Every safe pregnancy is a reflection of a nation’s commitment to its women. In a country with nearly 2.9 crore pregnancies annually, ensuring safe motherhood at scale requires robust health systems, sustained political commitment, timely interventions, and equitable access to quality health care services.The need is to continue strengthening quality antenatal care and equitable access to maternal health care. (Shutterstock)The remarkable decline in maternal mortality over the past decade — among India’s most significant public health achievements — has been driven by sustained investments in maternal health, strengthened service delivery systems, community participation and a relentless commitment to ensuring that every woman has access to quality care throughout her pregnancy. At the heart of this transformation is the Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA), completing its tenth year on June 9, a nationwide movement to provide assured, comprehensive and quality antenatal care services, free of cost, to all pregnant women on the ninth day of every month during the second and third trimesters of pregnancy.By dedicating the ninth day of every month to maternal health, the programme serves as a reminder that every pregnancy deserves continuous care, monitoring and support throughout the pregnancy period. One of the most important lessons in maternal health is that no pregnancy is entirely risk-free. Recognising that any pregnancy can become high-risk without warning, a simple yet transformative approach — identifying risks early, monitoring them closely and ensuring timely referral and management — was introduced. Every high-risk pregnancy (HRP) identified represents an opportunity to prevent a maternal death, a stillbirth, a newborn complication or lifelong disability. The focus under the PMSMA shifted from treating complications to preventing them.One of its defining strengths is the institutionalisation of a fixed-day, assured platform for specialist-led antenatal care: Pregnant women are screened for nearly 25 HRP conditions (including severe anaemia, hypertension, gestational diabetes, and infections) that threaten maternal and newborn survival if left undetected.As evidence emerged that HRPs require continued monitoring beyond routine antenatal care visit by a specialist/medical officer the programme was strengthened further in 2022: Women with HRPs receive additional follow-up visits over and above the regular sessions to ensure timely management until safe delivery. Name-based tracking of HRPs was introduced and follow-up mechanisms up to the 45th day after delivery were strengthened, ensuring continuous care throughout pregnancy and the immediate postnatal period. Incentives for Accredited Social Health Activists (ASHAs) accompanying women with HRPs for additional visits have further bolstered referral compliance and continuity of care.A centralised digital portal serves as the backbone of programme management, enabling real-time reporting of service delivery, name-based tracking of HRPs, monitoring of performance and evidence-based decision-making. Importantly, the platform also allows private-sector specialists and community volunteers to register and contribute.The programme works in synergy with other maternal-health focussed government initiatives such as the Janani Suraksha Yojana, Janani Shishu Suraksha Karyakram (JSSK), and Surakshit Matritva Aashwasan (SUMAN), among several others. This has contributed to building a stronger continuum of care for women throughout pregnancy, childbirth and post-partum.The tireless efforts of health personnel across levels, in community mobilisation, counselling, screening, referral and follow-up, have ensured that maternal health services reach women even in the most remote areas of the country. The impact is increasingly visible in national health outcomes. According to the Sample Registration System estimates for 2022–24, India’s maternal mortality ratio (MMR) has declined to 87 per 100,000 live births — close to the Sustainable Development Goal target of MMR below 70 by 2030.The National Family Health Survey (NFHS-6, 2023-24) reports that institutional deliveries have increased to 90.6% from 88.6% in NFHS-5 (2019-21), while antenatal care coverage has improved from 92.6% in NFHS-5 to 95.9% — more women are accessing essential maternal health services than ever before, enabling early detection of complications and timely interventions. This underscores the scale and effectiveness of India’s maternal health programmes. Since the programme’s launch in 2016, more than 7.5 crore antenatal check-ups conducted have enabled the identification of over 1.17 crore HRPs. These achievements represent millions of mothers whose lives — as well as those of their newborns — were protected through timely and quality health care services.A simple but powerful belief, that no woman should lose her life while giving life, and no family should lose a mother to a preventable pregnancy-related complication, guides the programme. The need is to continue strengthening quality antenatal care, HRP tracking, midwifery-led services, digital innovations and equitable access to maternal health care. The experience so far has reaffirmed a simple truth: When every pregnancy is monitored, every risk is identified early, and every woman receives timely, respectful and quality care, maternal deaths become preventable rather than inevitable. The last ten years are a testament to what can be achieved when political commitment, empowered frontline workers, digital innovation, community participation and quality health care services come together with a singular purpose.JP Nadda is Union minister of health and family welfare. The views expressed are personal