High Maternity deaths in India: Lancet Study

Syllabus: GS2/Health

Context

• A study published in The Lancet found that India remains among the countries with the highest number of maternal deaths globally.

Major Findings

• The progress slowed down post 2015 after years of rapid decline. 
• Around 2.4 lakh women died globally in 2023 due to pregnancy and childbirth-related causes. 
• India accounted for about 24,700 of the 2.4 lakh deaths, placing it among the highest-burden countries alongside Nigeria, Pakistan and Ethiopia. 

• Maternal mortality has declined significantly since 1990 due to better awareness, institutional deliveries and govt programmes, although progress remains uneven across states.
  • Kerala and Tamil Nadu are nearing global targets while others such as Uttar Pradesh, Bihar and Madhya Pradesh continue to report higher maternal mortality.
• In India deaths continue to be driven by largely preventable causes such as haemorrhage, hypertensive disorders, infections and complications linked to pre-existing conditions. 

What is Maternal Mortality?

• Maternal death is the death of a woman while pregnant or within 42 days of termination of pregnancy from any cause related to or aggravated by the pregnancy but not from accidental or incidental causes.
• Maternal Mortality Ratio (MMR) is the number of maternal deaths per 1,00,000 live births.
• Maternal Mortality Rate: This is calculated as maternal deaths to women in the ages 15-49 per lakh of women in that age group, reported under Sample Registration System (SRS).
• The Sustainable Development Goal (SDG) 3.1 targets reducing the global maternal mortality ratio to less than 70 per 1,00,000 live births by 2030.

Progress Made by India (National Family Health Survey-5 (2019-21))

• In India the MMR declined from 130 per 100,000 live births in 2014-16 to 97 per 100,000 live births in 2018-20.
• Institutional births have increased significantly from 79% (2015-16) to 89% (2019-21) at the national level. 
• Institutional delivery is 100% in Kerala, Goa, Lakshadweep, Puducherry and Tamil Nadu and more than 90% in eighteen other States/UTs.
• Even in rural areas, approximately 87% of births are delivered in institutions, while 94% are delivered in urban areas.

Challenges Still Faced By India

• High Out-of-Pocket Expenses (OOPE): Despite policy efforts, families often bear the cost of diagnostics, medicines, and private services during emergencies.
• Sociocultural Barriers: Gender dynamics, low education levels, restricted decision-making power among women, and stigma around maternal care all delay early care-seeking.
• Rise in High-Risk Pregnancies: Trends such as delayed childbirth, obesity, hypertension, diabetes, and short inter-pregnancy intervals contribute to riskier pregnancies. 
• Weak Infrastructure in Remote Areas: Rural, tribal, and hilly regions lack emergency obstetric care, reliable transport, and blood storage facilities.

Government Initiatives to Reduce MMR

• Janani Suraksha Yojana (JSY): Launched in 2005 with the objective of reducing maternal and neonatal mortality, JSY promotes institutional delivery among pregnant women especially with weak socio-economic status.
• Pradhan Mantri Matru Vandana Yojana (PMMVY), is a maternity benefit program run by the Ministry of Women and Child Development, Government of India.
  • The maternity benefit, of Rs. 5000/-, is available to a woman for the first living child of the family subject to fulfilment of conditionalities. 
  • Further under ‘Mission Shakti’, the scheme (PMMVY 2.0) provides additional cash incentive for the second child, if that is a girl child.
• Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA): Launched in 2016, PMSMA provides pregnant women a fixed day, free of cost assured and quality Antenatal Care on the 9th day of every month. 
• LaQshya: Launched in 2017, LaQshya aims to improve the quality of care in labour room and maternity operation theatres to ensure the quality care during delivery and immediate post-partum.
• Capacity building is taken-up for MBBS doctors in Anesthesia (LSAS) and Obstetric Care including C-section (EmOC) skills to overcome the shortage of specialists in these disciplines, particularly in rural areas.
• Maternal Death Surveillance Review (MDSR) is implemented both at facilities and at the community level. The purpose is to take corrective action at appropriate levels and improve the quality of obstetric care.
• Monthly Village Health, Sanitation and Nutrition Day (VHSND) is an outreach activity for provision of maternal and child care including nutrition.
• Reproductive and child health (RCH) portal is a name-based web-enabled tracking of pregnant women and new-born to ensure provision of regular and complete services to them including antenatal care, institutional delivery and post-natal care.

Way Ahead

• India has made significant progress in reducing maternal mortality, successfully achieving the National Health Policy (NHP) target of an MMR below 100 by 2020.
  • However, continued efforts are required to reach the SDG target of MMR by 2030. 
• Strengthening healthcare infrastructure, expanding maternal health programs, and addressing socioeconomic barriers will be critical in further reducing maternal mortality in the country.

Source: TOI