Equity, Access & Quality of Maternal Care

 

 Equity, Access & Quality of Maternal Care

Even in 2025, inequities in access and quality of maternal health care remain a global challenge — especially for women in low-resource, rural, and marginalized communities.
While global maternal mortality has declined over the past two decades, the World Health Organization (WHO) warns that thousands of preventable deaths still occur every week because care is either unavailable, inaccessible, or substandard.

The focus today is not just on increasing institutional deliveries — but on ensuring that all women receive respectful, high-quality, continuous maternal care, regardless of where they live or their socio-economic background.

1. Access to Maternal Health Services

• Geographic Barriers: In rural or remote areas, women often travel long distances to reach a hospital, sometimes without transport or road connectivity.
• Economic Barriers: Cost of care (tests, medicines, hospital fees) still prevents many from seeking help, especially in low-income households.
• Cultural & Social Barriers: Fear, gender norms, stigma, or lack of decision-making power can delay or prevent care-seeking.
• Digital Divide: Though telehealth and digital services are growing, poor internet access or digital literacy excludes many rural women.

Example (India):
In several parts of Bihar, Jharkhand, and Madhya Pradesh, women still rely on traditional birth attendants due to distance and lack of skilled health workers. Government efforts like Janani Suraksha Yojana (JSY) and Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA) aim to bridge these gaps through incentives and free check-ups.

2. Equity in Maternal Health

• Definition: Equity means every woman — regardless of her caste, income, religion, or region — should have the same opportunity to achieve a healthy pregnancy and birth.
• Current Reality:
  • Urban women are 2–3 times more likely to have skilled birth attendance compared to rural women.
  • Adolescent mothers, migrant women, and those from marginalized communities face higher risks of complications and lower quality care.
• Global Concern: WHO’s 2025 brief highlighted that migrant and displaced women are often denied consistent antenatal and postnatal services, even in middle-income nations.

In India:
The government’s LaQshya program (Labour Room Quality Improvement Initiative) and Ayushman Bharat aim to deliver safe, respectful, and equal-quality maternal services in both public and private facilities.

3. Quality of Care – Beyond Access

Even when women reach health facilities, the quality of care they receive can be inconsistent. WHO defines quality maternity care as care that is:

• Effective: Based on scientific evidence and best practices.
• Efficient: Avoiding unnecessary tests and delays.
• Respectful: Free from abuse, neglect, or discrimination.
• Continuous: Covering pre-pregnancy to postpartum.

Common quality issues include:

• Lack of skilled health workers during delivery.
• Delayed emergency response (e.g., for bleeding or hypertension).
• Disrespectful treatment or lack of privacy.
• Inadequate follow-up after discharge.

Solutions:

• Strengthening midwifery education and emergency obstetric care training.
• Implementing maternal death audits to identify systemic failures.
• Promoting community-based awareness for informed decision-making.

4. Respectful Maternity Care 

Respectful Maternity Care is now a global standard, emphasizing that every woman deserves:

• Dignity and respect during childbirth.
• Informed consent for all procedures.
• Freedom from discrimination or verbal/physical abuse.
• Emotional support and companionship during labor.

Example:
Studies in India, Nigeria, and Kenya show that women treated disrespectfully during labor are less likely to return to health facilities for future deliveries — creating a vicious cycle of unsafe births.

5. Global and National Initiatives

• WHO 2025 Global Goals:

  • Reduce preventable maternal mortality to fewer than 70 per 100,000 live births.
  • Ensure universal coverage of essential maternal services.
  • Integrate mental health, nutrition, and social support into pregnancy care.

• India’s Initiatives:

  • Janani Suraksha Yojana (JSY): Financial incentives for institutional deliveries.
  • LaQshya: Improves delivery room quality and patient experience.
  • Pradhan Mantri Matru Vandana Yojana (PMMVY): Maternity benefits for nutrition and rest.
  • Anemia Mukt Bharat: To address maternal anemia through iron supplementation.
  • Ayushman Bharat Health & Wellness Centers: Primary care access including maternal and child health.

6. The Way Forward

To achieve equity and quality in maternal care, health systems must:

• Strengthen primary health infrastructure and referral networks.
• Ensure skilled birth attendance and emergency response in all facilities.
• Empower women with health education, autonomy, and digital literacy.
• Integrate mental health and nutrition into antenatal care.
• Involve community health workers (ASHA, ANM) as continuous support links.

“Equity in maternal care means not just saving lives, but ensuring that every mother, everywhere, experiences pregnancy and childbirth with dignity, safety, and hope.”