Introduction It all begins with a mother—she is where the story begins. A healthy pregnancy and safe childbirth do not just benefit the mother, but strengthen the wellbeing of her children, her family, and her community for generations. This is the “mom effect,” and it positions maternal health as a macroeconomic and ethical imperative. Maternal health is a cornerstone of public health and an essential barometer of a country’s commitment to equity, dignity, and inclusive development. Despite notable global progress, maternal mortality remains high in low- and middle-income countries, especially in Asia. While clinical interventions such as skilled birth attendance and emergency obstetric care remain indispensable, these alone are insufficient to ensure safe motherhood. Understanding the Determinants of Maternal Health Outcomes Maternal health outcomes are shaped by interdependent determinants that stretch across the continuum of care from antenatal to intrapartum to postnatal stages. These can be broadly categorized into three determinants: Access: Physical proximity to health facilities is insufficient on its own. Women need reliable access to trained providers, essential medicines and equipment, functioning referral mechanisms, and integrated services that address physical and mental health. Affordability: Cost remains a barrier. Even when services are free, indirect expenses such as transport, diagnostic tests, and lost wages can discourage women, particularly those in informal employment, from seeking timely care. Financial protection must cover hidden costs so women are not forced to choose between her health and household survival. Accountability: Quality maternal healthcare depends on systems that enforce standards and ensure respectful, evidence-based care. This requires governance, monitoring, and feedback mechanisms— often weak in private sector oversight. An Indian Perspective India has registered measurable progress in reducing its maternal mortality ratio to 88 in 2022 per 100,000 live births from 384 in 2000. This reflects sustained government efforts and growing engagement of civil society, philanthropic institutions, private players, professional associations, and health technology innovators. These actors have expanded access, reduced costs, and strengthened service delivery. However, accountability has received less attention. While initiatives such as LaQshya and the National Quality Assurance Standards have improved public sector labor rooms and facilities, equivalent mechanisms in the private sector remain nascent. Private facilities account for nearly half of all institutional births, 80% of outpatient consultations, and 60% of inpatient admissions. They hold about 60% of hospital beds and 70% of the national health workforce, including 80% of physicians and majority of obstetricians. Despite this significant footprint, there is inconsistent application of evidence-based clinical guidelines, variable adherence to standardized obstetric protocols, limited regulatory oversight, and weak accountability mechanisms. To attain the Sustainable Development Goal target of fewer than 70 maternal deaths per 100,000 live births, Indian must integrate all providers into a cohesive quality framework that extends beyond the public sector. Raising the Bar One strategy to address private sector variability is accreditation. Accreditation frameworks help facilities: Adopt and institutionalize evidence-based protocols Standardize care across diverse facility types Embed quality through mentoring and audits One compelling example is the Manyata initiative, a national-level quality assurance initiative for private maternity facilities. It is built around 20 evidence-based standards covering antenatal, intrapartum, and postpartum care. It incorporates modular training, digital assessments, and post-training mentorship, with certification granted upon demonstrated adherence to these standards. Facilities track performance, identify gaps, and receive targeted support, embedding continuous improvement rather than one-time compliance. The initiative’s effectiveness is supported by an evaluation conducted across 466 private facilities in Jharkhand, Maharashtra, and Uttar Pradesh with Ariadne Labs, an affiliate of Harvard University. The evaluation documented substantial improvements: A twofold increase in provider knowledge scores A 650% increase in practical skills in preeclampsia, postpartum hemorrhage, and neonatal resuscitation Adherence to standards rising to over 90% from 29% Enhanced respectful care, including privacy, informed consent, and birth companionship While the evaluation did not record significant changes in facility-reported maternal or neonatal morbidity and mortality rates during the study period, referral rates for preeclampsia and newborn sepsis declined, indicating better early identification and management. Manyata, with support from MSD for Mothers, is led by the Federation of Obstetric and Gynaecological Societies of India—one of the largest professional bodies in the country, representing over 45,000 obstetricians and gynecologists nationwide. The initiative’s perceived legitimacy stems from its anchoring in a professional association rather than a regulatory mandate. Qualitative studies published in BMJ Health Journal shows that affiliation plays a pivotal role in motivating enrollment in Manyata. Facility owners and clinicians reported deeper engagement due to the validation it offers through the federation. The success of Manyata highlights the value of professional societies championing quality improvement, especially in fragmented health systems. Driving Sustainability As maternal health programs mature, long-term sustainability becomes a strategic imperative. Traditional grant-funded models are catalytic but limited. Manyata has pursued sustainability through the establishment of Centers for Skill Enhancement: regional hubs led by practicing obstetricians and gynecologists who are members of the federation. These professionals act as social entrepreneurs, offering capacity building and quality improvement support to facilities. By aligning incentives through a results-based financing approach and embedding leadership within local geographies, Centers for Skill Enhancement adapt the model to India’s linguistic, cultural, and infrastructural diversity. Sustainability also depends on integration with national systems. Manyata’s standards have been incorporated into the accreditation framework of the National Accreditation Board for Hospitals and Healthcare Providers, India’s apex body for quality accreditation. This integration anchors quality improvements within institutions and enables government ownership for scale and equity. As countries across Asia strive to elevate maternal health in pluralistic systems, Manyata offers a replicable model for engaging the private sector through professional ownership, collaboration, mentorship, and certification. Early steps toward regional adaptation are underway in Bangladesh and the Philippines, attesting to its broader relevance. Sustained progress depends not only on innovative models but also on the ecosystems that allow them to thrive—policy, financing, service delivery, and community engagement working together. Governments, professional bodies, private providers, and civil society each bring strengths to a shared agenda. This approach is aligns with Sustainable Development Goal 17, which recognizes partnerships as a cornerstone of effective implementation. As India and its regional peers work to close maternal health gaps, a system-oriented, evidence-backed strategy rooted in shared ownership and collective action offers the most promising path forward. Key Lessons Targeted quality interventions in private facilities are essential for equitable maternal health outcomes. Accreditation fosters accountability and consistent standards across fragmented health systems. Professional associations lend credibility, build trust, and drive voluntary participation. Long-term sustainability depends on local leadership and integration with government frameworks. Multisectoral collaboration amplifies impact and enables systemic improvements. Note: Maternal health was part of the discussions during ADB's 1st INSPIRE Health Forum: Inclusive, Sustainable, Prosperous and Resilient (INSPIRE) Health Systems in Asia and the Pacific. Resources EH News Bureau. 2024. NABH Integrates FOGSI’s Manyata Standards for Maternal Health Quality in Certification Programmes. Express Healthcare. 15 November. International Institute for Population Sciences and ICF. 2022. National Family Health Survey (NFHS-5), 2019-21: India: Volume II. L. Spigel et al. 2025. Perceived Effectiveness and Recommendations from a Childbirth Quality Assurance and Improvement Programme in India’s Private Sector: A Qualitative Evaluation Using the RE-AIM Framework. BMJ Public Health. 3 (1). M. Delaney et al. 2022. Does Quality Certification Work? An Assessment of Manyata, a Childbirth Quality Program in India’s Private Sector. Global Health: Science and Practice. 10 (6). M. Nundy et al. 2021. Public–Private Partnerships in Health Care Under the National Health Mission in India: A Review. The National Health Systems Resource Centre, New Delhi. S. Selvaraj et al. 2022. India Health System Review. Health Systems in Transition. 11 (1). Ask the Experts Pompy Sridhar India Director, MSD for Mothers Pompy Sridhar leads the organization’s strategic vision to advance maternal health. A Chevening Scholar from the London School of Economics, she brings over two decades of experience across the public, private, and development sectors. She has worked with the ICICI Group, World Bank, International Labour Organization, and Asian Development Bank, and has advised India’s Planning Commission and Unique Identification Authority of India—shaping systems-focused, market-based, and outcome-driven approaches to inclusive health and development. Follow Pompy Sridhar on MSD for Mothers MSD for Mothers is MSD's global initiative to help create a world where no woman has to die while giving life. Applying MSD’s business and scientific resources, MSD for Mothers works with grantees and collaborators to improve the health and well-being of women during pregnancy, childbirth and the months after. MSD for Mothers is an initiative of Merck & Co., Inc., Kenilworth, NJ, USA. Leave your question or comment in the section below: View the discussion thread.