What to Read in The Hindu Editorial( Topic and Syllabus wise)

Editorial 1: Fostering a commitment to stop maternal deaths

Context

The number of mothers dying during childbirth is going down in India, but some states still need to work on fixing basic and deep-rooted problems in healthcare.

Introduction

Why should 93 women die during childbirth in India when one lakh women have a safe delivery? Between 2019–21, India’s Maternal Mortality Ratio (MMR) was 93, meaning 93 women died for every 1,00,000 live births, according to the Sample Registration System (SRS). Maternal death means the death of a woman during pregnancy or within 42 days after its end, due to causes linked to the pregnancy or its treatment, not due to accidents or unrelated reasons. However, India’s MMR has been falling over the years — it was 103 in 2017–19, then 97 in 2018–20, and now 93 in 2019–21.

Categorisation of States Based on Maternal Mortality Ratio (MMR)

Category	States/UTs	MMR Data
Empowered Action Group (EAG) States	Bihar, Jharkhand, Madhya Pradesh, Chhattisgarh, Odisha, Rajasthan, Uttar Pradesh, Uttarakhand, Assam	– Madhya Pradesh: 175 – Assam: 167 – Jharkhand: 51 – Others (Bihar, Chhattisgarh, Odisha, Rajasthan, UP, Uttarakhand): 100–151
Southern States	Andhra Pradesh, Telangana, Karnataka, Kerala, Tamil Nadu	– Kerala (lowest): 20 – Karnataka (highest): 63 – Andhra Pradesh: 46 – Telangana: 45 – Tamil Nadu: 49
Other States/UTs	Maharashtra, Gujarat, Punjab, Haryana, West Bengal and others	– Maharashtra: 38 – Gujarat: 53 – Punjab: 98 – Haryana: 106 – West Bengal: 109

Key Insight

• Keralahas the lowest MMR among all states (20).
• Madhya Pradeshand Assam have the highest MMRs in the country (175 and 167 respectively).
• This shows the need for a differentiated strategybased on each state’s specific needs and health infrastructure.

Three Major Delays in Preventing Maternal Deaths

Type of Delay	Explanation
1. Delay in deciding to seek care	Families may not realize danger signs or delay decision to go to hospital
2. Delay in reaching a healthcare facility	Poor roads, transport, or long distances slow down access to medical help
3. Delay in getting proper treatment	Lack of trained staff, medicines, or quick response at the health facility

Key factors that endanger a life

First Delay – Delay in Recognising Danger and Deciding to Seek Care

• The first delayis in recognising danger and deciding to seek expert care.
• Husbands and family membersoften show inertia, assuming childbirth is natural and the mother can wait.
• Families may not go to the hospital due to:
  • Lack of money
  • Family-level issues
• If the educationand financial condition of the family is weak, decision-making is delayed and harmful.
• Empowered neighbourhood mothersand women’s self-help groups (SHGs) have brought remarkable change.
• The mother-to-be is no longer neglectedby lethargic family members.
• Since 2005, ASHA workershave been networking with ANMs under the National Rural Health Mission (NRHM).
• Institutional deliverieshave become more common than home deliveries.
• Financial incentivesfor both mothers and ASHA workers were the turning point.

Second Delay – Delay in Reaching Health Facility

Cause	Impact
Travel from remote rural hamlets, forest areas, or islands	May take hours or overnight
Difficulty in reaching a health facility	Many women die on the way
Need to access a midwife, nurse, doctor, or obstetrician	Skilled help is often too far away

• The 108 ambulance systemand emergency transport services under the National Health Mission (NHM) have made a difference.

Third Delay – Delay in Providing Specialised Care at the Health Facility

• The third delay, often unpardonable, happens at the hospital itself.
• Common excuses and delaysinclude:
  • Delay in attending the womanin the emergency room
  • Delay in reaching the obstetrician
  • Delay in arranging a blood donor
  • Delay in lab tests, operation theatre, or anaesthetist

Importance of First Referral Units (FRUs)

Feature	Purpose
Minimum 4 FRUs per district	For every 2 million population, to provide emergency care
Specialists available	Obstetrician, anaesthetist, paediatrician
Facilities required	Blood bank, OT (operation theatre)
Goal	Prevent maternal death at the hospital doorstep

• Introduced in 1992, but has not worked as expected.
• Key issues:
  • 66% vacancyof specialists in 5,491 CHCs (out of which 2,856 are FRUs).
  • Lack of blood banksor storage units delays urgent transfusion.
  • Fatalitiesoccur if blood is not given within 2 hours of heavy bleeding.

Medical Causes of Maternal Deaths

Cause	Explanation
Postpartum haemorrhage (bleeding)	– Caused by poor uterine contraction after delivery – Loss of more than 2.5 litres of blood can lead to shock and death
Anaemia	– Lack of iron-folic acid during pregnancy worsens bleeding outcomes
Obstructed labour	– Due to contracted pelvis in malnourished, stunted mothers – Can cause foetal distress or uterine rupture unless Caesarean section is done
Hypertensive disorders (high BP)	– If not treated early, can lead to convulsions, coma, and even death
Sepsis from unsafe deliveries/abortions	– Home births by untrained attendants, use of crude abortion methods by quackscause infections and death
Infections & co-morbidities	– Conditions like malaria, UTIs, and tuberculosis in EAG States increase the risk

What’s Needed

• Immediate blood transfusion
• Well-equipped OT, with obstetrician, surgeon, and anaesthetist on call
• Timely recognition and treatmentof high blood pressure
• Safe delivery practices
• Access to antibiotics, and prevention of unsafe abortions
• Address underlying diseaseslike malaria and TB, especially in EAG States

Prescription for Preventing Maternal Deaths

• Early registrationof pregnancy is essential to track and monitor maternal health.
• Regular antenatal check-upshelp identify risks during pregnancy.
• Promoting institutional deliveryensures access to skilled medical care.
• These steps help in early detectionof complications before they turn serious.
• Under the National Health Mission (NHM), mandatory reporting and auditof all maternal deaths is carried out.
  • The purpose is to highlight systemic deficienciesin maternal care services.
• State-specific prioritiesmust guide interventions:
  • EAG Statesneed to focus on basic implementation tasks.
  • Southern States, Jharkhand, Maharashtra, and Gujaratmust improve the quality of basic and emergency obstetric care.
• The Kerala model, known as the Confidential Review of Maternal Deaths, was initiated by  V.P. Paily.
  • Kerala’s MMR is 20, among the lowest in India.
  • The model offers insights that other southern States can adopt.
  • Focus is on refining clinical practices and response systems.
• Advanced strategiesfollowed in Kerala include:
  • Use of uterine artery clampson the lower uterine segment.
  • Suction canulaapplication to address uterine atonicity.
  • Active monitoring for:
    • Amniotic fluid embolism
    • Disseminated intravascular coagulation (DIC)
    • Hepatic failurefrom fatty liver cirrhosis
  • Kerala also addresses mental health conditionslike:
    • Antenatal depression
    • Post-partum psychosis
    • Reported cases of maternal suicideare taken seriously and managed accordingly.

Conclusion

Reducing maternal deaths requires timely care, institutional deliveries, and strong healthcare systems. While India’s MMR is improving, deep gaps remain across states. A focused, state-wise approach, backed by trained personnel, emergency support, and models like Kerala’s, is essential. With commitment and accountability, no woman should lose her life giving birth — a basic right, not a privilege.

 

Editorial 2: ​Keep it simple

Context

The ECI’s mixed messages put Bihar’s voter registration process at serious risk.

Introduction

The Election Commission of India (ECI) is conducting a Special Intensive Revision (SIR) of electoral rolls in Bihar, aiming to clean and update the voter list. However, conflicting instructions, strict document requirements, and discretionary verifications are causing confusion and risk voter exclusion, especially among the poor and marginalised, undermining the spirit of universal adult franchise.

Issue with Voter Roll Revision in Bihar

• The Election Commission of India (ECI)is conducting a Special Intensive Revision (SIR) of electoral rolls in Bihar.
• Though it appears smooth on paper, the process has many confusions and contradictions.
• Around 11% of votershave submitted forms — but that’s not the full picture.
• Two different instructions from top officials have created uncertaintyand mistrust.

Contradictions in ECI Instructions

Authority	Statement/Instruction
CEO, Bihar (via ads)	Voters without 11 documents could still apply by giving forms and providing documents later.
CEC (Central EC)	Said that document submission by July 25, 2025 is mandatory.
	Claims and objections period is from August 1 to September 1, 2025.

• This shift in stancehas created confusion for voters and ground staff.
• Local officers now have discretionto accept or reject applications based on field verification.

Concerns with the Current Approach

• Relying on local-level verificationincreases chances of:
  • Misuse of power
  • Biased decisions
  • Wrongful inclusion/exclusion
• The current process risks disenfranchising genuine voters, especially the poor and marginalised.

Challenges Faced by Voters in Bihar

Problem	Impact on Voters
Poor documentation	Many voters don’t have birth certificates, school records, etc.
Rigid document requirement	Voters without the listed 11 documents may be excluded from the rolls
Bureaucratic hurdles	Marginalised groups face more difficulty in dealing with official processes
Presumption of non-citizenship	Voters are treated as non-citizens unless they can prove otherwise

What Should Be Done

• ECI should widen the listof acceptable documents, such as:
  • Aadhaar cards
  • Ration cards
  • MGNREGA job cards

Document	Why It Should Be Accepted
Aadhaar	Used widely across services; almost everyone has one
Ration Card	Common among rural and low-income families
MGNREGA Job Card	Held by many in the agrarian population for government employment benefits

• These documents are realistic, widely available, and should be acceptable proof of identity.

Upholding the Right to Vote

• The right to vote is a constitutional right.
• The ECI must remove unnecessary hurdlesand make the process inclusive.
• The Supreme Courtis set to hear petitions on this issue — but action from ECI is needed now.
• The current SIR process must be revisedto ensure no eligible citizen is left out.

Conclusion

To protect the right to vote, the ECI must ensure the process is inclusive and fair. Accepting widely-held documents like Aadhaar, ration cards, and MGNREGA job cards will prevent mass disenfranchisement. In a democracy, the burden must not be on citizens to prove they belong — it is the state’s duty to enable every eligible voter.