The sorry state of maternal care in India has come to the media attention once again. A recent Lancet study noted that India has the highest number of stillbirths in the world, accounting for a little under a quarter of the global total. Significantly, the study pointed out that around 45 per cent of these can be prevented by timely medical attention. The District Level Household Survey (DLHS) conducted in 2002-04 estimated that stillbirths occurred in 1.7 per cent of all pregnancies for currently married women in the age group of 15 to 44 years in the three years preceding the survey. In the next round, DLHS-3 for 2007-08 estimated stillbirths at 1.3 per cent of all pregnancies.
However, as the survey respondents were in the age group of 15 to 49 years, the estimates of the two rounds are not strictly comparable. In six states – Bihar, Haryana, Karnataka, Uttar Pradesh, Chhattisgarh and West Bengal – the share of stillbirths to total pregnancies exceeded 1.7 per cent. And in Delhi, Mizoram, Himachal Pradesh, Lakshadweep and Goa the share was 0.5 per cent or less.
Age, education and wealth showed correlation with the incidence of stillbirths — girls less than 20 years of age had the highest share of pregnancies resulting in stillbirths. However, there was a sharp drop in the share of stillbirths when the woman had 10 or more years of schooling, also the highest wealth segment had the lowest incidence of stillbirths. Clearly, access to timely health intervention improves with education and wealth. (Click here for graph)
| MOTHERHOOD STATEMENT Stillbirths are low in the highest wealth segment | |||
| Wealth index | Still- births | Induced abortions | Spontaneous abortions |
| Lowest | 1.5 | 0.8 | 3.4 |
| Second | 1.6 | 1.1 | 4.2 |
| Middle | 1.4 | 1.6 | 4.6 |
| Fourth | 1.2 | 2.3 | 5.3 |
| Highest | 0.9 | 3.0 | 6.2 |
| Source: DLHS-3 2007-08 | |||
With an increase in wealth and educational levels, the incidence of abortions increases, not just induced but also spontaneous abortions. The latter technically refers to miscarriages that naturally occur. At an aggregate level, spontaneous abortions account for 4.7 per cent of all pregnancies while induced abortions account for 1.8 per cent. Though the DLHS report said, “The observed relatively higher level of spontaneous abortion could be due to reporting of induced abortions as spontaneous abortions.”
This ambiguity makes interpreting of the results of the survey difficult. In Goa, Manipur, Delhi and Assam the share of induced abortions exceeds 3.5 per cent while Haryana, Delhi and Tamil Nadu stand out with the share of spontaneous abortions exceeding seven per cent of all pregnancies. If induced and spontaneous abortions are taken into account, Haryana, Delhi, Manipur and Tamil Nadu rank at the top. Haryana, therefore, has the dubious distinction of being the state with the least share of live births to all pregnancies.
It goes without saying that pregnancies that do not culminate in live births take a toll on the physical and psychological health of women. Also the limited access to safe health care from qualified health professionals creates more risks. According to the Family Welfare Statistics 2009 of the Ministry of Health and Family Welfare, abortions were responsible for eight per cent of maternal deaths between 2001 and 2003, the latest period for which data are available. Timely and reliable health intervention – whether it is for safe contraceptive methods or during pregnancy – is vital for reducing the burden on women’s health in India.
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
sumita@indicus.net
