India’s Maternal Mortality Ratio (MMR) dropped from 113 to 103 between 2016-18 & 2017-19.[1] Over the same period, MMR in Bihar has also reduced from 149 to 130. This has been possible due to strategic focus and able policies on maternal health at the national level. Despite these achievements more needs to be done if we are to timely achieve the SDG targets at the state level and nationally.

Provision of quality ANC services still remains a concern and is prominent highlighted in the recent NFHS findings. To address the gaps in Quality of care of pregnant women during ANC period, Government of India introduced the Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA) initiative. The aim is to ensure an antenatal checkup at facility by a Gynecologist during 2^nd or 3^rd trimester, in addition to prescribed ANC visits.

Government of Bihar is committed to reducing MMR by implementing PMSMA at its healthcare facilities. Hence regular monitoring and mentoring visits are planned from state with support of various partners on each PMSMA day. Norway India Partnership Initiative (NIPI) is providing strategic Technical Assistance (TA) to Maternal health cell in Bihar. On 9^th of June 2022 NIPI conducted a follow up visit at district hospital Arwal.

The visit findings, in comparison to the initial visit on 9^th May, 2022 show improvement in multiple aspects of the PMSMA day by facility staff and district administration. A dedicated space for PMSMA services are setup within a dedicated area and 3 staff nurses under guidance of a gynecologist conduct antenatal checkup. Vitals of each pregnant women including fetal heart sound are documented and high risk pregnancies are identified & enumerated for further tracking. ANC cards and safe motherhood booklets are being distributed to all clients. Folic acid, Iron (IFA) and calcium tablets are being provided as indicated and food packets are also provided to all.

PMSMA services can be further strengthened by ensuring availability of BEmOC/CEmOC trained medical officer to support the Gynecologist in identification and management of high risk cases. Orientation and sensitization of all staff, including community health workers (ASHAs), on PMSMA can be undertaken to ensure that all high risk cases are mobilized at facilities on the designated day to ensure that not a single high risk case is missed. Quality of services on PMSMA can be strengthened by integrating dedicated counselling on nutrition, IFA & calcium supplementation, danger signs & complication readiness, birth preparedness, family planning, institutional delivery, identification of referral transport, entitlements under JSY & JSSK, postnatal care, breastfeeding and complimentary feeding.

Engaging DQAC members in supportive supervision on 9^th of each month to ensure quality of PMSMA services will go a long way in preventing thousands of maternal deaths and thus help accelerate achieving the set MMR targets in time.

Glimpses from PMSMA site: District Hospital, Arwal