in maternal

One mother, one life-threatening complication, and the healthcare training program that’s leading innovation.

By Indrani Kashyap, Jhpiego


Santosh Harijan bursts into an embarrassed giggle when asked how old she is.

Like most women in her village, Santosh married in her early teens and gave birth to her first child soon after.

The hamlet, where she lives with her husband, their four children, and his family, is tucked into the outskirts of Galiakot in Rajasthan, India, surrounded by the hilly Aravalli range, which runs through the northwestern corner of the country.

When Santosh was about to deliver her fourth child, she had a headache, blurred vision, vertigo, and swollen feet.

Instead of going to a traditional healer, her husband took her to the Galiakot Community Health Center

Sudhir Bhat, who received training from the nonprofit Jhpiego, a global health leader and Johns Hopkins University affiliate, was on duty

“We immediately checked her blood pressure,” he says. 

“It was very high. We started her treatment right away, along with preparing her for delivery as she was [almost fully] dilated.”

There has been tremendous global progress in maternal health.

From 2000 to 2017, the worldwide maternal mortality rate dropped 38% — from 342 deaths to 211 deaths per 100,000 live births. 

342 2000
248 2010
211 2017

Causes Of Maternal Death

Indirect (27.5%)
Haemorrhage (27.1%)
Hypertension (14%)
Sepsis (10.7%)
Other direct (9.6%)
Abortion (7.9%)
Embolism (3.2%)


In response, Jhpiego launched Dakshata, a quality improvement program to enhance health providers’ skills and competency, through trainings, mentorship, and efficient use of data, in partnership with the government of India.

Through Dakshata, health care providers like Sudhir are taught the skills necessary to help treat and prevent life-threatening complications of childbirth, like managing high blood pressure, severe bleeding, and caring for low-birthweight babies. 

They learn the impact of respectful, woman-centered care in creating an appreciation and demand for quality health services.

Sudhir also learned to document his patients’ vital signs and use a partograph—a simple lifesaving tool for monitoring the progress of labor.

Since Dakshata’s inception in 2015, nearly 2 million women in Rajasthan, including Santosh, have given birth with a trained provider by their side and received the health care every woman deserves.

Today, Rajasthan has achieved one of the most impressive declines in maternal mortality in all of India

Nurse Sudhir credits the program with adding to his confidence and abilities. 

“After Jhpiego training, the referrals [to other facilities] have reduced, still-birth rates have declined,” he says.

Jhpiego’s mentorship and innovation contributed to a reduction in maternal deaths and stillbirth, which fell by 11% in program facilities.

In 2020, India’s premier government think tank, the National Institution for Transforming India, recognized Dakshata for its innovative and effective strategies. The government of India’s flagship quality improvement initiative that Jhpiego started in Rajasthan has now been scaled up to more than 25 states.

Since then, Jhpiego’s mission has remained the same — to save lives, improve health, and transform the futures of mothers, children, and families in 36 countries around the world.

Learn how you can help Jhpiego make a difference in communities like Santosh’s.