Fostering a commitment to stop maternal deaths

Context :

Despite significant progress in reducing maternal mortality in India, 93 women still die for every 1,00,000 live births (MMR: 93 as per SRS 2019–21). This article highlights regional disparities, the "three delays" model, and practical interventions necessary to achieve the goal of zero preventable maternal deaths.

Key Data Points:

• India's MMR:

• 103 (2017–19) → 97 (2018–20) → 93 (2019–21)

• State-Wise Disparities:

• Kerala (Lowest): MMR 20

• Madhya Pradesh: MMR 175

• Assam: MMR 167

• Punjab, Haryana, WB: MMR 98–109

• Southern States Average: 20–63

• EAG States Average: 100–175

Three Delays Leading to Maternal Deaths:

1. Delay in Recognizing Danger and Seeking Care

• Lack of awareness, financial constraints, social barriers

• Mitigated by ASHA–ANM collaboration and JSY incentives

2. Delay in Reaching Health Facility

• Remote geographies, poor transport

• 108 Ambulance and NHM transport support helped but gaps remain

3. Delay in Receiving Quality Care at Facility

• Unavailable specialists, blood banks, equipment

• FRUs often non-functional due to staff and infrastructure gaps

Medical Causes of Maternal Mortality:

• Postpartum Hemorrhage (PPH): #1 killer

• Obstructed Labour: Often in undernourished adolescent mothers

• Hypertensive Disorders (eclampsia): If not managed in time

• Unsafe abortions and infections (esp. by quacks)

• Complications in home deliveries by untrained birth attendants

• Associated conditions: Malaria, TB, anaemia, UTI

Systemic Challenges Identified:

• 66% vacancies in specialist posts in CHCs

• Lack of operational FRUs (First Referral Units)

• Inadequate blood storage and transfusion capacity

• Neglected mental health issues in mothers

• Poor quality emergency obstetric care in some states

• Failure to implement technical protocols uniformly across India

Successful Interventions and Models:

• Kerala’s Confidential Review of Maternal Deaths

• Helps identify cause-specific mortality

• Has lowered MMR to 20

• Special protocols: Uterine artery clamp use, suction cannula for atonic uterus, rapid response to embolism, coagulopathy, hepatic failure

• Addressing perinatal depression and post-partum psychosis

• Kerala includes mental health in maternal care

Policy Suggestions & Way Forward:

1. Differentiated Strategy by State Cluster

• EAG states: Focus on basic implementation (access, antenatal care, transport)

• Southern/Better-off states: Refine quality, fill specialist gaps, mental health

2. Operationalize Minimum 4 FRUs/District

• Ensure staffing (obstetrician, anaesthetist, paediatrician) and blood units

• Emergency surgical care must be available 24x7

3. Ensure Early Antenatal Registration

• Iron-folic acid supplementation, hypertension monitoring

• Promote institutional deliveries with incentives

4. Strengthen Data Systems

• Enforce Maternal Death Surveillance and Response (MDSR)

• Use Confidential Reviews to identify systemic gaps

5. Focus on Adolescent Girls’ Nutrition and Education

• Address intergenerational malnutrition and anaemia

• Prevent early and unsafe pregnancies

6. Invest in Public Health Cadre and Infrastructure

• Fill specialist vacancies in CHCs

• Equip FRUs and PHCs for basic and emergency obstetric care

Conclusion:

India has made notable progress in reducing maternal mortality, but the goal of zero preventable maternal deaths requires targeted policy, better health infrastructure, skilled manpower, and community engagement. The Kerala model, ASHA-ANM efforts, and technology-enabled maternal care offer replicable examples. Political and administrative will, backed by scientific and empathetic public health planning, will be key to saving lives and ensuring safe motherhood for all.