India’s maternal mortality rate dips drastically, marches towards attaining SDGs

Hyderabad: World Health Organization's (WHO) systematic study on maternal mortality from 2009-2020 provides a detailed analysis of global and regional causes of maternal deaths.

The study is considered crucial as the WHO has set a sustainable development goal (SDG) target to reduce the maternal mortality rate (MMR) to below 70 per 1 lakh live births by 2030.

The study has identified 6 primary reasons accounting for 90% of the maternal deaths globally, raising challenges of regional variations and timings. A new challenge of maternal suicides has been identified by the study, raising concerns about the lack of postpartum mental health services and mental health stigma.

Despite the all-round effort of the countries, maternal mortality remains a pressing public health concern, especially in low and middle-income countries. Approximately 800 women lose their lives daily from preventable causes related to pregnancy and childbirth.

Primary reasons for deaths

The study identifies hemorrhage as the leading global cause of maternal mortality, accounting for 27% of the global deaths. Indirect obstetric causes (23%), hypertensive disorders (16%), abortion (8%), pregnancy-related sepsis (7%), embolism (7%), and other direct causes (10%) are the other reasons that contribute significantly to the overall maternal deaths.

MMR has drastically reduced in India thanks to the efforts and schemes rolled out by respective governments and health departments, but the rate needs to be brought down further.

"There has been a steady decline in maternal death with improved health care services and better access. Despite that, we lose around 24,000 women to maternal death in a year alone in India”, said Dr. Niharika Allu, Consultant Gynecologist, BirthRight By Rainbow Hospitals, Visakhapatnam.

Regional disparity in India and across the globe

Sub-Saharan Africa and South Asia continue to bear the highest burden of maternal deaths. While haemorrhage is the most common cause of maternal deaths in sub-Saharan Africa and Western Asia/Northern Africa, hypertensive disorders are the leading cause in Latin America and the Caribbean. Embolism is found to be the leading cause in countries like Australia and New Zealand.

“The present MMR stands at 97/100,000 live births in India (Latest SRS report 2018-2020), a significant improvement from 398/100,000 live births in 1998. Regional disparities continue to exist across India due to divergent health care services. Kerala records an MMR of 19/100,000 live births in comparison to 21/100,000 live births in the United States of America”, Dr Niharika said.

Need for essential care

Lack of skilled birth attendants, emergency obstetric care, and access to blood transfusions leads to a high MMR in low and lower-middle-income countries. The lack of postpartum care is also leading to deaths after discharge from the hospital.

Emphasising the need for better healthcare services, Dr Nikarika said, “Quality healthcare during pregnancy is essential to reduce the complications and maternal death. Improved access to healthcare services is the only way forward to reach the United Nations SDG goal of lowering the MMR to 70/100,000 live births by 2030."

Recommendations to reduce MMR

The WHO report concludes with 5 key recommendations to reduce the MMR to 70/100,000 live births across the globe. Strengthening the postpartum care with checkups within the first 2 days, and follow up for a minimum of 1 year, expanding mental health support to increase suicide prevention are suggested.

Addressing haemorrhage with proven interventions with improved transfusion facilities, identifying and tackling the indirect causes like cardiovascular, metabolic, infectious disease along with improving the data collection and reporting are strongly recommended.