- The maternal mortality ratio (MMR), according to the sample registration system (SRS) data (released by the office of Registrar General of India), has declined to 130 in 2014-16 from 167 in 2011-13.
What is MMR?
- The Maternal Mortality Ratio (MMR) is defined as the number of maternal deaths per 100,000 live births. .
Some facts regarding MMR:
- Globally, everyday approximately 830 women die from preventable causes related to pregnancy and childbirth.
- 99% of all maternal deaths occur in developing countries.
- Maternal mortality is higher in women living in rural areas and among poorer communities.
- Young adolescents face a higher risk of complications and death as a result of pregnancy than other women.
- Skilled care before, during and after childbirth can save the lives of women and newborn babies.
- Between 1990 and 2015, maternal mortality worldwide dropped by about 44%.
- Between 2016 and 2030, as part of the Sustainable Development Goals, the target is to reduce the global maternal mortality ratio to less than 70 per 100 000 live births.
Causes of maternal mortality
- Excessive blood loss (post-partum haemorrhage)- mostly bleeding after childbirth
- Infections (because women do not give birth in a hospital or health centre)
- High blood pressure during pregnancy (pre-eclampsia and eclampsia)
- Complications from delivery
- Unsafe abortion
Note – The major cause, post-partum haemorrhage is usually defined as the loss of more than 500-1,000 ml of blood within the first 24 hours following childbirth.
MMR in India
- In developing countries such as India, maternal mortality is a huge public health issue.
- India has reduced its maternal mortality by over 69 per cent since 1990, though it still has some catching up to do with better-performing Asian countries.
- Despite this, India, along with Nigeria, accounted for one-third of the global maternal deaths in 2015.
- India ranks 129 among 184 nations on maternal mortality and 145 out of 193 nations on infant mortality, according to the World Bank
What is Sample Registration System?
- Sample Registration System is the largest demographic survey in the country done by the Registrar General of India. The survey is mandated to provide annual estimates of fertility as well as mortality indicators at the state and national level.
The SRS segments States into three groups of states:
- Empowered Action Group (EAG): These are socioeconomically backward states which lag behind in the demographic transition with traditionally bad health. The group includes Bihar, Jharkhand, Madhya Pradesh, Chhattisgarh, Odisha, Rajasthan, Uttar Pradesh/ Uttarakhand and Assam. The highest reduction from the last SRS is with the EAG States at 23%, a drop from 246 (2011-2013) to 188. Truly encouraging is the massive drop of 29% in Uttar Pradesh/Uttarakhand where the MMR has dropped from 285 to 201.
- Southern States: Andhra Pradesh, Telangana, Karnataka, Kerala and Tamil Nadu; and Southern States, which are at a better average of 77, dropped 17%.
- Others: the remaining States and union territories. Other States have dropped by 19%, taking the MMR down from 115 in 2011-2013, to 93 now.
State wise data:
- Kerala remains at the top with an MMR of 46 (down from 61).
- Maharashtra retains its second position with 61, but the pace of fall has been much lower, dropping from 68 during 2011-13.
- Tamil Nadu with 66 (79) is in the third position.
These three States have already achieved the UN’s Sustainable Development Goal of MMR 70.
- The gap in maternal healthcare between urban and rural areas is often blamed for the overall poor scores and the inequalities are also evident through varying maternal mortality ratios across country.
The key steps taken under the National Health Mission (NHM) to improve MMR are:
- Promotion of institutional deliveries through Janani Suraksha Yojana.
- Janani Shishu Suraksha Karyakaram (JSSK) has been launched on 1st June, 2011, which entitles all pregnant women delivering in public health institutions to absolutely free and no expense delivery including Caesarean section.
- The initiative stipulates free drugs, diagnostics, blood and diet, besides free transport from home to institution, between facilities in case of a referral and drop back home.
- Similar entitlements have been put in place for ante-natal and post–natal complications during pregnancy and all sick infants accessing public health institutions for treatment.
- The Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA) has been launched by the Ministry of Health & Family Welfare (MoHFW), Government of India to provide fixed-day assured, comprehensive and quality antenatal care universally to all pregnant women on the 9th of every month.
- As part of the Abhiyan, a minimum package of antenatal care services would be provided to pregnant women in their 2nd / 3rd trimesters, by OBGY specialists/ Radiologist/ Physicians at government health facilities, with support from private sector doctors to supplement the efforts of the government.
- Provision of Ante-natal and Post-natal Care services including prevention and treatment of Anaemia by supplementation with Iron and Folic Acid tablets during pregnancy and lactation.
- Organizing Village Health and Nutrition Days (VHNDs) at anganwadi Centres to impart health and nutrition education to pregnant and lactating mothers.
- Augmenting the availability of skilled manpower thorough various skill- based trainings of Skilled Birth Attendants; training of MBBS Doctors in Life Saving Anesthetic Skills and Emergency Obstetric Care including Caesarean Section.
- DAKSHATA programme to equip them for managing normal deliveries, identify complications, do basic management and then refer at the earliest to higher facilities.
- Operationalizing round the clock facilities for delivery services in the 24X7 Primary Health Centres (PHCs) and First Referral Units (FRUs) including District Hospitals, Sub-district Hospitals, Community Health Centres and other institutions.
- Establishing Maternal and Child Health (MCH) Wings at high caseload facilities to improve the quality of care provided to mothers and children.
- Name Based Web enabled Tracking of Pregnant Women and New born babies so that provision of regular and complete services to them can be ensured.
- Mother and Child Protection Card in collaboration with the Ministry of Women and Child Development to monitor service delivery for mothers and children.
- Engagement of more than 9.15 lakhs Accredited Social Health Activists (ASHAs) to generate demand and facilitate accessing of health care services by the community.
- Operationalization of Comprehensive Abortion Care Services and Reproductive Tract Infections and Sexually Transmitted Infections (RTI/STI) at health facilities with a focus on “Delivery Points.
- Reproductive Maternal Newborn Child Health + Adolescent (RMNCH+A) interventions for achieving improved maternal and child health outcomes through continuum of care across life cycle.