Peer-reviewed article

Maternal and child well-being through Ayurveda and Yoga

Tanuja Manoj Nesari · 1 Apr 2024

Abstract

In any region or community, mothers and children constitute the priority group. Maternal and Child Health (MCH) has remained a crucial public health service and a global concern for decades. Since the year 2000, enhancing the health of mothers and children has been a top priority for global development, with a significant reduction in maternal and child mortality as one of the Millennium Development Goals, further continuing as one of the global targets for the Sustainable Development Goals (SDGs) 2030. According to United Nations (UN) interagency estimates, the worldwide Maternal Mortality Ratio (MMR) fell by 34% between 2000 and 2020, from 339 to 223 deaths per 100,000 live births, corresponding to an average yearly decline rate of 2.1%, which is almost one-third of the 6.4% annual rate required to attain SDG target of 70 maternal deaths per 100,000 live births by 2030.[1] Since the progress has been inconsistent, it requires investments and improvement in antenatal, birth, and postpartum care in terms of both access and quality. Over the past two decades, almost 1.3 million Indian women have died from maternal causes. However, the MMR has decreased by 70%, from 398/100,000 live births in 1997 to 98-99/100,000 in 2020, demonstrating significant progress in adopting measures to address the issue.[2] The Indian health-care system dealing with maternal and child care has been striving hard to deliver excellent services to pregnant women and neonates through different interventions and programs, capacity-building programs for health staff, and continuous upgradation of the health-care infrastructure. The Government of India has several initiatives to provide financial and medical support to all pregnant women including Janani Suraksha Yojana, which integrates cash assistance with delivery and postdelivery care;[3]Janani Shishu Suraksha Karyakram to eliminate out-of-pocket expenses for both pregnant women and sick infants including free deliveries, cesarean section, and treatment of sick neonates accessing public health institutions.[4] Apart from these, the government has taken various steps to ensure assured availability of all facilities to pregnant women in the remote areas of the country which includes setting up of “Delivery Points,” MCH Wings, functionalization of first referral units, birth waiting homes, and launch of other health programs such as Surakshit Matritva Aashwasan (SUMAN), Pradhan Mantri Surakshit Matritva Abhiyan, and LaQshya (Labor room quality improvement initiative).[5] Apart from these, the government has also implemented the Pradhan Mantri Matru Vandana Yojana to provide financial support for pregnant and lactating mothers and to improve the health and nutrition of mother and child as well as compensation for wage loss, if any.[6] CHALLENGES DURING PREGNANCY Each phase in a woman’s life is marked by distinct challenges and opportunities, characterized by significant physical, psychological, and social changes. The period of pregnancy, labor, and postpartum contribute to the health and well-being of the mother and child. This necessitates adequate antenatal care during and following delivery. Women in the reproductive and childbearing age groups deal with several difficulties and obstacles. Women experience specific physiological and psychological changes during pregnancy with specified physical and psychological demands. The well-being and Quality of Life (QoL) of the mother are critical for optimal pregnancy outcomes. Pregnancy-related minor physical illnesses significantly impact overall health and QoL, further impacted by stress, anxiety, and depression in the prenatal stage. This can further severely impact the neurocognitive development of newborns and children, causing unfavorable consequences to the mother and fetus, such as preterm birth, low birth weight, and postpartum depression.[7] Stress and anxiety experienced by the mother during her pregnancy can have several detrimental effects on the developing fetus. Pregnancy-related stress and anxiety in the mother are linked to several detrimental effects on the developing fetus. It has been observed that fetal exposure to stress and stress-related peptides increases the likelihood of negative effects on the neural system’s programming and the morphology of the developing fetus and baby brain. Furthermore, anxiety and stress experienced by pregnant mothers may also increase the risk of adverse outcomes later in life, such as attention-deficit hyperactivity disorder or poor performance on executive function tests.[8] Significant endocrine changes occur during pregnancy, where maternal cortisol levels and other stress hormones rise sharply, and these endocrine changes are critical for fetal development. It has been found that prenatal exposure to high-stress hormone levels has been shown to delay the maturation of the fetal nervous system, limit neuromuscular development, and impair mental development in infants possibly, resulting in reduced gray matter volume in children. This illustrates that fetal exposure to stress hormones and peptides affects the neurological system profoundly, perhaps increasing the risk of emotional and cognitive damage.[9] A significant proportion of women experience postnatal depression, which has substantial social and economic consequences. There is a proven bidirectional relationship between mental and physical health during a postpartum period which can further have detrimental effects on cognitive and psychosocial development as well as psychological outcomes such as anxiety, depression, and externalizing issues in children.[10] YOGA FOR HEALTHY TRANSITION PHASE Recognizing and addressing the unique needs at each stage of women can help to achieve better health, well-being, and fulfillment throughout their lives. One such transition phase is the adolescence phase. Adolescence is a developmental stage that marks the transition from childhood to adulthood, which encompasses significant physical, physiological, psychological, sexual, and behavioral changes. It is a unique stage of human development and an important time for laying the foundations of good health. It has been estimated that over 1.5 million adolescents and young adults aged 10–24 years died in 2021, where depression and anxiety have served as the leading causes of illness and disability among adolescents.[11] These highlight the need for high-level attention on the mental health needs and solutions to address the physical, physiological, emotional, and social issues faced by young adults in the growing years. Yoga as a science of consciousness (~Chitta) can help achieve a state of wakefulness and alertness among such young populations. Studies have shown that Yoga and meditation help in releasing happy hormones such as serotonin and dopamine that help in reducing stress and anxiety disorders.[12] A systematic review to examine the evidence base for Yoga intervention for anxiety reduction among children and adolescents in the age group of 3–18 years reported a reduction in anxiety in almost all studies.[13] Thus, integrating Yoga into the lives of adolescents can support their overall development by enhancing physical health, mental clarity, emotional stability, and social well-being. Given the many challenges adolescents face, Yoga offers a holistic approach to help them navigate this formative period with greater resilience and balance. YOGA AND HEALTHY MATERNAL JOURNEY Ayurveda emphasizes the significance of maintaining a healthy pregnancy, offspring, and optimal nursing for the necessary growth and development of infants which includes holistic nutrition from the time of conception up to delivery as well as to the postpartum period. The principles and concepts are well illustrated in Ayurveda classics which include Rajaswala paricharya (~care of a woman during the menstruation period), Garbhini charya (~antenatal care), and Sutika charya (~postpartum care), addressing the physiological demands at various stages of life of a woman. Furthermore, the science of Ayurveda advocates principles of neonatology, including Navjata shishu paricharya (~comprehensive infant care) from birth until complete stability of the child. Ayurveda also advocates inculcating Yoga practices during these different phases of women to foster the physical and mental well-being of mother and child. Yoga is a physical practice that integrates breathing exercises, relaxation, and physical postures with an emphasis on the mind, body, and soul. Yoga has been reported a positive impact on the health of women during pregnancy, labor, and the postpartum period. In one of the Randomized Controlled Trials (RCT), the effect of a Yoga program during pregnancy was studied on maternal comfort, labor pain, and birth outcomes. The study concluded that the experimental group had higher levels of maternal comfort during labor and postlabor, with lesser labor pain and a shorter duration of the first stage of labor, as well as the total time of labor than the control group.[14] Similarly, in another study, the role of prenatal yogic exercises in alleviating labor pain and improving birth outcomes was assessed using Numerical Pain Intensity Scale, Pain Behavioral Observational Scale, and Maternal Delivery Comfort Questionnaire. The study revealed that the requirement of induction of labor and analgesics was significantly less in the study group with significantly a greater number of normal vaginal deliveries and less cesarean sections, the shorter first stage of labor in the study group practicing Yoga. Furthermore, the number of low-birth-weight babies was also significantly less in the study group with no adverse effects attributed to Yoga.[15] According to a randomized trial on Yoga in high-risk pregnancies, visualization, and guided Yoga poses can enhance intrauterine fetal growth and utero-fetal-placental circulation.[16] Through a stratified RCT, it has been proved that antenatal-integrated Yoga is safe and effective in encouraging the healthy development of platelets and uric acid in women with high-risk pregnancies.[17] Evidence generated through RCTs has shown a reduction in pain, stress, anxiety, and depression, with proven improvement in labor metrics such as comfort, pain, and length as well as stress levels and QoL, confirming beneficial impacts on anxiety, depression, perceived stress, delivery, and labor time.[18] Consequently, to lower the risks associated with pregnancy and delivery, Yoga should be included in the treatment protocol of labor and delivery and routine midwifery nursing care. Maternal mental health is particularly vulnerable during the postnatal period, and thus, it is imperative to utilize feasible and affordable approaches to enhance postnatal mental well-being. Yoga has proven its role as a beneficial intervention for the mental health and well-being of mothers. Previous studies have suggested that postnatal Yoga is associated with decreased symptoms of depression and an increase in psychological well-being and QoL.[10] GLOBAL POSITIONING AND STRENGTHENING OF YOGA Yoga has developed over thousands of years and addresses the mental, emotional, physical, and spiritual health of individuals, especially women. Yoga therapy improves many aspects of health and the different components of Yoga work in different ways. “Yoga” refers to the unification of the individual’s consciousness with the Universal Divine Consciousness, which can be attained through a wide range of practices, including specific Yoga asanas, breathing exercises, cleansing exercises, meditation, and relaxation techniques. Due to its profound impact on the physical as well as mental well-being and health of individuals, a tremendous encouragement to this several decades old, “science of Yoga” was received in the year 2014. It was on December 11, 2014, responding to a call by the Honorable Prime Minister Shri Narendra Modi, 193 UN General Assembly members, and 73 co-sponsor nations, unanimously approved the resolution of the UN to establish June 21 as the International Day of Yoga (IDY). Since June 21, 2015, numerous Yoga-related events and programs have been held around the world to commemorate the IDY. YOGA AND INITIATIVES BY MINISTRY OF AYUSH Several initiatives have been taken by the Ministry of Ayush (MoA) to promote Yoga across the globe in promoting and popularizing this ancient practice as well as positioning Yoga as an evidence-based health-care system. To promote Indian classical Yoga for the well-being of individuals, the MoA has established a Yoga Certification Board with the objectives to bring synergy, quality, and uniformity in knowledge and skills of Yoga professionals across the world through certification programs. The MoA has also launched a scheme for Voluntary Certification of Yoga Professionals which aims at certifying the competence level of Yoga professionals through the certification process and promoting authentic Yoga as a preventive and health-promoting drugless therapy.[19] Apart from these, broad outreach initiatives with public–private partnerships improving accessibility to Yoga instruction and therapy through a network of Ayush Health and Wellness Centers are being taken by the Ministry. Under the National AYUSH Mission, the Ministry promotes the integration of AYUSH systems, including Yoga, into the public health system, with special emphasis being placed on MCH, recognizing the role of Yoga in improving health outcomes for women. Moreover, community-based Yoga programs such as Yoga Mahotsav and Yoga Volunteer Training Programs are being organized, specifically targeting women’s groups, to create a supportive environment where women can practice Yoga together, share experiences, and build a sense of community. Contributing to the initiative to strengthen the role of Yoga in the community, especially among women and females of reproductive age, the All India Institute of Ayurveda (AIIA) has developed a protocol for “standard operating procedures in preconceptional and prenatal care through Ayurveda” where the importance of Yoga, Pranayama (~breathing exercise), and meditation has been emphasized, and month-wise Yogasanas are mentioned for the pregnant women with their importance. Efforts are being made to increase the number of RCT trials to determine the effects of Yoga intervention in pregnancy, postpregnancy, and in infants. There is still a need to carry out more specified studies on Yoga intervention according to a varied range of difficulties and challenges faced by women during the different phases of pregnancy. Significant and impactful studies should be conducted to assess the role of Yoga practices in high-risk pregnancies. An evidence-based approach to develop a prenatal and postnatal Yoga protocol for the well-being of mother and child should be developed, with distinct and specified guidelines according to the different phases and stages of pregnancy. INTERNATIONAL DAY OF YOGA 2024 Owing to the overwhelming response and enthusiasm for Yoga among people across the world, this year, the MoA is celebrating its 10th edition of the IDY 2024 with the theme of “Yoga for Self and Society”. To commemorate 100 Days Countdown to IDY 2024, a grand event of “Yoga Mahotsav 2024” was organized.[20] It has been emphasized that the challenges posed by modern lifestyle disorders as well as Non-Communicable Diseases (NCDs) can be effectively tackled by integrating Ayush healthcare approaches into the daily lives. In an event organized by AIIA, New Delhi, a well-known motivational speaker, Sister BK Shivani, emphasized the importance and significance of Yoga for the betterment of humanity, and the role of Yoga practice for an informed decision. The science of Yoga has been accepted and adopted by the global community at large with its perceived global dimensions. Yet, there is a lack of knowledge about the benefits of Yoga during prenatal, antenatal, and postnatal periods among women, especially in rural areas along with a lack of motivation to practice Yoga during the most critical period of women. It requires the significant contribution of health workers to make and reinforce innovative Yoga interventions in pregnant women and to develop comprehensive Yoga guidelines to improve maternal and newborn care so that mothers, babies, and families can thrive in longer terms. A holistic, comprehensive, and life-course approach beyond reproductive health is needed to achieve better health for women starting from pregnancy and maintaining throughout the newborn, childhood, adolescence, and aging period. It is apt to refer to the quote of Acharya Charaka, which goes as “स्त्रीषु लोकाः प्रतिष्ठिताः” inferring that the women are noble and plays a pivotal role in the health of the entire universe. Thus, women must be empowered to take care of their health in multiple dimensions.