Fostering a Commitment to Stop Maternal Deaths in India
(Social Issues | GS Paper II – Health, Governance, Vulnerable Sections)
Despite consistent improvement, maternal deaths in India remain a significant concern, especially in high-risk states. The Maternal Mortality Ratio (MMR) has dropped to 93 per 1,00,000 live births (2019–21), from 103 (2017–19), but systemic and social challenges continue to cause preventable maternal deaths.
1. Understanding Maternal Mortality
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MMR: Number of maternal deaths per 1,00,000 live births.
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WHO Definition of Maternal Death: Death during pregnancy or within 42 days of its end due to pregnancy-related causes (excluding accidents/incidental reasons).
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Indicates broader issues in health infrastructure, social equity, and emergency response.
2. State-wise Trends and Disparities
States are grouped into three broad clusters based on performance and risk level:
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Empowered Action Group (EAG) States:
Bihar, Jharkhand, MP, Chhattisgarh, Odisha, Rajasthan, UP, Uttarakhand, Assam
➤ Highest MMR levels; reflect deep systemic deficits. -
Southern States:
Kerala, Tamil Nadu, Karnataka, Telangana, Andhra Pradesh
➤ Lower MMR; better maternal health systems. -
Other States:
Maharashtra, Gujarat, Punjab, Haryana, West Bengal
➤ Mixed performance; need to maintain emergency care standards. -
Kerala has the lowest MMR, while Assam and Madhya Pradesh consistently record highest rates.
➤ Highlights regional inequity in access to maternal care and effective governance.
3. The ‘Three Delays’ Model
(Concept by Deborah Maine – Key in Public Health Discourse)
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Delay in recognizing danger & deciding to seek care
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Due to lack of awareness, finances, and social stigma.
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Role of ASHA workers (NRHM 2005) critical:
➤ Promoted institutional deliveries, early registration, and community mobilisation.
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Delay in transportation to health facilities
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Geographic isolation, poor roads.
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108 Ambulance service (NHM) has reduced this lag.
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Delay in receiving adequate care at health facilities
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Infrastructural deficits, especially in rural India:
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66% vacancies in CHCs
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Many FRUs lack blood storage and specialists
➤ FRU model not yet fully functional.
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4. Major Medical Causes of Maternal Death
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Postpartum Hemorrhage (PPH):
➤ Caused by uterine atony, worsened by anaemia; emergency blood transfusion often unavailable. -
Obstructed Labour:
➤ Linked to malnutrition and stunted maternal growth; needs C-section and skilled care. -
Hypertensive Disorders of Pregnancy:
➤ Can cause eclampsia, coma, death if not managed. -
Sepsis:
➤ From unhygienic deliveries, crude abortions, late hospital access.
5. State-Level Focus Areas and Best Practices
EAG States:
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Strengthen Antenatal Care: Early registration and routine monitoring.
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Promote institutional deliveries and public awareness.
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Upgrade FRUs: Recruit specialists, equip with blood banks, C-section capacity.
Southern States, Maharashtra, Gujarat:
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Focus on emergency obstetric care quality.
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Train healthcare staff in high-risk delivery scenarios.
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Develop referral protocols and quick-response teams.
Kerala Model – A Best Practice Case Study:
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Advanced medical protocols:
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Use of uterine artery clamps, suction canulas.
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Management of rare complications: amniotic fluid embolism, hepatic failure, DIC.
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Addresses mental health: Antenatal depression, postpartum psychosis.
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Emphasis on institutional capacity, intersectoral coordination, and data-driven planning.
6. The Way Forward
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Invest in human resources: Bridge vacancy gaps at CHCs/PHCs.
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Strengthen referral systems: From sub-centres to tertiary care.
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Expand awareness: Community mobilisation on birth preparedness.
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Integrate mental health and nutritional support into maternal care.
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Ensure equity in maternal healthcare access, especially in tribal, remote, and conflict-prone areas.
Conclusion
India’s commitment to reducing MMR must go beyond statistics. Fostering a rights-based, equity-focused, and resilient maternal health ecosystem is essential. The lessons from Kerala, the efforts of ASHAs, and targeted interventions in high-risk states must converge into a nationwide movement to end preventable maternal deaths.
