Maternal mortality in India is the maternal death of a woman in India during pregnancy or after pregnancy, including post-abortion or post-birth periods. Different countries and cultures have different rates and causes for maternal death. Within India, there is a marked variation in healthcare access between regions and in socioeconomic factors, accordingly, there is also variation in maternal deaths for various states, regions, and demographics of women.
Pregnancy involves a vulnerability that puts women at risk of dying, and India is one of many countries which records a high number of pregnancy-related deaths of women each year.
Women die as a result of complications during and following pregnancy and childbirth or abortion. Most of these complications develop during pregnancy are easily preventable or treatable. Other complications may exist before pregnancy but are worsened during pregnancy, especially if not managed as part of a woman's care.
History India contributes one-fifth of the global burden of absolute maternal deaths; however, it has experienced an estimated 4.7% annual decline in maternal mortality ratio (MMR),RGI (2006) Registrar General/Centre for Global Health Research, University of Toronto. New Delhi: Registrar General of IndiaWHO, UNICEF, UNFPA, World Bank (2012) Trends in maternal mortality: 1990 to 2010. Geneva: World Health Organization and 3.5% annual increase in skilled birth attendance since 1990.IIPS (2010) District level household and facility survey (DLHS-3) 2007–2008: India. Mumbai: International Institute for Population Sciences
Ninety-four percent (94%) of all maternal deaths occur in low and lower middle-income countries.Trends in maternal mortality: 2000 to 2017: estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Geneva: World Health Organization; 2019 In September 2000, the United Nations, faced with the enormous maternal death toll in India and other developing countries, pledged as its fifth Millennium Development Goal (MDG 5) that the global MMR would be reduced to a quarter of its 1990 level by 2015. India is a signatory to the Millennium Declaration adopted at the United Nations General Assembly in September 2000, and consistently reaffirmed its commitment towards the eight development goals. These MDG targets were in convergence with India's own national development goals to reduce poverty and other areas of deprivation. In 2018 the World Health Organization (WHO) congratulated India for the great reduction in its maternal mortality since 2005, especially in recent years, reducing the maternal mortality ratio (MMR) by 77%, from 556 per 100 000 live births in 1990 to 130 per 100 000 live births in 2016, which was considered by WHO to be a remarkable feat in contrast with the global maternal mortality reported to have experienced a decline of 43%. Prior to that, various reports described high rates of maternal mortality in India, from which WHO and other international bodies concluded India could not reach the Millennium Development Goals (MDG).
Maternal deaths being a rare event require a large sample size to provide robust estimates. In order to enhance the Sample Registration System (SRS) sample size, results were derived by following the practice of pooling three years' data to yield reliable estimates of maternal mortality. The first report on maternal mortality in India (1997-2003), describing trends, causes and risk factors, was released in October 2006.
In 2005, a woman's lifetime risk of maternal death in India was estimated to be 1 in 70. Similarly, the maternal mortality ratio (MMR; number of maternal deaths per 100,000 live births) in India was 450. In 2010, approximately one-quarter of all pregnancy- and delivery-related maternal deaths worldwide occurred in India. Statistics showed that up until 2010, more than half a million women—most of them living in developing countries—died from pregnancy- or childbirth-related complications every year, and about a quarter of these "maternal" deaths occurred in India.
India showed a steady decline in maternal mortality, from 254 in every 100 000 live births in 2004-06 to 178 in every 100 000 live births in 2010-12.
As per the Sample Registration System (SRS), 2011-13 reports published by the Registrar General of India, the Maternal Mortality Ratio (MMR) was 167 per 1,00,000 live births in the country. Under Millennium Development Goal (MDG) 5, the target is to reduce Maternal Mortality Ratio (MMR) by three quarters between 1990 and 2015. This translates to reducing the MMR from 560 in 1990 to 140 in 2015.
In 2014, India was recognized to have contributed one-fifth of the global burden of absolute maternal deaths, while experiencing an estimated 4.7% decline in its Maternal Mortality Ratio which stood at 174 per 100,000 live births in India.
According to the Office of the Registrar General, the ratio has declined from 130 in 2014-2016 to 122 in 2015-17, registering a 6.15 per cent reduction since the last survey figures of 2014-2016. India's present MMR is below the Millennium Development Goal (MDG) target and puts the country on track to achieve the Sustainable Development Goal (SDG) target of an MMR below 70 by 2030.
By medical condition
From 1980-2015 eclampsia was the cause of 1.5% of maternal deaths in India. Over this period, the number of women who experience this disease was the same, but there was also a slight reduction in the number of maternal deaths from the condition.
Causes Approximately two-thirds of all maternal deaths are primarily caused by major complications, including severe bleeding (typically occurring after childbirth), infections (commonly arising after childbirth), high blood pressure during pregnancy (pre-eclampsia and eclampsia), delivery-related complications, and unsafe abortions. Between 50% and 98% of maternal deaths result from direct obstetric causes such as hemorrhage, infection, hypertensive disorders, ruptured uterus, hepatitis, and anemia. Additionally, around 50% of maternal deaths caused by sepsis are associated with illegal induced abortions.
Prevalence According to the Sample Registration System Bulletin-2016, India has registered a 26.9 per cent reduction in maternal mortality ratio (MMR) since 2013. The MMR has declined from 167 in 2011-2013 to 130 in 2014-2016, to 122 in 2015-17, to 113 in 2016-2018. According to the National Health Policy (NHP) 2017, India set a goal to reduce its Maternal Mortality Rate (MMR) to below 100 per lakh live births by the year 2020. The SRS estimates India had an MMR of 97 per lakh live births during the period of 2018-2020, accomplishing this target within the specified timeframe.
MMR (per 100,000 live births) 2004-06 2007-09 2010-12 2011-13 2014-16 2015-17 2016-182018-202020-222022-24 India Total 254 212 178 167 130 122 113978887 Assam 480 390 328 300 237 229 21519512584 Bihar 312 261 219 208 165 165 1491189196 Jharkhand 76 71565082 Madhya Pradesh 335 269 230 221 173 188 173173159135 Chhattisgarh 141 159137141124 Odisha 303 258 235 222 180 168 150119136124 Rajasthan 388 318 255 244 199 186 1641138787 Uttar Pradesh 440 359 292 285 201 216 197167141154 Uttarakhand 89 9910310499 EAG & Assam Subtotal 375 308 257 246 188 175 161137120116 Andhra Pradesh 154 134 110 92 74 74 65454739 Telangana 81 76 63435048 Karnataka 213 178 144 133 108 97 92695873 Kerala 95 81 66 61 46 42 43191824 Tamil Nadu 111 97 90 79 66 63 60543825 South Subtotal 149 127 105 93 77 72 67494241 Gujarat 160 148 122 112 91 87 75575564 Haryana 186 153 146 127 101 98 911108994 Maharashtra 130 104 87 68 61 55 46333637 Punjab 192 172 155 141 122 122 1291059277 West Bengal 141 145 117 113 101 94 9810310594 Other States 206 160 136 126 97 96 85778184 Other Subtotal 174 149 127 115 93 90 83767575
The RBI categorizes states usually into three groups, especially at the regional level, to understand the maternal mortality situation in the country better and to map the changes that have taken place: EAG, southern states and "other" states.
EAG states comprise Bihar, Jharkhand, Madhya Pradesh, Chhattisgarh, Odisha, Rajasthan, Uttar Pradesh, Uttarakhand, and Assam. The southern states are Andhra Pradesh, Telangana, Karnataka, Kerala and Tamil Nadu and the "other" states category covers the remaining states and Union territories.
Kerala, Maharashtra and Tamil Nadu have already met the sustainable development goals target of 70 per 100,000 MMR, while Andhra Pradesh and Telangana are within range.
Among southern states, the decline in MMR has been from 77 to 72 per 100,000 live births, from 93 to 90 in the other states. The decline was most significant in empowered action group (EAG) states and Assam from 188 to 175.
In the recently released report on maternal mortality ratio (MMR) prepared by the union government, Uttarakhand has fared significantly well recording 89 deaths per lakh deliveries between 2015 and 2017 as against the national average of 122.
According to officials of National Health Mission (NHM) in Uttarakhand, the state stood at 8th spot among the 19 top states in the country. Notably the last survey, which clubbed Uttarakhand and the neighboring Uttar Pradesh as one, ranked the two states at the 15th spot. It stated that the MMR in the two states (combined) between 2014 and 2016 stood at 201 maternal deaths per lakh births.
The rates for using maternal healthcare is the same for rural and urban women in wealthier Indian states. In poorer states, urban women access healthcare much more often than rural women.
Healthcare availability and use by region In November 2016, the government launched the Pradhan Mantri Surakshit Matritva Abhiyan, or the Prime Minister Safe Pregnancy Scheme, which aims to provide free and comprehensive care on the ninth day of every month during pregnancy. Pregnant women are provided special, free ante-natal checks in their second or third trimester at government health care facilities, including ultrasounds, blood and urine tests.
Full ANC refers to at least four antenatal visits, one tetanus toxoid (TT) injection and iron folic acid tablets or syrup taken for 100 or more days. Yet, getting these facilities to women is a challenge, especially in poorer states. No more than 3.3 per cent of pregnant women in Bihar reported receiving full antenatal care, lowest among states.
The rates for using maternal healthcare is the same for rural and urban women in wealthier Indian states. In poorer states, urban women access healthcare much more often than rural women.
The BIMARU states experience a range of problems including maternal mortality.
Assam Assam has the highest rate of maternal mortality in India. Within Assam, some of the highest rates of maternal mortality are among tea plantation workers.
Andhra Pradesh A regional program in Andhra Pradesh seeks to ask doctors and nurses about the causes of maternal mortality in local communities. The general circumstance is that maternal mortality has different causes in different places, but if clinics knew the common causes for that area, then they would be better prepared to prevent future deaths.
Bihar As compared to other states, Bihar has relatively low rates for use of medical care services.
West Bengal A 2019 survey in rural West Bengal reported that the "three delays" caused maternal death. Those are delay in deciding to go to the clinic, delay in actually arriving at the clinic, and delay in getting care at the clinic.
Karnataka Karnataka has the highest rate of maternal mortality in South India. In interviews, mothers reported that when they did not use healthcare services, their reasons included lack of access to transport to the clinic, the cost of care, and low value in a clinic visit. When a mother dies in this region it is often in the postpartum period.
Uttar Pradesh Surveys have found women in UP who are more educated and have more money tend to use more maternal health services.