study was guided by a conceptual framework to systematically examine distal (context, policies), intermediate (system and service changes, household factors) and proximate (service coverage) drivers of change in mortality and used a mixed-methods approach, including quantitative analysis of national and state-specific data (NFHS and DLHS), qualitative analysis of literature and document review, key informant interviews, and expert round table discussions at national and state levels.

The quantitative and qualitative evidence shows how India’s national policies and reforms since the late nineties, but especially since 2005 with the NRHM, have resulted in major increases in the coverage of MNH services with reduced inequalities, and related reductions in maternal and neonatal mortality. Such advances were made in both the higher and lower mortality states, but at different stages of a mortality transition. These health sector efforts were enabled by societal changes such as changing norms favoring smaller family size and increased women’s empowerment and education, as well as economic and technological progress with expanded mobile and road networks in rural areas. These changes have combined to support the health sector progress in coverage and survival of women and newborns in India. The India exemplar study provides a solid basis for planning of future strategies to further reduce maternal and neonatal mortality. Even though the primary aim of the exemplar study was to understand the drivers of past progress, the final section of the report also provides some reflection on the implications for current and future strategies using the maternal and newborn mortality transition framework.

Speaker Profile

Dr. Ramesh BM, PhD, is an Assistant Professor at the Department of Community Health Sciences, and Assistant Director, Research and Knowledge Translation at the Institute for Global Public Health, Rady Faculty of Community Health Sciences, University of Manitoba (UoM), Canada. He is also a founding member of India Health Action Trust (IHAT).

Previously, he was the Project Director for the UoM’s MNCH projects in Uttar Pradesh and Karnataka. He was also the Director, Population Research Centre, Dharwad and a faculty at the International Institute for Population Sciences, Bombay.

Ramesh, a Demographer by training, has a long experience of over 30 years of research and program implementation, monitoring and evaluation in the field of MNCH and HIV/AIDS.

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