According to the Office of Registrar General of India, the maternal mortality ratio (MMR) declined from 398 per 100,000 live births in 1997-98 to 301 in 2001-03, falling further to 254 in 2004-06. State-wise estimates of maternal mortality for 2004-06 showed Kerala was the only state with less than 100 deaths per 100,000 live births. The three worst performing states with a high MMR were Assam (480), Uttar Pradesh including Uttarakhand (440) and Rajasthan (388). According to the Institute of Health Metrics and Evaluation (IHME) estimates published in The Lancet in April 2010, India ranks 127 out of 181 countries in maternal mortality, with Sri Lanka and China way more successful than India in maternal care. Despite government intervention to achieve a faster rate of decline, especially under the Reproductive and Child Health Programme, it appears unlikely that the Millennium Development Goal for India set at 109 maternal deaths per 100,000 live births by 2015 will be met.(Click for graph)
Women die as a result of complications during and following pregnancy and childbirth. While 80 per cent of maternal deaths worldwide are caused by severe bleeding, infections, high blood pressure during pregnancy, obstructed labour and unsafe abortions, diseases such as malaria, anaemia and HIV/AIDS also contribute to maternal mortality. It is important for women to have access to health care solutions to prevent or manage complications. The World Health Organisation (WHO) notes, apart from access to antenatal care in pregnancy, and care and support in the weeks after childbirth, “it is particularly important that all births are attended by skilled health professionals, as timely management and treatment can make the difference between life and death”. If we look at this last indicator across states in India, once again there is a large disparity. The District Level Household Survey (DLHS-3) 2007-08 estimates that 52.7 per cent of women had safe deliveries, that is, deliveries either in institutions or at home with the assistance of trained personnel. As many as 43.3 per cent of rural deliveries and 75.6 per cent of urban deliveries could be termed safe, pointing to the low access to health care in rural India. Almost all women in Kerala and Puducherry had safe deliveries. Goa, Tamil Nadu and Lakshadweep recorded more than 90 per cent safe deliveries. However, in 11 states, less than 50 per cent of the deliveries that took place could be termed “safe deliveries”. The worst performing states, where less than one third of mothers had safe deliveries, are Bihar, Uttar Pradesh, Meghalaya, Chhattisgarh and Jharkhand. In Jharkhand and Chhattisgarh, more than 80 per cent of deliveries were at home, with 7.2 per cent and 11.6 per cent of these home deliveries assisted by skilled personnel. Interestingly, Manipur and Punjab stand out as states with the highest share of home deliveries conducted with the help of trained personnel — 14.3 per cent and 13.8 per cent respectively.
| MATERNAL CONCERNS | |||
| Country | MMR 1990 | MMR 2008 | Global rank out of 181 countries (2008) |
| Sri Lanka | 52 | 30 | 60 |
| China | 87 | 40 | 74 |
| Nepal | 471 | 240 | 126 |
| India | 523 | 254 | 127 |
| Bhutan | 1,145 | 255 | 128 |
| Bangladesh | 724 | 338 | 138 |
| Pakistan | 541 | 376 | 142 |
| Source: IHME, 2010; Maternal mortality ratio: the no. of maternal deaths per 100,000 live births | |||
| NURSING NEGLECT Maternal deaths per 100,000 live births | |
| (2004-06) | |
| INDIA | 254 |
| Assam | 480 |
| Uttar Pradesh, Uttarakhand | 440 |
| Rajasthan | 388 |
| Madhya Pradesh, Chhattisgarh | 335 |
| Bihar including Jharkhand | 312 |
| Orissa | 303 |
| Karnataka | 213 |
| Punjab | 192 |
| Haryana | 186 |
| Gujarat | 160 |
| Andhra Pradesh | 154 |
| West Bengal | 141 |
| Maharashtra | 130 |
| Tamil Nadu | 111 |
| Kerala | 95 |
| Source: SRS Bulletin April 2009 | |
Last year, the WHO reported India as the country with the largest number of maternal deaths in the world. Though the percentage of safe deliveries has increased from 48 per cent to 52 per cent between DLHS-2 (2002-04) and DLHS-3 (2007-08) at the national level, this rate of increasing coverage is woefully inadequate, especially given the wide regional disparities in the country.
Indian States Development Scorecard is a weekly feature by Indicus Analytics that focuses on the progress in India and the states across various socio-economic parameters