Maternal Mortality Rate in India: Issues and challenges

In developing countries like India, maternal mortality is still one of the highest. As per a recent global report of Lancet, India accounts for 15% of world’s maternal deaths as of 2015. According to this report, while the total number of global maternal deaths has almost halved since 1990, one-third maternal deaths in 2015 happened in India and Nigeria. Different socio demographic factors are responsible for high maternal deaths in India. MMR also varies within India, with Kerala having the lowest and Bihar/Jharkhand having highest ratio.

Definition

Maternal Mortality Ratio (MMR) is defined as death of a woman from any cause related or aggravated by pregnancy while pregnant or within 42 days of termination of pregnancy. It is calculated as number of maternal deaths per 1 lakh live births during a given period.

Reasons

As per WHO, the maternal deaths are classified broadly into direct causes and indirect causes. The direct causes include deaths resulting from obstetric complications (pregnancy, delivery, and postpartum), incorrect treatment etc. the indirect causes include deaths resulting from previously existing diseases or diseases developed during pregnancy and are not directly related to the obstetric causes.

In India, direct obstetric causes result in over 80% of maternal deaths. Haemorrhages and infections are the leading causes for high MMR. Myriad of factors like early age of marriage, high birth rate, little spacing between consecutive pregnancies, lack of awareness about the danger signs of pregnancy, non-institutional deliveries, practices of unskilled medical staff have resulted in high MMR in India.

Lastly, illiteracy and lack of knowledge about health facilities is one of the primary reasons for high MMR especially among the people belonging to urban slum areas and lower socio-economic classes.

Interventions by Government

India had set a target of reducing maternal mortality ratio (MMR) by three quarters as a part of India’s millennium development goals (MDG). Government of India tries to reduce MMR under its flagship health programme National Health Mission (NHM). The efforts put by government includes promotion of institutional deliveries through Janani Suraksha Yojana, providing round the clock comprehensive obstetric care in sub-centres, primary health centres, community health centres and district hospitals etc. Under Janani Sukarsha Yojona, mothers will get incentive if they deliver their babies at Government accredited institutions. This scheme promotes safe motherhood under the NHM.

Way forward & suggestions

• Government should establish antenatal clinic in periphery and unaccessible areas
• Early registration of antenatal cases and promotion of regular home visit by Accredited Social Health Activist (ASHA) to sensitize mothers about the need of pregnancy.
• Improving nutritional status of women during pregnancy.
• Prevention and aggressive treatment of anaemia.
• Health care centres must be well equipped with adequately trained staff especially in rural areas.
• Improving awareness regarding family planning and safe abortion services through local media.
• To address the shortage of human resources in public health facilities, emphasis must be placed on medical education. To this end, at least one medical college need to be established in each districts of the country as successfully done by the states like Kerala and Tamil Nadu.

Conclusion

Although India has well structured public health system with the operationalization of sub-centres, primary health centre, community health centre, district hospitals, and medical colleges, still it lacks high service standards and practices. It is held that governance and strong political support to the health system are keys to a good public health system. Maternal deaths are not only a health issue but also a matter of social injustice.