Is India Caring Enough For Its Mothers, Districts Show Higher Maternal Deaths Than SDG Target

India is not caring enough for its mothers as a study recently published in the journal PLOS Global Public Health has shown that 71 per cent of districts in India have a Maternal Mortality Rate(MMR) Above 140. MMR refers to the total maternal deaths due to complications of childbirth or pregnancy per 100,000 births in a year. Out of 640 districts analysed in the study, the MMR was higher than the UN SDG Target of 70 in 448 districts of India, signalling a huge gap and uncovered population in terms of adequate maternal health mechanisms available to the women going into labour in India. 

The study used data from Health Management Information System, Sample Registration System(SRS), Census of India 2011 and National Health Family Survey  among other sources to provide inputs for 29 states and seven UTs showing demographic, socioeconomic and healthcare correlation with MMR in India.

The study noted that in 2017, India had 35000 estimated maternal deaths, as the country accounted for 12 per cent of global maternal deaths second only to Nigeria.

As per the inputs of the study, Arunachal Pradesh has the highest MMR at 284 while the lowest was recorded in Maharashtra at 40. The north-east India in particular showed larger clusters of districts showing a higher rate of maternal deaths, with Manipur, Arunachal Pradesh, Meghalaya and Sikkim having MMR above 210, with the study showing an all India MMR of 122.

The rest of India also does not fare any better, with seven out of the nine Empowered Action Group states subsuming Uttar Pradesh, Madhya Pradesh, Uttarakhand, Rajasthan, Chattisgarh, Bihar and Odisha contributing 75 per cent of India’s total estimated maternal deaths with U.P solely responsible for 30 per cent maternal deaths as per the inputs disclosed by the SRS 2020 which looked at the MMR data from 2016-18.

“The various causes of maternal deaths in India are, complications arising from severe bleeding, infections, increased blood pressure ( preeclampsia), obstructed labour, unsafe abortions, other direct causes (amniotic  fluid embolism, throboembolism, peritpartum cardiomyopathy etc) and indirect causes ( heart attack, accident, suicide etc.)” stated Dr Anagha Chatrapati, Consultant Gynaecology, Global Hospital Parel, Mumbai.

Maternal deaths are higher in socio- demographic weaker states than the states which are socio economically advanced. Regions where there is a low age at first birth, low contraception usage, persistence of underweight and anaemic women report a higher MMR. 

MMR is also found to be higher in places where there is a low percentage of antenatal care, postnatal care, institutional deliveries and overall a lower health infrastructure. 

“While urban centres have got far better facilities, the rural population deals with poor physical infrastructure. Sometimes, basic healthcare services are unable to reach the patients or vice versa, leading to a wide gap. In addition, the poor status of malnutrition and girls getting married at an early age because of which they conceive early are also reasons for districts showing greater MMR. There is also lack of awareness of childbirth and lack of use of contraceptives. Having too many children also leads to chances of maternal mortality,” stated Dr Archana Dhawan Bajaj, Gynaecologist, Obstetrician and IVF Expert, Nurture Clinic.

Dr Anagha explained that the main reason behind lack of healthcare in rural areas is extremely poor financial remuneration to the healthcare providers and lack of livable conditions. There needs to be appropriate fund allotment, development of proper infrastructure, various activities to promote training, and implementation of quality standards.

The global United Nations Sustainable Developments Goals 2030 outlines the target of achieving an MMR of 70 for all the signatories. The Government of India although has been successful over the years at bringing down the maternal deaths considerably with antenatal schemes like Janani Suraksha Yojana which has contributed to care for mothers and institutional deliveries but a lot of ground still needs to be covered as the study argues that the country lacks a district level investigation for these government schemes.

Dr Archana says that there has to be a multipronged, multi-dimensional approach to deal with the situation so that India is able to meet the UN SDG 2030 target. It will stem from extending awareness, providing healthcare, correcting anaemia, malnutrition at pre-pregnancy level and ensuring that every delivery is attended by a healthcare provider. It requires consistent and persistent effort by the government and healthcare providers besides scaling up social levels and removing social ills that have made deep inroads in society.

She further said that diseases should be detected at pre-natal stages and they should be referred to a tertiary institute for correct medicinal provisioning. We should identify the reason for each maternal mortality. “Certain schemes like Anemia Mukth Bharat, Surakshit Matritva Aashwashan and Janani-Shishu Suraksha Karyakram are constructive steps to provide medical care to women and reduce maternal mortality. It's an uphill task but it's certainly reachable,” she added.