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Hindustan Times
24-05-2025
- Health
- Hindustan Times
A future at risk: Prioritising women, children, adolescents
The last few months have proven to be catastrophic for global health and development. Sector-wide funding cuts and a lack of alternative options, and a pushback on critical rights, threaten the gains made over recent decades. This is when access to quality sexual and reproductive health services, particularly for women and girls, continues to be inadequate. And maternal deaths remain unacceptably high. As per the latest WHO estimates, a maternal death occurred nearly every two minutes in 2023, and every day in 2023, over 700 women died from preventable causes related to pregnancy and childbirth. WHO also estimates that globally, one in seven 10- to 19-year-olds experiences a mental health issue, accounting for 15% of the global burden of disease in this age group. Depression, anxiety, and behavioural disorders are among the leading causes of illness and disability among adolescents. Suicide is the third leading cause of death among 15- to 19-year-olds. According to Unicef, globally in 2023, an estimated 13% of adolescent girls and young women gave birth before age 18. Global commitments such as the Sustainable Development Goals (SDGs) and Every Woman Every Child initiative have driven progress, yet we are not on track to meet our targets by 2030. The cost of inaction is too high. Between now and 2050, it is estimated that the world will lose over $110 trillion in potential benefits if we fail to invest in adolescent well-being alone. Change must begin with three key shifts. First, we must put women, children, and adolescents at the centre of policies and investments. We must prioritise and invest in health systems and interventions that are people-centred, inclusive, and resilient, particularly for those who have historically been left behind. This includes scaling up integrated SRHR services, mental health support, and nutrition interventions. Second, we must ensure youth-driven and youth-co-owned solutions. Adolescents must not be seen as passive beneficiaries but as co-creators of the systems and services they use. When young people are empowered to lead — through youth-led accountability, advocacy, and research — we see smarter, more sustainable results. Third, we must strengthen partnerships and accountability. Governments, civil society, the private sector, and multilateral actors must work together in partnership, through shared action, resources, and decision-making. India offers a powerful example of what's possible. It has reduced maternal mortality from 130 per 100,000 live births in 2014-16 to 97 per 100,000 live births in 2018-20, and expanded access to care through initiatives such as Janani Suraksha Yojana and Pradhan Mantri Surakshit Matritva Abhiyan, which promote institutional deliveries and access to skilled care. Child health has also seen marked progress through programmes like Mission Indradhanush, expanding immunisation coverage, and Poshan Abhiyaan, addressing malnutrition at scale. For adolescents, the Rashtriya Kishor Swasthya Karyakram (RKSK) has created a strong platform for delivering age-appropriate health services. As the largest alliance for women, children, and adolescents, Partnership for Maternal, Newborn and Child Health (PMNCH) is bringing together partners to focus on the need for urgent and swift implementation of the World Health Assembly Resolution on Maternal and Child Health, which calls for strengthened health systems, increased investments, and enhanced accountability. We have the tools. We have the evidence. Now, we must act — with urgency, with boldness, and in solidarity. A healthier, more equitable world isn't a luxury — it's a necessity, a must-have. Rajat Khosla is executive director, PMNCH, and Helen Clark, PMNCH Board Chair and former Prime Minister, New Zealand. The views expressed are personal
Hindustan Times
11-05-2025
- Health
- Hindustan Times
Maternal health needs all of us: Midwives, men, and the power of shared care
In a government hospital in Rajasthan, a young woman named Lakshmi enters for her prenatal checkup, her heart pounding with fear. It is her first pregnancy, and so many unknowns lie ahead. Will she face this journey alone? Then something unexpected happens… she is greeted by a midwife who wears pink scrubs and a moustache. Yes, a male midwife. He speaks softly, explains everything clearly, and includes her husband in the conversation, showing him how to support her. In that moment, Lakshmi's isolation transforms into connection. Her fear dissolves into confidence. This is not just Lakshmi's story. This is the future of maternal healthcare in India, where no woman walks alone. India has reduced maternal deaths by 78% between 2000 and 2023. This means one million more mothers are alive today, raising children and building communities. How did this happen? Over the past two decades, India's commitment to maternal healthcare has been driven by a series of government-led initiatives that are empowering women to make more informed choices about their care. During village health, sanitation and nutrition days, Ashas and auxiliary nurse midwives (ANMs) deliver essential services at the grassroots. At the same time, major schemes like Janani Suraksha Yojana (JSY) have boosted institutional deliveries whereas Janani Shishu Suraksha Karyakram (JSSK) guarantees free healthcare for mothers and newborns. Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA) further offers free, quality antenatal checkups. Newer programmes such as Surakshit Matritva Aashwasan (SUMAN) and LaQshya have enhanced the quality of maternal care and labour rooms. Because of India's efforts to support family planning, there has been a 56% uptake of modern contraceptive use, with each woman having on average two children, empowering women to plan their families and pregnancies better. These efforts, strengthened by continuous community outreach, have improved maternal and newborn health outcomes. But here is the hard truth: many women still face risks that are largely preventable. In states such as Bihar, Madhya Pradesh, Chhattisgarh, Odisha, Rajasthan, Uttar Pradesh, Uttarakhand, and Assam, many women, especially from underserved communities, continue to face life-threatening risks during childbirth, especially in remote areas. These women are not statistics. They have names, families, hopes, and rights. Progress means ensuring that every woman, regardless of where she lives, her financial and social identity, has access to the care she needs to bring new life into the world safely and with dignity. The solution is not complicated. It lies with having more midwives. Around the world evidence shows that when midwives are trained and integrated into health systems, they can deliver nearly 90% of essential sexual, reproductive, maternal, newborn, and adolescent health (SRMNAH) services. Recognising this, India has been building something remarkable since 2018: a group of highly skilled nurse practitioners in midwifery. Across 12 states, eight national and 14 state midwifery training institutes are shaping a new generation of midwives. The institutions do not just teach clinical excellence… they nurture compassion, empathy, and respect. Many are embracing cutting-edge tools like virtual reality simulations, giving trainees hands-on experience before they step into labour rooms. These midwives are not just healthcare providers; they are guardians of safe birth and champions of women's dignity. And now increasingly, they are men. However, when male nurse in a conservative community decides to become a midwife, he faces multiple challenges. His friends taunt him. His family questions. Society raises eyebrows. Yet he persists. Why? Because he sees something others do not: that bringing life into the world should not be a women's burden alone. Real strength is not shown by standing outside the delivery room, it is demonstrated by standing beside a woman during her most vulnerable hours. At SMTI (State Midwifery Training Institute) Jaipur, male midwives often share a common insight: 'It is not about big gestures. It is the small things that matter, welcoming and reassuring her when she comes into labour, explaining procedures clearly, respecting her choices, involving her family.' These male midwives are cultural catalysts, redefining masculinity one birth at a time. The change extends beyond the hospital. Husbands who once paced nervously outside are now invited in to hold hands, to wipe tears, to witness the miracle of their child's first breath. And something remarkable happens: Men who participate in birth tend to participate in childcare. They support recovery. They become advocates for women's health. In communities across India, fathers who have been present during childbirth share a common sentiment: 'I thought giving birth was a woman's business. Now I understand this is a family concern.' Midwifery-led care can prevent two-thirds of maternal and newborn deaths by 2035. Every $1 invested in midwives brings up to 16 times the return in social and economic benefits. With 26 million births a year and a shortage of 1.8 million healthcare workers, India needs smart, urgent solutions. Midwives, trained faster and at lower cost than doctors, can bridge the gap handling normal pregnancies so doctors can focus on complex cases. The way ahead is simple: Expand midwife training, bring more men into the profession, promote family-centered births, and strengthen community support for women's health. Above all, maternal health must be seen as a basic human right. UNFPA stands committed to India's midwifery movement. Together, we can ensure that every birth is safe, every mother is valued, and every family has the chance to flourish. Andrea M Wojnar is UNFPA India Representative and Country Director Bhutan. The views expressed are personal
