On the face of it, India may appear to have made great strides in reducing the maternal mortality rate by 65 per cent, from 569 per one lakh live births in 1990 to 190 in 2013. But scratch the surface, and the real picture emerges. In 2013, India had 17 per cent (50,000) of the global maternal deaths. Together with Nigeria at 14 per cent (40,000), the two countries accounted for one-third of total global maternal deaths. The MMR of 190 last year is much higher than the government’s target of below 100 by 2012. Also, India is yet to achieve the expected average annual maternal mortality rate decline of 5.5 per cent or more during the period 1990-2013 to reach the Millennium Development Goal 5 target. With only a 4.5 per cent decline in MMR during the last 23 years, the country falls under the “making progress” category and would fail to meet the MMR target of 109 before 2015. The only silver lining is that India has been making steady progress in reducing the MMR since 1990. But for a country where an estimated 26 million deliveries take place annually, the absolute number of maternal deaths continues to be high.

Besides the medical reasons like severe bleeding and infections after childbirth and high blood pressure levels during pregnancy, one of the factors that is playing a big role in maternal mortality is the lack of skilled care “before, during and after childbirth.” Maternal mortality is counted when deaths occur during pregnancy or in the first 42 days after the birth of the child, caused either directly or indirectly by pregnancy. One way of tackling this is by having more institutional deliveries. India launched a programme in 2005 to facilitate such deliveries on a larger scale than was prevalent, but the results were not encouraging: there was no corresponding decline in the number of deaths. The reason for that is not difficult to find. In 2008, more than 50 per cent of women in Uttar Pradesh and Bihar, and 41 per cent in Rajasthan, continued to deliver at home, according to a United Nations Population Fund-India report. Therefore, a greater focus on increasing the number of well-trained birth attendants should go hand in hand with promoting institutional deliveries. According to a 2008 UNICEF report, the quality of training of such attendants has been found to be “poor” in these three States that fare badly. The 2013 UNICEF report also found many other inadequacies contributing to poor outcomes when deliveries took place in health centres. Insufficient availability of health workers at primary care levels and “gaps” in the availability of equipment and supplies are some of them. The need for India to take up a more serious and multi-pronged approach to bring down the MMR cannot be overemphasised.

Published in The Hindu on May 22, 2014