Despite the consistent decline in India’s Maternal Mortality Ratio (MMR), significant inter-state disparities and systemic challenges remain. Examine the causes behind the high MMR and suggest measures. (15M)

India’s Maternal Mortality Ratio (MMR) (defined as maternal deaths per 100,000 live births) has declined from 103 (2017–19) to 93 (2019–21) as per SRS data. The SDG Goal 3.1 targets an Maternal Mortality Ratio (MMR) of less than 70 by 2030. Despite national progress, states like MP (175), Assam (167), UP (151) show worrying trends.

Causes of High Maternal Mortality Ratio (MMR) in India:

Delays in Maternal Care:

• Delay in seeking care due to poor awareness, low literacy, and traditional beliefs.
• Delay in reaching healthcare facilities due to poor transport and geographical barriers.
• Delay in receiving care due to shortages of trained personnel and life-saving equipment.

Inadequate Healthcare Infrastructure:

• Only 66% of First Referral Units (FRUs) are fully operational.
• Shortage of ICUs, blood banks, ultrasound machines, and emergency care facilities.
• Many rural areas lack proper diagnostic and monitoring tools.

Human Resource Constraints:

• Acute shortage of gynaecologists, anaesthetists, and nurses in rural areas.
• Low presence of trained midwives and skilled birth attendants.
• Poor incentives for doctors to serve in underserved areas.

Socio-Economic Factors:

• Around 22% of the population lives below the poverty line (Tendulkar Committee).
• Poor nutritional status and high levels of anaemia among pregnant women.
• High prevalence of child marriage leading to early and unsafe pregnancies.
• Repeated pregnancies due to son preference and lack of contraceptive use.

Unsafe Abortion Practices:

• Limited access to safe abortion services and lack of awareness.
• High rate of post-abortion complications in rural areas.

Data Discrepancies:

• Underreporting and misclassification of maternal deaths affect policy responses.
• Inadequate monitoring systems, especially in tribal and remote districts.

Government Initiatives to Reduce Maternal Mortality Ratio (MMR):

• Janani Suraksha Yojana (JSY): Promotes institutional deliveries with cash assistance.
• Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA): Free antenatal check-ups on the 9th of every month.
• 108 Ambulance Services: Ensures transport for pregnant women.
• Ayushman Bharat Health and Wellness Centres (HWCs): Provide maternal and child health services.
• POSHAN Abhiyaan: Focuses on reducing malnutrition and anaemia among women and children.

Measures needed to reduce Maternal Mortality Ratio (MMR):

Replicate Best Practices:

• States with high MMR should emulate Kerala’s real-time audits and data-driven governance.

Strengthen Infrastructure:

• Ensure fully functional FRUs (First Response Units) with blood banks, specialists, and ICU support.
• Improve emergency referral and transport systems, especially in remote regions.

Bridge Human Resource Gaps:

• Provide monetary incentives and career progression for rural health postings.
• Partner with private medical colleges to deploy more specialists in public hospitals.

Address Social and Cultural Issues:

• Strict enforcement against child marriage and early pregnancy.
• Strengthen awareness on contraception, safe abortion, and birth spacing.

Invest in Community Health Workers:

• Increase training and incentives for ASHAs, ANMs, and Anganwadi workers.
• Promote community participation and IEC campaigns on maternal health.

Improve Data Quality:

• Use digital platforms for real-time reporting of maternal deaths.
• Collaborate with the UN Maternal Mortality Estimation Interagency Group (MMEIG) for global benchmarking.

Conclusion:

A comprehensive strategy focusing on health infrastructure, community engagement, inter-state collaboration, and addressing social determinants is key.Maternal health is a fundamental component of public health and gender justice.

‘+1’ value addition:

• Kerala’s Success:
• Implementation of Confidential Review of Maternal Deaths since 2004–05.
• Establishment of High Dependency Units (HDUs) and improved labour rooms with an emphasis on managing key causes: PPH, sepsis, hypertension.
• Integration of maternal near-miss audits and quality standards in obstetric care.
• Successful implementation of LaQshya initiative to upgrade delivery points.
• Maternal death is classified by the World Health Organization (WHO) as the death of a woman during pregnancy or within 42 days of the termination of pregnancy, from any cause related to or aggravated by pregnancy or its management.

https://www.thehindu.com/opinion/lead/fostering-a-commitment-to-stop-maternal-deaths/article69784339.ece

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