A Comparative Assessment of Maternal Health and Maternal Health Policies in India and the U.S.: Need to Transition from a Biomedical Model to a Biopsychosocial Model for Maternal Health Policies

Abstract

More than 300,000 women died due to pregnancy related causes in 2015, a global maternal mortality ratio (MMR) of 216 per 100,000 live births (Alkema et al., 2016). Millennium Development Goals have led to a 44% decline in global MMR, but significant variations still remain across geographical regions (United Nations [UN], 2015). India accounts for the second highest maternal deaths in the world (World Health Organization [WHO], 2015). In contrast, the U.S. is the only developed country with an increasing MMR in recent years (“Maternal Mortality,” 2015). However, little attention has been given to maternal health in public policy research and practice in both countries. This paper compares and contrasts maternal health status and analyzes maternal health policies in India and the U.S. two health models. Based on comparative case analysis, the overall recommendation is to expand the scope of maternal health from a biomedical health model towards a biopsychosocial model and restructure the policy frameworks. This paper contributes to the maternal health discourse and hopes to garner attention of global and regional health policy scholars and policy makers.

Keywords

Maternal Health Healthcare Policies Maternal Mortality India United States

Get full access to this article

View all access options for this article.

References

Alkema

, Chou

, Hogan

, Zhang

, Moller

A.-B.

, Gemmill, A., … others. (2016). Global, regional, and national levels and trends in maternal mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN Maternal Mortality Estimation Inter-Agency Group. The Lancet, 387(10017), 462–474.

American Psychological Association. (2017). Postpartum Depression. Retrieved July 26, 2017, from http://www.apa.org/pi/women/resources/reports/postpartum-depression.aspx.

Annandale

(1998). The Sociology of Health and Medicine: A Critical Introduction (1 edition). Malden, MA: Polity.

Balarajan

, Selvaraj

, & Subramanian

S. V.

(2011). Health Care and Equity in India. The Lancet, 377(9764), 505–515.

Bang

(2015). Health insurance, assurance, and empowerment in India. The Lancet, 386(10011), 2372–2373.

Berman

(2015). India's health: more practical solutions needed. The Lancet, 386(10011), e58–e59.

Census . (2011). Houselisting and Housing Census Data Highlights (Census Data 2011). India: Government of India. Retrieved from http://censusindia.gov.in/2011census/hlo/hlo_highlights.html.

Center for Disease Control and Prevention. (2017, June). Pregnancy Mortality Surveillance System. Retrieved March 7, 2017, from https://www.cdc.gov/reproductivehealth/maternalinfanthealth/pmss.html.

Chang

, Elam-Evans

L. D.

, Berg

C. J.

, Herndon

, Flowers

, Seed

K. A.

, & Syverson

C. J.

(2003). Pregnancy-related mortality surveillance–United States, 1991–1999. Morbidity and Mortality Weekly Report. Surveillance Summaries (Washington, D.C.: 2002), 52(2), 1–8.

10.

Chescheir

N. C.

(2016). Drilling Down on Maternal Mortality. Obstetrics and Gynecology, 128(3), 427–428.

11.

Collins

J. W.

Jr , David

R. J.

, Handler

, Wall

, & Andes

(2004). Very low birthweight in African American infants: the role of maternal exposure to interpersonal racial discrimination. American Journal of Public Health, 94(12), 2132–2138.

12.

Creanga

A. A.

, Berg

C. J.

, Ko

J. Y.

, Farr

S. L.

, Tong

V. T.

, Bruce

F. C.

, & Callaghan

W. M.

(2014). Maternal Mortality and Morbidity in the United States: Where Are We Now? Journal of Women's Health, 23(1), 3–9. https://doi.org/10.1089/jwh.2013.4617.

13.

Day

(2011, March). Dr Abhay Bang: the revolutionary pediatrician. The Guardian. Retrieved from http://www.theguardian.com/global-development/2011/mar/20/dr-abhay-bang-revolutionary-paediatrician.

14.

Deshpande

, Gadappa

, Pagare

, Dhaduti

, & Andurkar

(2016). Awareness regarding Janani Shishu Suraksha Karyakram among pregnant women of Marathwada, Maharashtra, India. International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 5(6), 1985–1991.

15.

Edwards

J. E.

, & Hanke

J. C.

(2013). An update on maternal mortality and morbidity in the United States. Nursing for Women's Health, 17(5), 376–388.

16.

Falcao

V. L.

, Khanuja

, Matharu

, Nehra

, & Sinha

(2015). The Study of the Indira Gandhi Matritva Sahyog Yojna. New Delhi: Centre For Equity Studies. Retrieved from http://centreforequitystudies.org/report-on-the-study-of-the-indira-gandhi-matritva-sahyog-yojna.

17.

Fielding

J. E.

, Teutsch

, & Breslow

(2010). A framework for public health in the United States. Public Health Reviews, 32(1), 174.

18.

Firoz

, Chou

, von Dadelszen

, Agrawal

, Vanderkruik

, Tunçalp

, … Say

(2013). Measuring maternal health: focus on maternal morbidity. Bulletin of the World Health Organization, 91(10), 794–796.

19.

Garfield

, & Damico

(2016, October 19). The Coverage Gap: Uninsured Poor Adults in States that Do Not Expand Medicaid. Retrieved from http://www.kff.org/uninsured/issue-brief/the-coverage-gap-uninsured-poor-adults-in-states-that-do-not-expand-medicaid/.

20.

Gavin

N. I.

, Adams

E. K.

, Hartmann

K. E.

, Benedict

M. B.

, & Chireau

(2004). Racial and ethnic disparities in the use of pregnancy-related health care among Medicaid pregnant women. Maternal and Child Health Journal, 8(3), 113–126.

21.

Giddens

(2009). Sociology (6 edition). Cambridge: Polity Press.

22.

Government of India. (1956). First Five Year Plans 1951–56. Planning Commission. Retrieved from http://www.planningcommission.nic.in/plans/planrel/fiveyr/welcome.html.

23.

Government of India. (2014). Annual Report 2013–2014. New Delhi: Ministry of Health and Family Welfare, Government of India.

24.

Grad

F. P.

(2002). The preamble of the constitution of the World Health Organization. Bulletin of the World Health Organization, 80(12), 981–981.

25.

Graham

W. J.

, Bell

J. S.

, & Bullough

C. H.

(2001). Can skilled attendance at delivery reduce maternal mortality in developing countries? Safe Motherhood Strategies: A Review of the Evidence. Retrieved from http://193.190.239.98/bitstream/handle/10390/2655/2001shsop0097.pdf?sequence=2.

26.

Griffiths

, & Stephenson

(2001). Understanding Users' Perspectives of Barriers to Maternal Health Care use in Maharashtra, India. Journal of Biosocial Science, 33(03), 339–359.

27.

Halfon

, & Hochstein

(2002). Life course health development: an integrated framework for developing health, policy, and research. The Milbank Quarterly, 80(3), 433–479.

28.

Halfon

, Larson

, Lu

, Tullis

, & Russ

(2014). Lifecourse health development: past, present and future. Maternal and Child Health Journal, 18(2), 344–365.

29.

Hardee

, Gay

, & Blanc

A. K.

(2012). Maternal morbidity: neglected dimension of safe motherhood in the developing world. Global Public Health, 7(6), 603–617.

30.

Herd

, DeLeire

, Harvey

, & Moynihan

D. P.

(2013). Shifting Administrative Burden to the State: The Case of Medicaid Take-Up. Public Administration Review, 73(s1), S69–S81.

31.

Hollen

C. V.

(2003). Birth on the Threshold: Childbirth and Modernity in South India. University of California Press.

32.

Kesterton

A. J.

, Cleland

, Sloggett

, & Ronsmans

(2010). Institutional delivery in rural India: the relative importance of accessibility and economic status. BMC Pregnancy and Childbirth, 10(1), 1.

33.

Kozhimannil

K. B.

, Trinacty

C. M.

, Busch

A. B.

, Huskamp

H. A.

, & Adams

A. S.

(2011). Racial and Ethnic Disparities in Postpartum Depression Care Among Low-Income Women. Psychiatric Services (Washington, D.C.), 62(6), 619–625. https://doi.org/10.1176/appi.ps.62.6.619.

34.

Krishna

(2004). Escaping poverty and becoming poor: who gains, who loses, and why? World Development, 32(1), 121–136.

35.

Kumar

, Kumar

, Das

, Srivastava

N. M.

, Baqui

A. H.

, Santosham

, & Darmstadt

G. L.

(2012). Community-driven impact of a newborn-focused behavioral intervention on maternal health in Shivgarh, India. International Journal of Gynecology & Obstetrics, 117(1), 48–55.

36.

Kuriya

, Piedimonte

, Spence

A. R.

, Czuzoj-Shulman

, Kezouh

, & Abenhaim

H. A.

(2016). Incidence and causes of maternal mortality in the USA. Journal of Obstetrics and Gynaecology Research. Retrieved from http://onlinelibrary.wiley.com/doi/10.1111/jog.12954/pdf.

37.

Lim

S. S.

, Dandona

, Hoisington

J. A.

, James

S. L.

, Hogan

M. C.

, & Gakidou

(2010). India's Janani Suraksha Yojana, a conditional cash transfer programme to increase births in health facilities: an impact evaluation. The Lancet, 375(9730), 2009–2023.

38.

MacDorman

M. F.

, Declercq

, Cabral

, & Morton

(2016). Is the United States Maternal Mortality Rate Increasing? Disentangling trends from measurement issues Short title: US Maternal Mortality Trends. Obstetrics and Gynecology, 128(3), 447.

39.

Main

E. K.

, & Menard

M. K.

(2013). Maternal mortality: time for national action. Obstetrics and Gynecology, 122(4), 735.

40.

Obama

(2016). United States health care reform: progress to date and next steps. Jama, 316(5), 525–532.

41.

Ogden

(2012). Health Psychology. McGraw-Hill Education (UK).

42.

Paradise

(2015, March 9). Medicaid Moving Forward. Retrieved March 7, 2017, from http://kff.org/health-reform/issue-brief/medicaid-moving-forward/.

43.

Patel

, Parikh

, Nandraj

, Balasubramaniam

, Narayan

, Paul

V. K.

, … Reddy

K. S.

, (2015). Assuring health coverage for all in India. The Lancet, 386(10011), 2422–2435.

44.

Patra

(2016). Motherhood in childhood: addressing reproductive health hazards among adolescent married women in India. Reproductive Health, 13(1), 52.

45.

Ramey

S. L.

, Schafer

, DeClerque

J. L.

, Lanzi

R. G.

, Hobel

, Shalowitz, M., … others. (2015). The preconception stress and resiliency pathways model: A multi-level framework on maternal, paternal, and child health disparities derived by community-based participatory research. Maternal and Child Health Journal, 19(4), 707–719.

46.

Rhodes

, & Segre

(2013). Perinatal Depression: A Review of U.S. Legislation and Law. Archives of Women's Mental Health, 16(4), 259–270.

47.

Rosenthal

(2013, June 30). American Way of Birth, Costliest in the World. The New York Times. Retrieved from http://www.nytimes.com/2013/07/01/health/american-way-of-birth-costliest-in-the-world.html.

48.

Russ

S. A.

, Larson

, Tullis

, & Halfon

(2014). A lifecourse approach to health development: implications for the maternal and child health research agenda. Maternal and Child Health Journal, 18(2), 497–510.

49.

Savarimuthu

R. J. S.

, Ezhilarasu

, Charles

, Antonisamy

, Kurian

, & Jacob

K. S.

(2010). Post-partum depression in the community: a qualitative study from rural South India. International Journal of Social Psychiatry, 56(1), 94–102.

50.

Say

, Chou

, Gemmill

, Tunçalp

Ö.

, Moller

A.-B.

, Daniels

, … Alkema

(2014). Global causes of maternal death: a WHO systematic analysis. The Lancet Global Health, 2(6), e323–e333.

51.

Say

, Souza

J. P.

, & Pattinson

R. C.

(2009). WHO working group on Maternal Mortality and Morbidity classifications. Maternal near miss– towards a standard tool for monitoring quality of maternal health care. Best Pract Res Clin Obstet Gynaecol, 23(3), 287–96.

52.

Sesia

P. M.

(1996). “Women come here on their own when they need to”: prenatal care, authoritative knowledge, and maternal health in Oaxaca. Medical Anthropology Quarterly, 10(2), 121–140.

53.

Sharma

D. C.

(2015). India still struggles with rural doctor shortages. The Lancet, 386(10011), 2381–2382.

54.

Shrivastava

S. R.

, Shrivastava

P. S.

, & Ramasamy

(2013). Implementation of Public Health Practices in Tribal Populations of India: Challenges and Remedies. Healthcare in Low-Resource Settings, 1(1), 3.

55.

Sonfield

, & Kost

(2013). Public costs from unintended pregnancies and the role of public insurance programs in paying for pregnancy and infant care: estimates for 2008. New York: Guttmacher Institute. Retrieved from https://www.guttmacher.org/pubs/public-costs-of-UP.pdf.

56.

Sundari

T. K.

(1992). The Untold Story: How the Health Care Systems in Developing Countries Contribute to Maternal Mortality. International Journal of Health Services, 22(3), 513–528. https://doi.org/10.2190/91YH-A52T-AFBB-1LEA.

57.

Sunil

T. S.

, Rajaram

, & Zottarelli

L. K.

(2006). Do individual and program factors matter in the utilization of maternal care services in rural India? A theoretical approach. Social Science & Medicine, 62(8), 1943–1957.

58.

Thind

, Mohani

, Banerjee

, & Hagigi

(2008). Where to Deliver? Analysis of Choice of Delivery Location from a National Survey in India. BMC Public Health, 8(1), 29.

59.

United Nations International Children's Emergency Fund. (2017, February). Maternal Mortality-Current Status and Progress. Retrieved July 21, 2017, from //data.unicef.org/topic/maternal-health/maternal-mortality/.

60.

United Nations. (2015). United Nations Millennium Development Goals. Retrieved July 21, 2017, from http://www.un.org/millenniumgoals/maternal.shtml.

61.

United Nations. (2016). United Nations Sustainable Development Goals-Health Targets. Retrieved March 6, 2017, from http://www.un.org/sustainabledevelopment/health/.

62.

U.S. Centers for Medicare & Medicaid Services. (n.d.). Health Coverage Options for Pregnant or Soon to Be Pregnant Women. Retrieved March 7, 2017, from https://www.healthcare.gov/what-if-impregnant-or-plan-to-get-pregnant/.

63.

U.S. Department of Health and Human Services. (2017). Maternal, Infant, and Child Health | Healthy People 2020. Retrieved July 21, 2017, from https://www.healthypeople.gov/2020/topics-objectives/topic/maternal-infant-and-child-health.

64.

Vij

(2016). Role of information technology in policy implementation of maternal health benefits in India. Syracuse University. Retrieved from http://gradworks.umi.com/10/16/10165521.html.

65.

Vikram

, Sharma

A. K.

, & Kannan

A. T.

(2013). Beneficiary level factors influencing Janani Suraksha Yojana utilization in urban slum population of trans-Yamuna area of Delhi. The Indian Journal of Medical Research, 138(3), 340.

66.

Wadley

(1980). Hindu Women's Family and Household rites in a North Indian Village. In Falk

& Gross

, Unspoken worlds: Women's religious lives in non-western cultures (pp. 94–109). Retrieved from http://personal.carthage.edu/jlochtefeld/texts/vrats.doc.

67.

Williams

G. H.

(2003). The determinants of health: structure, context and agency. Sociology of Health & Illness, 25(3), 131–154.

68.

World Bank. (2015a). Maternal Mortality Ratio India. Retrieved March 6, 2017, from http://data.worldbank.org/indicator/SH.STA.MMRT?end=2015&locations=IN&start=1990&view=chart.

69.

World Bank. (2015b). Maternal Mortality Ratio United States of America. Retrieved March 6, 2017, from http://data.worldbank.org/indicator/SH.STA.MMRT?end=2015&locations=US&name_desc=false&start=1990&view=chart.

70.

World Bank. (2017a). Health expenditure per capita (current US$). Retrieved March 7, 2017, from http://data.worldbank.org/indicator/SH.XPD.PCAP.

71.

World Bank. (2017b). Health expenditure, total (% of GDP). Retrieved March 7, 2017, from http://data.worldbank.org/indicator/SH.XPD.TOTL.ZS?locations=IN.

72.

World Bank. (2017c). World Maternal Mortality Ratio. Retrieved July 26, 2017, from http://data.worldbank.org/indicator/SH.STA.MMRT.

73.

World Health Organization. (2015). Trends in maternal mortality: 1990 to 2015: estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Geneva, Switzerland: World Health Organization. Retrieved from http://apps.who.int/iris/bitstream/10665/194254/1/9789241565141_eng.pdf.

74.

World Health Organization. (2016, November). Maternal Mortality Fact Sheet. Retrieved March 6, 2017, from http://www.who.int/mediacentre/factsheets/fs348/en/.

75.

World Health Organization. (2017a). Health Topics-Maternal health. Retrieved July 22, 2017, from http://www.who.int/topics/maternal_health/en/.

76.

World Health Organization. (2017b, July 25). Public Health Services. Retrieved July 25, 2017, from http://www.euro.who.int/en/health-topics/Health-systems/public-health-services.

77.

Yuill

, Crinson

, & Duncan

(2010). Key Concepts in Health Studies. SAGE.

78.

Zeitlin

, Mohangoo

, & Delnord

(2012). European Perinatal Health Report 2010 - Euro-Peristat. Paris: EURO-PERISTAT. Retrieved from http://www.europeristat.com/reports/european-perinatal-health-report-2010.html.