Model Answer
0 min readIntroduction
Maternal Mortality Rate (MMR) is a critical indicator reflecting the health and well-being of women in a society. As per the World Health Organization (WHO), maternal death is defined as the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes. India has made commendable progress in reducing its MMR, which has declined significantly over the past decades. Despite this progress, understanding the underlying causes remains crucial for achieving the Sustainable Development Goal (SDG) target of reducing MMR to less than 70 per 100,000 live births by 2030.
Understanding Maternal Mortality Rate (MMR)
The Maternal Mortality Ratio (MMR) is the number of maternal deaths during a given time period per 100,000 live births during the same time period. It serves as a key metric to assess the quality of maternal healthcare and the overall reproductive health of women in a region. The Office of the Registrar General, India, through the Sample Registration System (SRS), provides crucial estimates of maternal mortality.
Causes of Maternal Mortality in India
Maternal deaths in India stem from a complex interplay of direct obstetric complications and indirect causes, often exacerbated by socio-economic and systemic factors.
1. Direct Obstetric Causes (Majority of Deaths):
These are complications arising during pregnancy, childbirth, or the puerperium (postpartum period), directly related to obstetric causes.
- Hemorrhage: Severe bleeding, particularly postpartum hemorrhage (PPH), is the leading cause of maternal deaths. This can be due to uterine atony, trauma during delivery, retained placental tissue, or coagulation disorders.
- Hypertensive Disorders of Pregnancy: Conditions like pre-eclampsia and eclampsia, characterized by high blood pressure, can lead to seizures, organ damage, and death if not managed promptly.
- Infections (Sepsis): Puerperal sepsis, often resulting from unhygienic delivery practices, unsafe abortions, or prolonged labor, can lead to severe infections and multi-organ failure.
- Complications from Delivery: Obstructed labor, uterine rupture, and other complications during childbirth require timely medical intervention, often surgical (like C-section), which may not be readily available.
- Unsafe Abortions: Complications arising from unsafe abortion practices, including hemorrhage, infection, and uterine perforation, contribute significantly to maternal deaths.
- Embolism: Rare but fatal conditions like amniotic fluid embolism or pulmonary embolism can occur during or after delivery.
2. Indirect Causes:
These are deaths resulting from pre-existing diseases or conditions that are aggravated by the physiological effects of pregnancy, not directly due to obstetric causes but influenced by them.
- Anemia: Widespread iron-deficiency anemia among pregnant women reduces oxygen-carrying capacity, making them more vulnerable to complications like hemorrhage and infection.
- Non-Communicable Diseases (NCDs): Increasing prevalence of NCDs like heart disease, diabetes, and kidney disease among women can worsen during pregnancy, leading to adverse outcomes.
- Malnutrition: Poor nutritional status before and during pregnancy weakens the mother's body, making her susceptible to various complications.
- Other Diseases: Infections like malaria, tuberculosis, or HIV/AIDS can complicate pregnancy and increase mortality risk.
3. Socio-Economic and Healthcare System Factors:
These systemic issues act as underlying determinants, exacerbating both direct and indirect causes of maternal mortality.
- Inadequate Healthcare Access: Limited access to quality antenatal care (ANC), skilled birth attendants, and emergency obstetric care (EmOC) services, particularly in rural and remote areas.
- Lack of Awareness and Education: Insufficient knowledge among women and communities regarding maternal health, danger signs during pregnancy, and the importance of institutional deliveries.
- Poverty: Economic constraints often prevent women from accessing nutritious food, transportation to health facilities, and quality medical services.
- Early Marriages and Adolescent Pregnancies: Adolescent mothers face higher risks of complications due to their underdeveloped bodies and often lack adequate care.
- Gender Discrimination and Social Norms: Societal attitudes can limit women's autonomy in healthcare decisions, delay care-seeking, and perpetuate harmful traditional practices.
- Shortage of Skilled Health Professionals: Dearth of obstetricians, gynecologists, anesthetists, and nurses, especially in public health facilities in underserved regions.
- Weak Referral Systems: Inefficient mechanisms for transporting pregnant women with complications from primary health centers to higher-level facilities.
- Poor Infrastructure: Lack of well-equipped facilities, essential medicines, blood banks, and diagnostic services in many public health institutions.
The Government of India has implemented various schemes like Janani Shishu Suraksha Karyakaram (JSSK), Janani Suraksha Yojana (JSY), Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA), and Surakshit Matritva Aashwasan (SUMAN) to address these causes by promoting institutional deliveries, providing free maternal and neonatal healthcare, and strengthening antenatal care and referral systems.
A tabular representation of the major causes and their contribution is presented below:
| Category of Cause | Specific Causes | Approximate Contribution to Maternal Deaths (Global/India Trends) |
|---|---|---|
| Direct Obstetric Causes | Hemorrhage (Postpartum, Antepartum) | ~27% (Leading cause in India) |
| Hypertensive Disorders (Pre-eclampsia, Eclampsia) | ~14% | |
| Sepsis/Infections | ~11% | |
| Obstructed Labor & Other Delivery Complications | ~9% | |
| Complications of Unsafe Abortion | ~8% | |
| Indirect Causes | Anemia, Heart Disease, Other pre-existing conditions aggravated by pregnancy | ~28% |
Conclusion
Maternal mortality remains a significant public health challenge in India, despite considerable progress in reducing the MMR. While direct obstetric complications like hemorrhage and hypertensive disorders are the immediate causes, a multitude of indirect factors, including socio-economic disparities, inadequate access to quality healthcare, and systemic deficiencies, contribute significantly. Sustained efforts through robust policy implementation, strengthening healthcare infrastructure, community awareness, and addressing social determinants are imperative. Achieving the SDG target of less than 70 maternal deaths per 100,000 live births requires a holistic approach ensuring every woman has access to respectful, quality maternal care.
Answer Length
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