MAHARASHTRA AND TAMIL NADU: LOWER MORTALITY EXEMPLAR STATES IN NEONATAL AND MATERNAL MORTALITY REDUCTION
In India, two Exemplar states with lower baseline mortality levels have achieved rapid rates of neonatal and maternal mortality reduction since 2000.
Acknowledgements:
Ministry of Health and Family Welfare, India MNH Exemplars Steering Committee, India MNH Exemplars Technical Working Group, Countdown to 2030, and Other Contributors
Contents
Introduction to the Exemplars study in India
India is a diverse country, with a population that grew from 1.06 billion in 2000 to 1.42 billion by 2022.1 Considering India’s size and diversity, in this analysis, states were grouped into clusters based on their neonatal and maternal mortality levels and per capita incomes. As shown below in Figure 1, these states are accordingly referred to as members of either the higher mortality state cluster or the lower mortality state cluster. While India has made remarkable progress in reducing neonatal and maternal mortality in recent decades, the strategies underlying this progress vary across state clusters. Differences in socioeconomic status and health system capacity by state cluster meant that each cluster faced unique challenges, with maternal and newborn health programming varying by cluster to meet these challenges. As such, Exemplar states within each of the state clusters were identified to highlight lessons from states that had made the most progress from their respective baseline mortality levels.2,3
This narrative tells the story of how two Exemplar states within India’s lower mortality state cluster achieved progress. Additional context can be found in the national-level narrative, with the story of four Exemplar states within the higher mortality cluster highlighted separately as well. Throughout this report, key indicators, interventions, policies, and programs that contributed to neonatal mortality rate and maternal mortality ratio declines will be featured, highlighting opportunities to learn from Maharashtra and Tamil Nadu’s success.
Figure 1: Higher and lower mortality state clusters
Emphasized data-driven quality improvement in MNH services across health facilities
As the lower mortality states have achieved high levels of coverage of key maternal and newborn health indicators, the focus has increasingly shifted to improving the quality of care.
Hospitals became increasingly accessible and more well-equipped to provide emergency care
The vast majority of institutional deliveries in the lower mortality cluster now occur in either public or private hospitals. This has ensured access to comprehensive emergency obstetric and newborn care.
Pro-poor policies helped mitigate equity gaps within the lower mortality states
India’s landmark conditional cash transfer programs like Janani Suraksha Yojana (JSY) and Janani Shishu Suraksha Karyakaram (JSSK) were targeted to the most vulnerable communities within the lower mortality state cluster.
Contextualizing the current and future progress of the lower mortality state cluster in an Integrated Mortality Transition Framework
Between 2000 and 2018, the higher mortality state cluster progressed from mid-phase II to early-phase IV of the integrated mortality transition framework
Exemplars in Global Health program
The Exemplars in Global Health program aims to learn from countries that have made rapid progress in improving health outcomes and disseminate this evidence to inform health policy and funding decisions. Our aim is to research success stories from low- and middle-income countries and share findings that can be useful for leaders looking to act in comparable contexts.
In selecting Exemplar countries, we reviewed evidence to identify countries that outperformed their peers in vital areas of public health, controlling for factors such as economic growth. In this way, we aim to provide more actionable, policy-relevant insight for stakeholders about how health progress can be made despite resource limitations.
Guided by research partners and technical advisers, we conduct quantitative and qualitative analyses to validate our initial assessments and assess factors that contribute to a country’s exemplary performance.
Research in and across Exemplar countries could help ministries, nongovernmental organizations, and multinational bodies address key public health issues in low- and middle-income countries.
By studying proven strategies to prevent disease, malnutrition, and other conditions that burden populations of low- and middle-income countries, we aim to create a list of data-driven narratives that can serve as resources for leaders looking to improving health within their own countries. The following narrative focuses on factors that contributed to Maharashtra and Tamil Nadu’s exemplary reductions in neonatal and maternal mortality.
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1
World Bank. Population, total - India 2021 (1960-2023) [data set]. https://data.worldbank.org/indicator/SP.POP.TOTL?locations=IN
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2
Ram U, Ramesh BM, Blanchard AK, et al. A tale of two exemplars: the maternal and newborn mortality transitions of two state clusters in India. BMJ Glob Health 2024;9(suppl 2):e011413. https://doi.org/10.1136/bmjgh-2022-011413
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3
Bhushan H, Ram U, Scott K, et al. Making the health system work for over 25 million births annually: drivers of the notable decline in maternal and newborn mortality in India. BMJ Glob Health 2024;9(suppl 2):e011411. https://doi.org/10.1136/bmjgh-2022-011411
MAHARASHTRA AND TAMIL NADU: LOWER MORTALITY EXEMPLAR STATES IN NEONATAL AND MATERNAL MORTALITY REDUCTION
