Maternal mortality is defined as the death of women while pregnant or within 42 days of termination of pregnancy. Death may be due to any cause related to or aggravated by pregnancy and its management. Maternal mortality rate (MMR) is the number of maternal deaths per 100,000 live births in one year.
In many developing nations, complications of pregnancy and childbirth are the leading causes of death among women of reproductive age. More than one woman dies every minute and 585,000 women die every year from such causes. Less than one percent of these deaths occur in developed countries, demonstrating that these could be avoided if resources and services were available. The gap between maternal mortality between developed and developing regions is wide.
In addition to maternal death, women experience more than 50 million maternal health problems annually. As many as 300 million women (more than one-quarter of all adult women living in the developing world) currently suffer from short or long term illness and injuries related to pregnancy and childbirths.
Every woman can experience sudden and unexpected complications during pregnancy, childbirth and just after delivery. Although high quality, accessible health care has made maternal death a rare event in developed countries, these complications can often be fatal in the developing world. Women risk death and disability each time they become pregnant. Women in developing countries face these risks much more often, since they bear many more children than women in the developed world, apart from other reasons.
At least 40 percent of women experiences complications during pregnancy, childbirth and the period after delivery. An estimated 15 percent of these women develop potentially life-threatening problems. Long term complications can include chronic pain, impaired mobility, damage to the reproductive system and infertility. Women’s poor health during pregnancy, inadequate care during delivery and lack of newborn care cause almost 8 million still births and neonatal deaths (death within one week of birth) each year. A study in Bangladesh found that a mother’s death sharply increased the probability that her children, up to age 10, will die within 2 years. This was especially true for her daughters.
Women’s risk of dying from pregnancy and childbirth varies by regions around the world:
All Developing countries -1 in 48
Africa -1 in 16
Asia -1 in 65
Latin America and Caribbean -1 in 130
All Developed countries -1 in 1,800
Europe -1 in 1,400
North America -1 in 3,700
Country-level differences are even more dramatic. For example, in Ethiopia, 1 out of every 9 women dies from pregnancy-related complications, as compared to 1 in 8,700 in Switzerland.
The Indian Scenario: Surveys, special studies or indirect estimation of MMR have been made to assess levels of maternal mortality in India. Estimates of MMR vary between 400-500 per 100,000 live births. According to World Health Organization (WHO) estimates, India accounted for 25.7 percent of maternal deaths in the world in 2000 (i.e. 136,000 out of 529,000 global maternal deaths occurred in India). This is the highest for any single nation in the world. Maternal mortality in India varies by region and state. MMR is higher in the eastern and central regions and lower in the north western and southern regions. Socio-economic variations are not well documented in India.
A report, “Advocating Accountability: Status Report on maternal Health and Young People’s Sexual and Reproductive Health and Right in South Asia”, prepared by South Asian Association for Regional Cooperation (SAARC) revealed the above figures about India, maintaining that the main cause was the unskilled birth attendants. The overall MMR of the SAARC region was 500 per 100000 live births, which is among the highest in the world. The region also accounts for approximately 7.2 million unsafe abortions annually according to the report.
Another report on “Maternal and Newborn Health”, released in Jaipur on January 24, 2009, by the UNICEF says about 8000 women and 1.17 lakh children die every year in Rajasthan due to complications arising out of pregnancy and child birth. While Rajasthan contributes about 7 per cent of the total live births in India, it accounts for 9.2 per cent of the total maternal deaths.
MMR under Sample Registration System (SRS) in some of the Indian States (1998):
Uttar Pradesh - 707 (As per January 2009 Report, Uttarakhand ranks first with MMR of 517)
Rajasthan – 670 (445 as per January 2009 Report, ranking 3rd at present in MMR)
Madhya Pradesh – 498
Bihar – 452
Assam – 409 (490 as per the January 2009 Report, ranking 2nd in terms of MMR)
Orissa – 369
West Bengal – 266
Punjab – 199
Kerala – 198
Karnataka – 195
Andhra Pradesh – 154
Maharashtra – 135
Haryana – 103
Tamil Nadu – 79
Gujarat - 28 (lowest)
All India – 407
There was an overall relative decline in maternal mortality of nearly 24 percent during 1997-2001. This included a 16 percent decline in the 8 Empowered Action Group (EAG) states of Bihar, Jharkhand, Orissa, Madhya Pradesh, Chattisgarh, Rajasthan, Uttar Pradesh and Uttaranchal. In contrast, MMR has fallen by only 7 percent in the southern states of Andhra Pradesh, Karnataka, Kerala and Tamil Nadu. MMR has declined from 398 in 1997-98 to 301 in 2001-2003 in India according to a report on ‘Maternal Mortality in India: 1997-2003 – Trends, Causes and Risk Factors’. MMR is higher in the EAG states and Assam than in the other states in India. In 2001-03, lifetime risk of a woman dying during childbirth was 1.8 percent in the EAG states and in Assam, 0.4 percent in the southern states and 0.6 percent in other states.
UNICEF’s latest report, “State of the World’s Children – 2009” says that in India, more than two-thirds of all maternal deaths occurred in U.P., Uttaranchal, Bihar, Jharkhand, Orissa, M.P., Chhattisgarh, Rajasthan and Assam. Despite an increase in institutional deliveries, 60 per cent of women still deliver their babies at home.
Causes of Maternal Deaths and Complications (most of which occur either during or shortly after delivery):
Research shows that common risk factors for maternal deaths are: a mother’s age below 20 years or above 35 years, illiteracy, poor socio-economic status and lack of antenatal care. Some of the commonly identified factors include bad obstetric history, anemia, maternal complications and diseases, delivery by an unskilled person and unsafe abortions. These can be further elaborated:
During Pregnancy: The percentage of women who seek antenatal (pre-delivery) care at least once, is 63 percent in Africa; 65 percent in Asia and 73 percent in Latin America and the Caribbean. At the country level, however, use of such services can be extremely low. In Nepal, for example, only 15 percent of women receive antenatal care. Poor or negligible care during pregnancy is an important factor in aggravating death.
During Childbirth: Each year, 60 million women give birth with the help of untrained traditional birth attendant or a family member or with no help at all. Almost half of births in developing countries take place without the help of a skilled birth attendant (such as a doctor or midwife), which increase the cases of casualties during birth.
After Delivery: The majority of women in developing countries receive no post-partum (after delivery) care. In very poor countries and regions, as few as 5 percent of women receive such care.
Causes preventing women in Developing Countries from seeking/getting their needed Life-Saving Health Care include:
• Distance from health services;
• Cost (direct fees as well as the cost of transportation, drugs and supplies);
• Women’s lack of decision-making power within the family;
• Multiple demands on women’s time;
• Poor quality of services, including shoddy treatment by health providers, makes some women reluctant to use services;
Most maternal deaths, many health problems among women and children, and also the deaths of at least 1.5 million infants each year could be prevented through:
• Routine maternal care for all pregnancies, including a skilled attendant (midwife or doctor at birth);
• Emergency treatment of complications during pregnancy, delivery and after birth;
• Post Partum (after delivery) family planning and basic neonatal (within a week of birth of baby) care. Such care would cost about $3 per person per year in low income countries. Basic maternal care alone can cost as little as $2 per person per year.
• Improvement of women’s status alongwith support from their husbands and raising awareness about the consequences of poor maternal health. Families and communities must encourage and enable women to receive proper care during and after delivery.
An analysis of the causes of decline in MMR in various western countries such as Sweden, Holland and Denmark, reveals that introduction of skilled midwives to conduct deliveries has led to reductions in maternal deaths as much as 250-300 per 100000 live births.
In many developing nations, complications of pregnancy and childbirth are the leading causes of death among women of reproductive age. More than one woman dies every minute and 585,000 women die every year from such causes. Less than one percent of these deaths occur in developed countries, demonstrating that these could be avoided if resources and services were available. The gap between maternal mortality between developed and developing regions is wide.
In addition to maternal death, women experience more than 50 million maternal health problems annually. As many as 300 million women (more than one-quarter of all adult women living in the developing world) currently suffer from short or long term illness and injuries related to pregnancy and childbirths.
Every woman can experience sudden and unexpected complications during pregnancy, childbirth and just after delivery. Although high quality, accessible health care has made maternal death a rare event in developed countries, these complications can often be fatal in the developing world. Women risk death and disability each time they become pregnant. Women in developing countries face these risks much more often, since they bear many more children than women in the developed world, apart from other reasons.
At least 40 percent of women experiences complications during pregnancy, childbirth and the period after delivery. An estimated 15 percent of these women develop potentially life-threatening problems. Long term complications can include chronic pain, impaired mobility, damage to the reproductive system and infertility. Women’s poor health during pregnancy, inadequate care during delivery and lack of newborn care cause almost 8 million still births and neonatal deaths (death within one week of birth) each year. A study in Bangladesh found that a mother’s death sharply increased the probability that her children, up to age 10, will die within 2 years. This was especially true for her daughters.
Women’s risk of dying from pregnancy and childbirth varies by regions around the world:
All Developing countries -1 in 48
Africa -1 in 16
Asia -1 in 65
Latin America and Caribbean -1 in 130
All Developed countries -1 in 1,800
Europe -1 in 1,400
North America -1 in 3,700
Country-level differences are even more dramatic. For example, in Ethiopia, 1 out of every 9 women dies from pregnancy-related complications, as compared to 1 in 8,700 in Switzerland.
The Indian Scenario: Surveys, special studies or indirect estimation of MMR have been made to assess levels of maternal mortality in India. Estimates of MMR vary between 400-500 per 100,000 live births. According to World Health Organization (WHO) estimates, India accounted for 25.7 percent of maternal deaths in the world in 2000 (i.e. 136,000 out of 529,000 global maternal deaths occurred in India). This is the highest for any single nation in the world. Maternal mortality in India varies by region and state. MMR is higher in the eastern and central regions and lower in the north western and southern regions. Socio-economic variations are not well documented in India.
A report, “Advocating Accountability: Status Report on maternal Health and Young People’s Sexual and Reproductive Health and Right in South Asia”, prepared by South Asian Association for Regional Cooperation (SAARC) revealed the above figures about India, maintaining that the main cause was the unskilled birth attendants. The overall MMR of the SAARC region was 500 per 100000 live births, which is among the highest in the world. The region also accounts for approximately 7.2 million unsafe abortions annually according to the report.
Another report on “Maternal and Newborn Health”, released in Jaipur on January 24, 2009, by the UNICEF says about 8000 women and 1.17 lakh children die every year in Rajasthan due to complications arising out of pregnancy and child birth. While Rajasthan contributes about 7 per cent of the total live births in India, it accounts for 9.2 per cent of the total maternal deaths.
MMR under Sample Registration System (SRS) in some of the Indian States (1998):
Uttar Pradesh - 707 (As per January 2009 Report, Uttarakhand ranks first with MMR of 517)
Rajasthan – 670 (445 as per January 2009 Report, ranking 3rd at present in MMR)
Madhya Pradesh – 498
Bihar – 452
Assam – 409 (490 as per the January 2009 Report, ranking 2nd in terms of MMR)
Orissa – 369
West Bengal – 266
Punjab – 199
Kerala – 198
Karnataka – 195
Andhra Pradesh – 154
Maharashtra – 135
Haryana – 103
Tamil Nadu – 79
Gujarat - 28 (lowest)
All India – 407
There was an overall relative decline in maternal mortality of nearly 24 percent during 1997-2001. This included a 16 percent decline in the 8 Empowered Action Group (EAG) states of Bihar, Jharkhand, Orissa, Madhya Pradesh, Chattisgarh, Rajasthan, Uttar Pradesh and Uttaranchal. In contrast, MMR has fallen by only 7 percent in the southern states of Andhra Pradesh, Karnataka, Kerala and Tamil Nadu. MMR has declined from 398 in 1997-98 to 301 in 2001-2003 in India according to a report on ‘Maternal Mortality in India: 1997-2003 – Trends, Causes and Risk Factors’. MMR is higher in the EAG states and Assam than in the other states in India. In 2001-03, lifetime risk of a woman dying during childbirth was 1.8 percent in the EAG states and in Assam, 0.4 percent in the southern states and 0.6 percent in other states.
UNICEF’s latest report, “State of the World’s Children – 2009” says that in India, more than two-thirds of all maternal deaths occurred in U.P., Uttaranchal, Bihar, Jharkhand, Orissa, M.P., Chhattisgarh, Rajasthan and Assam. Despite an increase in institutional deliveries, 60 per cent of women still deliver their babies at home.
Causes of Maternal Deaths and Complications (most of which occur either during or shortly after delivery):
Research shows that common risk factors for maternal deaths are: a mother’s age below 20 years or above 35 years, illiteracy, poor socio-economic status and lack of antenatal care. Some of the commonly identified factors include bad obstetric history, anemia, maternal complications and diseases, delivery by an unskilled person and unsafe abortions. These can be further elaborated:
During Pregnancy: The percentage of women who seek antenatal (pre-delivery) care at least once, is 63 percent in Africa; 65 percent in Asia and 73 percent in Latin America and the Caribbean. At the country level, however, use of such services can be extremely low. In Nepal, for example, only 15 percent of women receive antenatal care. Poor or negligible care during pregnancy is an important factor in aggravating death.
During Childbirth: Each year, 60 million women give birth with the help of untrained traditional birth attendant or a family member or with no help at all. Almost half of births in developing countries take place without the help of a skilled birth attendant (such as a doctor or midwife), which increase the cases of casualties during birth.
After Delivery: The majority of women in developing countries receive no post-partum (after delivery) care. In very poor countries and regions, as few as 5 percent of women receive such care.
Causes preventing women in Developing Countries from seeking/getting their needed Life-Saving Health Care include:
• Distance from health services;
• Cost (direct fees as well as the cost of transportation, drugs and supplies);
• Women’s lack of decision-making power within the family;
• Multiple demands on women’s time;
• Poor quality of services, including shoddy treatment by health providers, makes some women reluctant to use services;
Most maternal deaths, many health problems among women and children, and also the deaths of at least 1.5 million infants each year could be prevented through:
• Routine maternal care for all pregnancies, including a skilled attendant (midwife or doctor at birth);
• Emergency treatment of complications during pregnancy, delivery and after birth;
• Post Partum (after delivery) family planning and basic neonatal (within a week of birth of baby) care. Such care would cost about $3 per person per year in low income countries. Basic maternal care alone can cost as little as $2 per person per year.
• Improvement of women’s status alongwith support from their husbands and raising awareness about the consequences of poor maternal health. Families and communities must encourage and enable women to receive proper care during and after delivery.
An analysis of the causes of decline in MMR in various western countries such as Sweden, Holland and Denmark, reveals that introduction of skilled midwives to conduct deliveries has led to reductions in maternal deaths as much as 250-300 per 100000 live births.
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