By Dr. Dylan G. Momin
Public health specialists explain maternal deaths through a simple framework known as the three delays. The first is the delay in deciding to seek care, when a family fails to recognise danger signs or hopes the situation will improve on its own. The second is the delay in reaching care, caused by barriers such as poor road connectivity, lack of transport, or the absence of someone to look after other children. The third is the delay in receiving care once a woman reaches a health facility, whether due to the absence of a doctor, a shortage of blood, or delays in referral. Almost every maternal death can be traced to one or more of these delays. And almost everyone is preventable.
Meghalaya has historically faced a high maternal mortality burden, much of which can be attributed to its challenging geography. Around a quarter of the state’s nearly 7,000 villages are difficult to access. For a woman in labour, a forty-minute walk to the nearest motorable road can mean the difference between life and death.
This is why recent figures deserve far greater attention than they have received. Maternal deaths recorded in the state fell from 244 in 2020–21 to 106 in 2025–26. Infant deaths declined from 3,064 to 1,833 over the same period. Institutional deliveries, which stood at 51 per cent during NFHS-4 and 66 per cent during NFHS-6, have since risen to around 80 per cent, according to the state’s health information data. The government has set a target of increasing this figure to 95 per cent within three years.
What has changed? Not one scheme alone, but a concerted effort to address all three delays simultaneously. To tackle the first delay, the MOTHER app, launched in 2019, enables frontline health workers to register and track pregnancies. This helps identify high-risk cases early and ensure timely follow-up, rather than allowing complications to go unnoticed until a crisis occurs.
To address the second delay, the Chief Minister’s Safe Motherhood Scheme, launched in 2022, adopted an unconventional approach. Under the scheme, transit homes were established near health facilities, allowing expectant mothers from priority groups to move in a week or ten days before their expected delivery date, where they can feel safe and receive the care they need.
Alongside, rather than offering a narrowly defined cash entitlement, the scheme channels funds directly to health facilities, empowering medical officers to identify and address the practical barriers faced by individual women. These may include transportation, accommodation in a transit home near a hospital, or assistance for the family member accompanying the expectant mother.
To tackle the third delay, the state has recruited doctors and specialists and invested in healthcare infrastructure. A medical college is now operational in Shillong, with another planned for Tura.
The flexibility built into the Safe Motherhood Scheme is particularly instructive for other states. A rigid scheme provides a fixed sum for a predetermined purpose. Yet the barriers facing a mother in the plains of the Garo Hills may differ considerably from those confronting a woman in the uplands of West Khasi Hills. Allowing the medical officer on the ground to determine the most appropriate support reflects confidence in frontline decision-making. The approach appears promising. An independent study published in Annals of Global Health has examined Meghalaya’s multisectoral approach to maternal health, providing the kind of external scrutiny that effective public health programmes should welcome.
There is, however, much more to be done. Child stunting remains a concern, underscoring the importance of the Mission 1000 Days initiative, which focuses on nutrition from pregnancy through a child’s second birthday. Birth spacing, anaemia and the growing burden of lifestyle-related diseases also require sustained attention. And 106 maternal deaths still represent 106 families that have lost a mother.
Nevertheless, when a state more than halves its recorded maternal deaths over five years, those of us working in public health should acknowledge the achievement plainly. It reflects the efforts of thousands of ASHAs, ANMs, nurses and doctors, supported by a government willing to invest in their work and trust their judgement. Mothers in Meghalaya’s villages are safer today than they were five years ago. That is no small achievement.
(The author is an Obstetrician-Gynaecologist at MCH Hospital, Tura)
