Skip to main content

Whither SDG goal? India's maternal mortality rate fall target 5.5% per yr, actual 4.5%

By Srinivas Goli, Parul Puri*
The maternal mortality ratio (number of maternal deaths per one lakh live births) is a key and sensitive parameter used by health policymakers to monitor maternal health conditions in particular and women's status in general in a country.
Although the maternal mortality ratio is falling at an average of 4.5% yearly, achieving the target set under Sustainable Development Goals-(SDGs)-3 has to bring down the maternal mortality ratio at the annual rate of 5.5%. Currently, India accounts for 15% of world maternal deaths, second only to Nigeria (19%).
Since the launch of Janani Suraksha Yojana under the National Rural Health Mission in 2005, there has been accelerating progress in reducing maternal deaths in India. The rise in education, age at marriage, decline in number of children per woman, and increasing use of maternal health care (pregnancy, delivery, and post-delivery care) contributed to the decline in maternal mortality ratio.
However, the progress is not uniform across the states. The latest special bulletin on maternal mortality (2015-17) from the Office of Registrar General of India suggests that nine EAG states (Assam, Bihar, Jharkhand, Madhya Pradesh, Chhattisgarh, Odisha, Rajasthan, Uttar Pradesh, and Uttarakhand) contribute to 61% of total maternal deaths in the country.
In contrast, the five south Indian states (Andhra Pradesh, Karnataka, Kerala, Tamil Nadu, and Telangana) account for only 12% of the country’s maternal mortality. Assam has the highest (229 maternal death per one lakh live births), while Kerala has the lowest (42 maternal death per one lakh live births) maternal mortality ratio in the country.
Sample Registration System of Office of Registrar General of India provides data for only major states with no evidence on the district-level picture of maternal deaths. Along with other smaller states, the estimates for all districts shoulder immense importance for policy, planning, and monitoring progress towards maternal mortality-related sustainable development goals.
Districts are critical administrative units for micro-level policy exclusion and monitoring. Therefore, identification of “hot-spots” of the issue at hand acts as an effective way of pursuing the problem.
To fill this critical gap in the knowledge, researchers from the University of Western Australia, Australia, International Institute for Population Sciences, India, and the University of Portsmouth from the United Kingdom have together put out a Pre-Print which, for the first time in India, provide maternal mortality ratio for all states and districts of India**.
Authors analyzed a total of 61,982,623 live births and 61,169 maternal deaths reported during 2017-20 at the Government of India’s Health Management Information System (HMIS) portal and validated it using data from the Office of Registrar General of India.
Their findings suggest that 24 states and 450 districts have a maternal mortality ratio above 70 deaths per one lakh live births. Among the states, Arunachal Pradesh reported the highest maternal mortality ratio, while Maharashtra reported the lowest. Authors identify five states with maternal mortality ratios greater than or equal to 210.
Eight states and three union territories registered maternal mortality ratio in the range of 140-209, while eleven states shows 70-139 maternal deaths per 1 lakh live births. A startling finding is about the presence of Punjab in the range of medium to high maternal mortality ratio. A comparison of successive rounds of information from the Office of Registrar General of India reveals a surprising rise in maternal mortality ratio in Punjab. 
We are guessing that it could be due to unsafe sex-selective abortions leading to the death of women in the state. However, a detailed examination of reasons for such a rise is needed from the state government’s side.
Maternal Mortality ratio by States, 2017-2020
Among the districts, the highest maternal mortality ratio is found in the Tirap district in Arunachal Pradesh and the lowest in Kinnaur and Lahul & Spiti in Himachal Pradesh. Overall, 115 districts registered a maternal mortality ratio greater than or equal to 210; 125 districts shows a range of 140-209; while 210 districts fall in the range of 70-139, and only 190 districts reported maternal mortality ratio less than 70.
Among the districts with maternal mortality ratio ≥210, 46 districts belonged to the Central Region, and 35 districts were located in the North-eastern region, while 17 districts belonged to the Northern region, 16 from the Eastern region and one from southern India. The findings illustrated enormous within-state variations.
Maternal Mortality ratio by Districts, 2017-2020
Authors also put out that in order of their importance reduction in higher-order births and poverty, improving health infrastructure, years of schooling, maternal health care, maternal age, and nutrition can significantly improve progress towards achieving the maternal mortality target set under SDGs.

Road ahead

The study findings can immensely useful for identifying ‘hot spots’ of maternal mortality within the states, thus aiding in micro-level maternal health care policy and planning. These “hotspots” (cluster of districts) need to initiate immediate action to meet the ambitious SDG-3 target for maternal mortality ratio and thereby eliminate all preventable maternal mortality.
Although achieving SDG target for all the districts of India is a difficult task, especially for most high maternal mortality ratio (>210) districts, the states that made a concerted effort to reduce maternal mortality, especially post-2005 provide guidelines on best practices and paths for how to accomplish the acceleration necessary to substantially reduce preventable maternal deaths.
In particular, post-2005 maternal mortality ratio reduction in Maharashtra, Telangana and Andhra Pradesh are very impressive. Further, these researchers advance that despite some caveats about the completeness of information in a few states, HMIS is a reliable, cost-effective, and routine source for monitoring progress in reducing avoidable maternal mortality in India and its states and districts.
Therefore, the government of India must bring in a mission mode stratagem to strengthen the vital registration system at a national level with an inspiration of reasonably good quality registration evident in case of maternal deaths under HMIS.
---
*Respectively: Australia India Institute (AII) NGN Research Fellow, UWA Public Policy Institute, University of Western Australia, Perth, and Assistant Professor at the Centre for the Study of Regional Development, School of Social Sciences, Jawaharlal Nehru University, New Delhi; Doctoral Fellow at the Department of Mathematical Demography and Statistics, International Institute for Population Sciences, Mumbai
**The data and analysis that inform this piece are available in our preprint paper titled, “Estimates and Correlates of District-Level Maternal mortality ratio in India” on medRxiv

Comments

Post a Comment

TRENDING

Modi win may force Pak to put Kashmir on backburner, resume trade ties with India

By Salman Rafi Sheikh*  When Narendra Modi returned to power for a second term in India with a landslide victory in 2019, his government acted swiftly. Just months after the election, the Modi government abrogated Article 370 of the Constitution of India. In doing so, it stripped the special constitutional status conferred on Jammu and Kashmir, India’s only Muslim-majority state, and downgraded its status from a state with its own elected assembly to a union territory administered by the central government in Delhi. 
Post a Comment
more»

Stagnating wages since 2014-15: Economists explain Modi legacy for informal workers

By Our Representative  Real wages have barely risen in India since 2014-15, despite rapid GDP growth. The country’s social security system has also stagnated in this period. The lives of informal workers remain extremely precarious, especially in states like Jharkhand where casual employment is the main source of livelihood for millions. These are some of the findings presented by economists Jean Drèze and Reetika Khera at a press conference convened by the Loktantra Bachao 2024 campaign. 
Post a Comment
more»

'Assault on civic, academic freedom, right to dissent': TISS PhD student's suspension

By Our Representative  The Mumbai-based civil rights group All India Secular Forum (AISF) has said that the suspension of Tata Institute of Social Sciences (TISS) PhD student Ramadas Prini Sivanandan (30) for two years for allegedly indulging in activities which were "not in the interest of the nation" is meant to send out the message that students and educational institutes will be targeted if they don’t align with the agenda and ideology of the ruling regime.  TISS in a notice served to Ramadas has cited that his role in screening the documentary 'Ram Ke Naam' on January 26 as a "mark of dishonour and protest" against the Ram Mandir idol consecration in Ayodhya.  Another incident cited in the notice was Ramadas’ participation in the protest against unfair government policies in Delhi under the banner of the Progressive Students' Forum (PSF)-TISS. TISS alleges the institute's name was "misused", which wrongfully created an impression that
Post a Comment
more»

A Hindu alternative to Valentine's Day? 'Shiv-Parvati was first love marriage in Universe'

By Rajiv Shah*   The other day, I was searching on Google a quote on Maha Shivratri which I wanted to send to someone, a confirmed Shiv Bhakt, quite close to me -- with an underlying message to act positively instead of being negative. On top of the search, I chanced upon an article in, imagine!, a Nashik Corporation site which offered me something very unusual. 
16 comments
more»

Magnetic, stunning, Protima Bedi 'exposed' malice of sexual repression in society

By Harsh Thakor*  Protima Bedi was born to a baniya businessman and a Bengali mother as Protima Gupta in Delhi in 1949. Her father was a small-time trader, who was thrown out of his family for marrying a dark Bengali women. The theme of her early life was to rebel against traditional bondage. It was extraordinary how Protima underwent a metamorphosis from a conventional convent-educated girl into a freak. On October 12th was her 75th birthday; earlier this year, on August 18th it was her 25th death anniversary.
Post a Comment
more»

Tyre cartel's monopoly: Farmers' groups seek legal fight for better price for raw rubber

By Our Representative  The All India Kisan Sabha and the Kerala Karshaka Sangham that represents the largest rubber producing state of Kerala along with rubber farmers have sought intervention against the monopoly tyre companies that have formed a cartel against the interests of consumers and farmers.  Vijoo Krishnan, AIKS General Secretary, Valsan Panoli, Kerala Karshaka Sangham General Secretary, and four farmers representing different rubber growing regions of Kerala have filed an intervention application in the Supreme Court.
Post a Comment
more»

Why it's only Modi ki guarantee, not BJP's, and how Varanasi has seen it up-close

"Development" along Ganga By Rosamma Thomas*  I was in Varanasi in this April, days before polling began for the 2024 Lok Sabha elections. There are huge billboards advertising the Member of Parliament from Varanasi, Prime Minister Narendra Modi. The only image on all these large hoardings is of the PM, against a saffron background. It is as if the very person of Modi is what his party wishes to showcase.
Post a Comment
more»

Joblessness, saffronisation, corporatisation of education: BJP 'squarely responsible'

Counterview Desk  In an open appeal to youth and students across India, several student and youth organizations from across India have said that the ruling party is squarely accountable for the issues concerning the students and the youth, including expensive education and extensive joblessness.
Post a Comment
more»

Following the 3000-year old Pharaoh legacy? Poll-eve Surya tilak on Ram Lalla statue

By Sukla Sen  Located at a site called Abu Simbel in Nubia, Upper Egypt, the eponymous rock temples were created in 1244 BCE, under the orders of Pharaoh Ramesses II (1303-1213 BC)... Ramesses II was fond of showcasing his achievements. It was this desire to brag about his victory that led to the planning and eventual construction of the temples (interestingly, historians say that the Battle of Qadesh actually ended in a draw based on the depicted story -- not quite the definitive victory Ramesses II was making it out to be).
Post a Comment
more»

India's "welcome" proposal to impose sin tax on aerated drinks is part of to fight growing sugar consumption

By Amit Srivastava* A proposal to tax sugar sweetened beverages like tobacco in India has been welcomed by public health advocates. The proposal to increase sin taxes on aerated drinks is part of the recommendations made by India’s Chief Economic Advisor Arvind Subramanian on the upcoming Goods and Services Tax (GST) bill in the parliament of India.
Post a Comment
more»