MATERNAL MORTALITY IN INDIA: A UN REPORT

MATERNAL MORTALITY IN INDIA: A UN REPORT

• A report from the United Nations titled Trends in Maternal Mortality 2000-2023 highlighted the current situation of maternal deaths globally.
• India was shown prominently as one of the countries with the highest maternal mortality rates.
• This report was prepared by the World Health Organization (WHO), UNICEF, UN Population Fund, World Bank, and UN Department of Economic and Social Affairs.
• It sheds light on significant trends, causes, and regional disparities that contribute to maternal mortality in India and across the world.

KEY FACTS & FIGURES FROM THE REPORT

• India’s Global Ranking:
  • India recorded 19,000 maternal deaths in 2023, ranking second globally, tied with the Democratic Republic of Congo (DRC).
  • Nigeria reported the highest number of maternal deaths in 2023, with approximately 75,000 deaths, which accounted for 28.7% of all maternal deaths globally.
  • India and DRC each represented 7.2% of global maternal deaths, while Pakistan had about 11,000 deaths, accounting for 4.1%.
  • These 4 countries—Nigeria, India, DRC, and Pakistan—together accounted for 47% of all maternal deaths worldwide in 2023.
• Maternal Mortality Ratio (MMR) in India:
  • India’s Maternal Mortality Ratio (MMR) (deaths per 100,000 live births) improved from 362 in 2000 to 80 in 2023, marking a 78% reduction over the 23-year period.
  • By comparison, China reduced its MMR from 56 in 2000 to 16 in 2023, a 70% reduction in the same timeframe.
  • Despite these improvements, India’s MMR of 80 in 2023 is still higher than that of China, signaling ongoing challenges in maternal health in India.

• Global Trends in Maternal Mortality:
  • Globally, maternal deaths decreased by 40% from 2000 to 2023, with an estimated 260,000 maternal deaths worldwide in 2023.
  • This equates to one maternal death approximately every 2 minutes
  • The global decline in maternal deaths is largely attributed to improved access to essential health services, such as antenatal care, skilled birth attendance, and emergency obstetric care.
• The Impact of COVID-19 on Maternal Mortality:
  • The COVID-19 pandemic had a significant impact on maternal mortality. In 2021, 40,000 additional women died during pregnancy or childbirth due to the pandemic.
  • This increase in deaths was caused by COVID-related complications, as well as the disruption of maternal health services.
  • Many healthcare systems were overwhelmed, and women couldn’t access the necessary medical care, leading to higher death rates.
  • The total number of maternal deaths in 2021 was estimated at 322,000, compared to 282,000 the previous year.

CAUSES OF MATERNAL MORTALITY

Maternal deaths are generally caused by complications during pregnancy, childbirth, or the postpartum period. The report identifies three main categories of causes:

• Direct Obstetric Causes:
  • Haemorrhage (severe bleeding) is the leading cause of maternal death globally, particularly during childbirth or the immediate postpartum period.
  • Other significant direct causes of maternal death include hypertensive disorders (e.g., pre-eclampsia), infections (such as sepsis), and complications from unsafe abortion.
• Indirect Causes:
  • Non-communicable diseases (NCDs) like diabetes, hypertension, and heart conditions are increasing indirect causes of maternal death.
  • These conditions may predate pregnancy or develop during pregnancy, increasing the risk for the mother.
  • Mental health issues, including depression and substance use disorders, are also factors that complicate maternal health.
  • Other conditions like gestational diabetes, epilepsy, and asthma also increase the risk of complications during pregnancy.

REGIONAL DISPARITIES IN INDIA

• Southern vs. Northern India:
  • Southern states like Kerala, Tamil Nadu, and Karnataka have seen substantial improvements in maternal health, mainly due to better access to private healthcare and better public health infrastructure. These regions have managed to reduce maternal mortality significantly.
  • Northern states, including Uttar Pradesh, Bihar, and Madhya Pradesh, continue to face higher maternal mortality rates.
    1. This is mainly due to limited healthcare infrastructure, lack of trained healthcare professionals, and low socio-economic conditions.
    2. In these northern states, primary health centers (PHCs) and community health centers (CHCs) often lack the resources and specialized staff to handle complicated pregnancies or emergency situations, leading to many preventable deaths.

SOCIO ECONOMIC DISPARITIES

• Women from poorer and rural regions often have limited access to quality healthcare.
• In these regions, private hospitals may be inaccessible due to high costs, and many families rely on under-resourced government healthcare centers.
• The economic capacity to afford private healthcare is higher in southern states, leading to better maternal health outcomes there.
• In contrast, northern states with poorer socio-economic conditions see more maternal deaths due to the lack of emergency obstetric care.

PUBLIC HEALTH CENTRES & COMMUNITY HEALTH CENTRES

• PHCs and CHCs in India are generally equipped to handle normal deliveries, but they often struggle with complicated cases.
• They are often understaffed, under-equipped, and unable to provide advanced obstetric care (such as Caesarean sections or blood transfusions) when needed.
• Women with complicated pregnancies may be referred to higher-level facilities, but many do not have the means to reach them in time, particularly in remote areas.

PREVENTABLE CAUSES OF MATERNAL DEATHS

• Many of the causes of maternal deaths, such as haemorrhage, hypertensive disorders, infections, and unsafe abortions, are preventable with timely medical intervention.
• However, despite the availability of clinical interventions to treat these conditions, many women still die due to inaccessible or inadequate care.
• This is especially true in low-income or conflict-affected areas, where healthcare systems are weak and resources are scarce.

KEY RECOMMENDATIONS TO ADDRESS MATERNAL MORTALITY

• Improving Healthcare Access:
  • There is a need to strengthen healthcare infrastructure, particularly in rural and underserved areas.
  • Primary health centers and community health centers need to be equipped with trained staff, medical resources, and specialized care to handle complicated pregnancies.

• Increasing Emergency Obstetric Care:
  • Improving emergency obstetric care (e.g., Caesarean sections, blood transfusions) in public healthcare centers can help reduce maternal mortality, particularly in regions where women have limited access to private hospitals.
• Health Education and Family Planning:
  • Family planning services should be expanded, and women should have better access to birth control, prenatal care, and post-natal care.
  • Health education should be focused on encouraging regular check-ups and teaching women the importance of seeking care early during pregnancy to prevent complications.
• Tackling Socio-Economic Barriers:
  • Governments should focus on reducing socio-economic inequalities by improving access to healthcare for low-income families, and ensuring that all women, especially in remote areas, have access to skilled medical care.
• Addressing the Impact of COVID-19:
  • Ensuring continuity of maternal health services during pandemics and other crises is crucial.
  • Pregnant women need reliable access to routine check-ups and emergency care, even during public health emergencies.

CONCLUSION

India has made notable progress in reducing maternal mortality, but much work remains. The high maternal mortality rate is still a significant challenge, especially in rural areas and poorer states. Improvements in healthcare infrastructure, training of healthcare providers, and better access to emergency obstetric care are necessary to save more lives. Addressing socio-economic disparities and ensuring equal access to healthcare for all women, regardless of their economic status or location, will be critical in achieving further reductions in maternal mortality in India.

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