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

Whither Govt of India strategy to reduce import dependence on crude oil, natural gas?

By NS Venkataraman* India presently imports around 80% of it’s crude oil requirement and around 50% of its natural gas requirements . As the domestic production of crude oil and natural gas are virtually stagnant and the domestic demand is increasing at around 7% per annum, India’s steadily increasing dependence on import of the vital energy source is a matter of high energy security concern. This is particularly so, since the price of crude oil and natural gas are considerably fluctuating / increasing in the global market due to geo political factors, which are beyond the control of India. India has promised to achieve zero emission by the year 2070, which mean that the level of emission has to start declining at slow and steady rate from now onwards. It is now well recognized that global emission is caused largely due to use of coal as fuel and natural gas as fuel and feedstock. While burning of coal as fuel cause emission of global warming carbon dioxide gas and sulphur

Muslim intellectuals met Bhagwat, extra-constitutional authority 'like Sanjay Gandhi'

By Shamsul Islam* In a significant development a delegation of five Muslim intellectuals namely former chief election commissioner SY Quraishi; former senior bureaucrat Najeeb Jung; former AMU vice-chancellor and Lt Gen (retd) Zameer U Shah; politician-cum-journalist Shahid Siddiqui (presently with RLD); and businessman Saeed Shervani [Samajvadi Party] met RSS Supremo Mohan Bhagwat at RSS Delhi headquarters. The meeting was kept secret for reasons known to the participants and was held in August. According to the Muslim intellectuals the meeting held in “a very cordial” atmosphere continued for 75 minutes whereas time allotted was 30 minutes! In a post-meeting justification of the parleys Quraishi stated that their main concern was “the insecurity being increasingly felt by the Muslim community in the wake of recurring incidents of lynching of innocents, calls by Hindutva hotheads for genocide and the marginalisation of the community in almost every sphere”. This delegation consistin

'Massive concern for people': Modi seeking to turn India into global manufacturing hub

By Shankar Sharma* The news item quoting Narendra Modi at the Shanghai Cooperation Organisation (SCO) meet, "Want to turn India into a manufacturing hub: PM Modi at SCO Summit" should be of massive concern to our people. One can only continue to be shocked by such policies, which can be termed as ill-conceived to say the least. Without objectively considering the environmental and social impacts on our communities in the medium to long term, such policies will also result in massive economic impacts because a lack of environmental and social perspective cannot be economically attractive either. In order to become the global manufacturing hub, India will have to meet an enormous demand for energy of various kinds, and in order to meet this much energy demand the economy has to manufacture enormous number of appliances/ gadgets/ machineries (to generate and distribute commercial forms of energy such as coal, nuclear, gas, hydro, and renewable energy (RE) sources such as so

Denying dissent democratic space in Gujarat: 'sad narrative of eroding ethical values'

By Sandeep Pandey* A padyatra (foot march) was to be taken out between 26 September and 4 October, 2022 from Randhikpur village in Dahod district of Gujarat to Ahmedabad to apologise to Bilkis Bano. Randhikpur is Bilkis Bano’s village. In 2002 Gujarat communal violence she was gang raped, her 3 years old daughter, another child in womb and a total of 14 family members were killed. 11 people were convicted and sentenced for life in 2008. However, on 15 August, 2022 after Prime Minister Narendra Modi made a speech from Red Fort appealing to people to change their attitude towards women and treat them with respect, a district level committee of Panchmahal decided to release the 11 rapists and murderers. A Bhartiya Janata Party leader described four of these criminals as virtuous Brahmins. Before the padyatra could begin from Randhikpur, on 25 September night, 7 activists were picked up from Godhra corporator Hanif Kalandar’s house where they had gone for d

Pesticide companies' lobbying 'seriously impairing' basics of governance, regulation

Dr Narasimha Reddy Donthi* The Indian agricultural sector is grappling with low incomes, shortage of natural resources, increasing pest incidence and low public investments in research and extension. Pest attacks are increasing. Previously unknown pests are attacking crops. Farmers, indebted as they are due to various market mechanisms, are finding it hard to protect their crop investments. Thus, farmers are pushed into the conundrum of pesticide usage by pesticide markets and companies. Pesticide usage in India is increasingly becoming a regulatory problem. Regulation has not been effective in the face of such challenges. Scientific expertise on pesticides is often subsumed in the policy tradeoffs that, in the ultimate scenario, encourage production and marketing of Highly Hazardous Pesticides (HHPs). Expert Committee reports, which are recommending withdrawal of certain HHPs, are not being acted upon. Lobbying by pesticide companies has seriously impaired the basics of governance an

Kerala health bill public hearing? Here the minister 'ensured' cameras were turned off

By Our Representative On Friday, September 30, 2022, about 100 members of the general public gathered at the conference room of the collectorate at Ernakulam, Kerala, to express their apprehensions about the Kerala Public Health Bill, 2021, which the state assembly referred to a 15-member select committee chaired by state health and family welfare minister, Veena George. Minister Veena George asserted at the outset that this was a sitting of the select committee, and all cameras would need to be turned off. Advocate PA Pouran, general secretary of the People’s Union for Civil Liberties in Kerala, stood up in protest, arguing that the meeting was a public hearing and should ideally be televised to reach vast numbers of people. Other members of the audience protested too, but the minister insisted that the gathering was part of a sitting of the select committee. “Why then did you invite all of us?” protested George Mathew, who had arrived from Aluva and earlier served as a member of t

How Gandhian values have become 'casualty' in India under majoritarian BJP rule

By Sandeep Pandey* A Muslim youth was beaten recently when he tried to witness the famous garba performance during the Hindu religious nine days festival of Navratri in Gujarat. There was a time when Muslims could easily participate in Garbha events in an atmosphere of cordiality. Bilkis Bano was gang raped in 2002 Gujarat communal violence, her 3 years old daughter, the child in womb and a total of 14 family members were killed. 11 accused were awarded life term. However, recently a District level committee has decided to release all the culprits. A ruling Bhartiya Janata Party leader has described some of these criminals as virtuous Brahmins, the highest among the Hindu hierarchical caste system. In a communally polarized Gujarat today most Muslims feel offended by the decision of the government and BJP supporters either justify the release of rapists and murderers or just ignore the ignominious decision. Mahatma Gandhi came from the Guj

GoI 'feeling threatened' by forces which can potentially fight 'Brahmanical fascism'

Counterview Desk A network of civil rights and people’s organisations , Campaign Against State Repression (CASR)*, has characterised the recently-imposed ban on Popular Front of India (PFI), National Confederation of Human Rights Organizations (NCHRO) and other organisations as “Brahmanical Hindutva fascist” move of the Government of India (GoI), calling it “onslaught on democratic dissent”. In a statement, CASR said, the move is aimed at terrorizing and vilifying the Muslim community, adding, at the same time, the GoI is curbing any protest and demonstration against the “fascist diktat of ban”, with peoplebeing “detained and arrested.” It added, “This kind of attack on right to oppose or criticize any step of government should be conceived as an attack on the very democratic values of the people.” Text : On 28 September 2022, Central Government led by BJP-RSS banned the Popular Front of India, National Confederation of Human Rights Organizations, Campus Front of India, National Wom

Buddhist shrines were 'massively destroyed' by Brahmanical rulers: Historian DN Jha

Nalanda mahavihara By Our Representative Prominent historian DN Jha, an expert in India's ancient and medieval past, in his new book , "Against the Grain: Notes on Identity, Intolerance and History", in a sharp critique of "Hindutva ideologues", who look at the ancient period of Indian history as "a golden age marked by social harmony, devoid of any religious violence", has said, "Demolition and desecration of rival religious establishments, and the appropriation of their idols, was not uncommon in India before the advent of Islam".

Golwalkar's views on tricolour, martyrs, minorities, caste as per RSS archives

By Shamsul Islam* First time in the history of independent India, the in-charge minister of the Cultural Ministry in the current Modi government, Prahlad Singh Patel, has glorified MS Golwalkar, second supremo of the RSS and the most prominent ideologue of the RSS till date, on his birth anniversary, February 19. In a tweet he wrote : “Remembering a great thinker, scholar, and remarkable leader #MSGolwalkar on his birth anniversary. His thoughts will remain a source of inspiration & continue to guide generations.”

Counterview

Search This Blog