A/HRC/14/20/Add.2
areas and does not give her skills to provide delivery care”.15 In practice, the “M” for
“midwife” has almost disappeared from the job title.
29.
The international community defines a skilled birth attendant as “an accredited
health professional — such as a midwife, doctor or nurse — who has been educated and
trained to proficiency in the skills needed to manage normal (uncomplicated) pregnancies,
childbirth and the immediate postnatal period, and in the identification, management and
referral of complications in women and newborns”.16 According to this definition, today’s
ANMs are not skilled birth attendants. Neither, of course, are traditional birth attendants,
whose training and competencies do not approach those of ANMs. A recent study
emphasizes that the current “pre-service training of ANMs does not equip them to function
as skilled birth attendants”.17 Also, in its NRHM the Government recognizes that ANMs
need upgrading to skilled birth attendants.18 This has profound and far-reaching
implications. As already observed, other professionals in India have the necessary
competencies, but they are insufficient in number and are not in sub-centres. Since ANMs
are not skilled birth attendants, India lacks one of the cornerstone interventions to reduce
maternal mortality. This is a major factor contributing to the country’s stubbornly high
maternal mortality.
30.
Taking into account resource availability, India is in breach of its right-to-health
obligations because it falls far short of having a sufficient number of skilled birth
attendants.
Technical senior management19
31.
At the national level, maternal health is the responsibility of the Department of
Family Welfare. Within the Department, the technical unit for maternal health consists of
one Deputy Director General and three Assistant Commissioners. One Assistant
Commissioner post has been vacant for many years. So, in effect, three national-level
officers are responsible for all the technical and related aspects of maternal health
throughout India. A survey of six states showed that only one (Kerala) had a technical
officer dedicated full time to maternal health. Maharashtra had seven, and Rajasthan two,
part-time maternal health technical officers.
32.
In short, India has extremely weak technical capacity for managing maternal health
programmes at the national and state levels. This represents a major constraint on the
country’s attempts to reduce maternal mortality and achieve Millennium Development Goal
5. Unless this constraint is removed, increased investment in maternal health runs the risk
of being ineffective. The cost of increasing technical senior management is only a small
fraction of the total resources devoted to maternal health in India.
33.
At the national level, a country of 1 billion should have at least 10 maternal health
technical officers (1 per 100 million).20 A state of 50 million should have at least five
maternal health technical officers (1 per 10 million). So Rajasthan should have 5–6 officers,
15
16
17
18
19
20
GE.10-12866
D. Mavalankar and K.S. Vora, “The changing role of auxiliary nurse midwife in India: Implications
for maternal and child health”, Working Paper No. 2008-03-01 (Ahmedabad, Indian Institute of
Management (IIMA), 2008), p. 16.
WHO, World Health Report 2005 (Geneva, 2005), p. 95.
Iyengar, Iyengar and Gupta, “Maternal health”, p. 290.
India, “National Rural Health Mission”, 2005, para. 17. Available from
http://mohfw.nic.in/NRHM/Documents/NRHM_Framework_Latest.pdf.
This section draws extensively from D. Mavalankar, “Study of technical top management capacity for
safe motherhood program in India”, 2004. On file with author.
Mavalankar, “Study of technical top management capacity”, p. 18.
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