Unravelling Maternal Health Success of Jharkhand - A Potential Case Study for Positive Deviance.

Jharkhand has shown significant progress in reducing Maternal Mortality Ratio (MMR) from 371 in 2011 to 56 per 100,000 live births by 2020 which places it alongside the Southern states of India. MMR and TFR data from Sample Registration Surveys (SRS) and maternal and key fertility indicators from National Family Health Surveys (NFHS) were retrieved. We plotted graphically all the states of India based on their MMR and TFR achievements as reported in SRS (2018-20) and explored the reasons of the unique position of Jharkhand's maternal health achievements. Jharkhand is the only state of India which has achieved the national MMR targets but falls short of national TFR targets. The progress of key maternal health indicators was significant whereas the improvement of key fertility indicators can be considered as work in progress. We examined the possible explanations of the unique position of Jharkhand in terms of health care provision and socio-cultural preferences. To sustain the progress achieved, Jharkhand must focus on behavioural interventions to limit the family size and achieving the national targets of TFR and ensuring respectful maternity care. While the reduction in MMR is promising, focused efforts are needed to reduce TFR by complex socio-behavioural interventions to reduce fertility while continuing the medical interventions for maternal morbidity and mortality.