More than one Mother’s Day (Source:- The Economic Times)

Time to further reduce maternal mortality rate

Bjorn Lomborg & Manorama Bakshi,  (Lomborg is president, Copenhagen Consensus Centre, and Bakshi is senior adviser, India Consensus)

Life expectancy in India has increased almost four years in the last decade. Every 24 hours, India added more than nine hours to the life of a newborn — thereby ‘allowing’ a baby born today four more years of life. To a large extent, this progress is due to substantial reductions in infant and maternal mortality, dropping a quarter and a third over the last decade. Yet, India can do better. It ranks 145th out of 193 nations on infant mortality, and 129 of 184 nations on maternal mortality, according to the World Bank. New research by US India Policy Institute’s Abusaleh Shariff and People Research on India’s Consumer Economy’s Amit Sharma shows smart next steps for Rajasthan (goo.gl/4Z9mFr) and Andhra Pradesh (goo.gl/iv2tmw).

In 2005, the ministry of health and family welfare launched the Janani Suraksha Yojana (JSY), or Maternity Benefit Scheme. In addition to federal programmes, Rajasthan’s ANM Samvad (auxiliary nurse midwife dialogue) strengthens health staff capacity in delivering antenatal care (ANC), while Rashtriya Kishor Swasthya Karyakram focuses on adolescent health and improving nutritional status. Partnerships and Opportunities to Strengthen and Harmonise Actions for Nutrition (POSHAN) aims at community-based management of malnourished children. Shariff examines enhancing the successful JSY, which has worked at improving uptake, with 39% of Rajasthan pregnant mothers now making at least four ANC visits. Shariff suggests providing an incentive of Rs 2,000 to each mother. This could boost uptake to 61%. The total cost for Rajasthan is Rs 229 crore, with Rs 174 crore being cash incentives. The remainder is higher costs to the healthsystem and private costs to mothers.

This could reduce neonatal mortality by 8 per 1,000 live births, based on similar programmes, saving 2,764 infant lives in Rajasthan annually. If replicated nationally, analysis by Copenhagen Consensus suggests it could bring India 19 places ahead in the global infant mortality ranking. The new research uses cost-benefit analysis, which puts benefits — including health, social, environmental and economic benefits — into numbers, so policies can be compared. In this case, the benefits are estimated to be of Rs 2,086 crore annually. Every rupee achieves Rs 9 of benefits.

In Andhra Pradesh, 76% of women make at least four ANC visits. The Bhavita programme (initially ‘Maarpu’) aims to bring a quick decline in infant and maternal mortality rates and malnutrition, while the Talli-Bidda Express scheme focuses on providing safe and hygienic transportation from government facilities to homes for new mothers, babies and pregnant mothers who go for routine ANC visits. Infant and maternal mortality rates are lower than in Rajasthan, and mothers make more ANC visits. But here, too, the policy would have considerable benefits, estimated at six times the costs.

Shariff studies a breastfeeding mass media campaign, using TV advertisements and counselling. In Rajasthan, 58% of mothers exclusively breastfeed, while in Andhra Pradesh it’s 70%. Based on international evidence, a campaign could increase these to 90% and 93%, saving 12,628 infant lives in Rajasthan and 5,982 lives in Andhra Pradesh. In each state, the policy would have benefits worth around eight times the costs. By far, the most compelling case in the study is for expanding immunisation programmes in lagging districts. Just 55% of children in Rajasthan are fully vaccinated, and 65% in Andhra Pradesh. Based on a trial in Rajasthan, the study proposes setting up ‘immunisation camps’ in lagging districts, providing daal and meals worth Rs 685 to parents for vaccinating their children.

The policy would cost Rs 24 crore in Rajasthan and, if it raised the level of fully immunised children to the state average, would save 827 children annually. In Andhra Pradesh, the same policy would be cheaper at Rs 10 crore, saving 219 children. In both places, immunisation would generate benefits worth more than Rs 30 for every rupee spent. Both states, and India as a whole, inevitably have to make hard choices on where to spend limited funds. New data on costs and benefits closes evidence gaps, and helps ensure more good can be done with each rupee.