Context:
India’s Maternal Mortality Ratio (MMR) stands at 93 per 1 lakh live births (SRS 2019–21), showing notable improvement. However, regional disparities and healthcare system gaps persist, especially in Empowered Action Group (EAG) states.
Key Highlights:
Definition and Measurement
- Maternal Mortality Ratio (MMR): Number of maternal deaths per 100,000 live births.
- Maternal Death (WHO): Death of a woman during pregnancy or within 42 days of termination due to pregnancy-related causes.
MMR Data (2019–21)
- India’s MMR: 93
- Lowest MMR: Kerala (20)
- Highest MMR: Assam (167)
- Southern states outperform EAG states (e.g., Bihar, UP, MP, Odisha).
Why MMR Matters
- Public Health Barometer: Reflects healthcare access, gender equity, emergency care systems.
- SDG 3.1 Target: Reduce global MMR to <70 by 2030 — India needs faster progress.
- Avoidable Tragedy: Majority of maternal deaths are preventable with timely obstetric care.
Key Challenges
- Three Delays Model (Deborah Maine Framework):
- Delay in Decision: Due to social stigma, ignorance, or poor family support.
- Delay in Transit: Especially in tribal, hilly, or remote areas.
- Delay in Treatment: Lack of specialists, surgical readiness, blood availability.
- Infrastructure Bottlenecks:
- Only 2,856 out of 5,491 Community Health Centres (CHCs) function as First Referral Units (FRUs).
- 66% shortage of specialists in public health facilities.
- Medical Causes of Maternal Deaths:
- Postpartum haemorrhage, hypertensive disorders, sepsis, obstructed labour, unsafe abortions.
- Underlying Risk Factors
- Anaemia, malnutrition, and comorbidities (e.g., TB, malaria, UTIs) are prevalent among pregnant women in vulnerable states.
Government Initiatives
- Janani Suraksha Yojana (JSY):
- Cash incentives for institutional deliveries.
- Incentives to ASHAs for mobilising pregnant women.
- Janani Shishu Suraksha Karyakram (JSSK):
- Free transport, medicines, diagnostics, and delivery care at public hospitals.
- FRU Strengthening:
- Goal of minimum 4 FRUs per district, with specialists and blood storage.
- Maternal Death Reviews (MDRs):
- Mandatory under National Health Mission (NHM) to identify and correct gaps.
- Kerala’s Confidential Maternal Death Reviews:
- Focus on clinical audits, training, and facility preparedness (e.g., use of uterine clamps, embolism protocols) — key to Kerala’s low MMR.
