Maternal Mortality in India
Kartavya Desk Staff
Syllabus: Health
Source: TH
Context: India’s Maternal Mortality Ratio (MMR) stands at 93 per 1 lakh live births (2019–21), showing improvement but also highlighting regional disparities and system failures in emergency obstetric care.
About Maternal Mortality in India:
• What is Maternal Death? Death of a woman during pregnancy or within 42 days of termination, due to causes related to or worsened by pregnancy (WHO definition).
• Death of a woman during pregnancy or within 42 days of termination, due to causes related to or worsened by pregnancy (WHO definition).
• How is it Calculated? Maternal Mortality Ratio (MMR) = maternal deaths per 100,000 live births, as per Sample Registration System (SRS) data.
• Maternal Mortality Ratio (MMR) = maternal deaths per 100,000 live births, as per Sample Registration System (SRS) data.
• Data Snapshot (2019–21): India’s MMR: 93 Kerala: Lowest (20) and Assam: Highest (167) Southern States fare better than Empowered Action Group (EAG) States.
• India’s MMR: 93
• Kerala: Lowest (20) and Assam: Highest (167)
• Southern States fare better than Empowered Action Group (EAG) States.
Need for Controlling Maternal Deaths:
• Public Health Indicator: MMR reflects quality of healthcare, gender equity, and governance.
• Preventable Tragedy: Most maternal deaths are avoidable with timely care and basic obstetric support.
• Global Commitments: SDG Target 3.1 aims to reduce global MMR to <70 by 2030. India needs faster acceleration.
Key Challenges:
• Three Delays Framework (Deborah Maine Model): Delay in decision-making to seek care due to lack of awareness or social barriers. Delay in reaching care, especially in remote/tribal areas. Delay in receiving care due to lack of specialists, blood, or operation readiness.
• Delay in decision-making to seek care due to lack of awareness or social barriers.
• Delay in reaching care, especially in remote/tribal areas.
• Delay in receiving care due to lack of specialists, blood, or operation readiness.
• Infrastructure Gaps: Only 2,856 of 5,491 CHCs function as First Referral Units (FRUs); 66% specialist vacancies reported.
• Only 2,856 of 5,491 CHCs function as First Referral Units (FRUs); 66% specialist vacancies reported.
• Medical Complications: Postpartum haemorrhage, hypertensive disorders, obstructed labour, sepsis, and unsafe abortions are leading causes.
• Postpartum haemorrhage, hypertensive disorders, obstructed labour, sepsis, and unsafe abortions are leading causes.
• Underlying Health Issues: Anaemia, malnutrition, and comorbidities like malaria, TB, and UTIs heighten risks, especially in EAG States.
• Anaemia, malnutrition, and comorbidities like malaria, TB, and UTIs heighten risks, especially in EAG States.
Government Initiatives:
• Janani Suraksha Yojana (JSY): Promotes institutional deliveries via financial incentives to mothers and ASHAs.
• Janani Shishu Suraksha Karyakram (JSSK): Provides free transport, diagnostics, and delivery services.
• FRU Operationalisation: Aims for minimum 4 FRUs per district, equipped with specialists and blood storage.
• Maternal Death Reviews (MDRs): Mandatory under NHM to audit every maternal death and correct systemic failures.
• Kerala’s Confidential Review Model: An example in reducing MMR to 20 using targeted clinical training and facility readiness (e.g., uterine clamps, embolism response).
Way Ahead:
• Focus on EAG States: Invest in specialist recruitment, FRU infrastructure, and localised health education.
• Strengthen Emergency Response: Ensure 24×7 blood banks, ambulance access, and obstetric surgical capacity in rural belts.
• Empower Community Health Workers: Scale up ASHA-ANM collaboration, maternal tracking, and family counselling.
• Enhance Pre-natal & Post-natal Care: Early registration, iron-folic supplementation, and antenatal risk screening must be mandatory.
• Adopt Best Practices Nationally: Emulate Kerala’s confidential review system in Tamil Nadu, Maharashtra, Jharkhand, etc., for deeper systemic corrections.
Conclusion:
Maternal deaths are largely preventable through timely, quality care and responsive systems. India must combine grassroots action with facility preparedness to reduce MMR further. The goal is not just safe delivery but safe motherhood.
• In order to enhance the prospects of social development, sound and adequate health care policies are needed particularly in the fields of geriatric and maternal health care. Discuss. (2020)