Choubey notes, that maternal deaths, being a rare event, require large sample size to provide robust estimates. Registrar General of India uses the Sample Registration System (SRS) to provide estimates on maternal mortality which does not generate data on yearly basis.
In order to enhance the SRS sample size, therefore, the results are derived by pooling the three years data, he says.
As per the report of Sample Registration System (SRS) released by Registrar General of India (RGI), Maternal Mortality Ratio (MMR) of India has shown a gradual decrease. For every 100,000 live births, there were:
- 167 maternal deaths in SRS 2011-13,
- 130 maternal deaths in SRS 2014-16,
- 122 maternal deaths in SRS 2015-17.
As per the state-wise data provided in the answer, Uttar Pradesh had the most number of maternal deaths for all three SRS periods. For the 2015-17 period, Uttar Pradesh saw 12,340 maternal deaths, 2.5 times more than Bihar which is next in line.
A 2014 study had noted that India contributes one-fifth of the global burden of absolute maternal deaths, but the nation experienced an estimated 4.7% annual decline in maternal mortality ratio (MMR) and 3.5% annual increase in skilled birth attendance since 1990. The total number of maternal deaths reported in the last SRS report was 37,890.
Etiology of maternal mortality
The last nation-wide survey covering causative factors that result in maternal deaths were covered by the RGI.
As per the RGI-SRS report titled “Maternal Mortality in India: 2001-2003 Trends, Causes and Risk Factors”, major causes of maternal deaths in the country are haemorrhage (38%), sepsis (11%), hypertensive disorders (5%), obstructed labour (5%), abortion (8%) and other conditions (34%) including anaemia.
WHO categorizes maternal deaths into direct, indirect and unknown/undetermined.
The whole picture
Chaubey in his response listed out steps being taken under the National Health Mission to further curb the incidence of maternal mortality in the country: Janani Suraksha Yojana, Janani Shishu Suraksha Karyakram, Midwifery programme, etc.
Although these state efforts as well as the resultant decrease in maternal mortalities are worth noting, only looking at these statistics would obscure our view of India’s overall reproductive health conditions.
Maternal nutrition is a major concern in the country. A third of women of reproductive age in India are undernourished, and inevitably give birth to an undernourished babies, thereby perpetuating an intergenerational cycle of undernutrition. UNICEF’s State of the World’s Children 2019 (SOWC) report 38% of all Indian children below four years of age are stunted.
Another vital issue is infant mortality. A 2018 report by the United Nations Inter-agency Group for Child Mortality Estimation (UNIGME) observed that 802,000 infants died in the country in 2017. The deaths were attributed to the lack of access to water, sanitation, proper nutrition and basic health services, despite the government’s programmes on sanitation, health and nutrition.
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