India's maternal health revolution: Scaling impact through local innovation and leadership

An estimated 260,000 women lose their lives each year due to pregnancy complications worldwide. The global maternal mortality ratio (MMR) decreased from 328 per 100,000 live births in 2000 to 197 in 2023, yet the rate of decrease has slowed down over the past few years. Unless there is renewed urgency and commitment, the world is in danger of failing the Sustainable Development Goal (SDG) 3.1 target of achieving an MMR below 70 by 2030.

India, however, is on the verge of a significant public health achievement. Over the last two decades, the country has reduced its MMR by an impressive 86%, significantly outperforming the global average decline of 48%. The MMR fell from 130 in the 2014–16 timeframe to 93 in 2019–21 and is estimated to have reached 80 by 2023. This progress positions India among the better-performing nations globally. A few states, including Maharashtra, Kerala, Tamil Nadu, Andhra Pradesh, Telangana, Gujarat, and Karnataka, have already reached or crossed the SDG target, with Maharashtra's lowest MMR being 38.

Even with this advancement, some of the states still fall behind, and maternal deaths due to avoidable conditions such as postpartum hemorrhage, pre-eclampsia, sepsis, and unsafe abortion are observed. These fatalities, in many instances, could be caused by delays in seeking care, perhaps inadequate infrastructure and lack of skilled birth attendants, and other systemic obstacles.

A new program, called the Leadership Development Initiative—Removing Barriers to Effective Access and Coverage (LDI-REACH), has been launched with a view to supporting the improvement in maternal health, especially among high-priority states such as Uttar Pradesh and Bihar. The program is focused on empowering health providers with the capacity, tools, and skills to influence change in their own facilities and communities. It aims to change the way maternal care is being provided by closing the gap between practice and policy.

LDI–REACH operates through a systematic, practical intervention. It is focused on establishing leadership among obstetricians, midwives, nurses, and frontline workers to enhance outcomes at the ground level. It promotes the increased use of evidence-based interventions like intravenous (IV) iron for anemia treatment, tranexamic acid for the management of postpartum hemorrhage, and cost-effective objective measurement of blood loss based on international research and guidelines. This evidence-based best practice, when applied in a systematic manner, can save lives and reduce complications.

In addition, the program also identifies actual barriers to care and complications in real-world scenarios in a very systematic manner. Under this program, a specially designed Barrier Assessment Tool is used by the healthcare teams to assess the local environments, identify implementation gaps, and then design and implement workable solutions based on the local context. In order to improve maternal health and lower the maternal mortality rate, this inclusive strategy emphasizes the need to involve local teams at all steps throughout the entire process.

Since the program focuses on the use of local teams at all steps, they regularly assess their performance by collecting real-time data and improvise through low-cost but high-success-rate interventions.

With regular government funding and support, this program, if implemented in a systematic manner, can guarantee that no Indian woman dies while giving birth. LDI-REACH provides a scalable and replicable approach to incorporating these ideas into India's healthcare system.