By Aayupta Mohanty
Group no. 5
5th year 1st semester
“The challenge to human rights principles is to make the promise of safe
motherhood real. The opportunity of advancement through ensuring respect
for human rights has been recognized nationally and internationally, and the
language of human rights has come to define the best enjoyments of life that
countries can offer their populations.”
Maternal mortality 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.”
2010, countries with highest maternal mortality
were Chad(1,100), Somalia (1,000), CentralAfrican
Republic, (890), Sierra Leone (890) and Burundi (800)
Lowest rates included Estonia at 2 per 100,000
and Singapore at 3 per 100,000.
In India, roughly one maternal death occurs every five minutes.
According to the government, these deaths account for 15%
of all deaths of women of reproductive age.
Data from the most recent National Family Health Survey
(NFHS-3) suggest that the maternal mortality ratio has fallen
fromapproximately 400 deaths per 100,000 live births in 1997
it has come down to 212 per 100,000 live births in 2007-09
i.e. a decline by 115 points in the last 10 years. Thus, the
country has reduced MMR by an average of 11 points per
year. In view of this there is likely to be a decline of another
50 to 60 points by 2015 i.e. country may attain MMR of 162.
To achieve the millenium development goal on maternal health,
India is needed to reduce MMR from 437 deaths per 100,000
live births in 1991 to 109 by 2015. It has only reached the 212
mark just yet. Long way to go ….
Since many deaths happen in the anonymity of women’s
homes or on the way to seek help at a medical facility,
they often go unrecorded. Absence of official registration
and auditing for maternal deaths.
In response to the lackof accurate and complete national
government data on maternal mortality, several forms of
maternaldeath auditing have been developed as
accountability measures in India, including the United
Nations Children’s Fund’s (UNICEF)
Maternal and Perinatal Death Inquiries and Response
(MAPEDIR) –verbal autopsy method
Academy of Nursing Studies’ (ANS) maternal death social
State governments are particularly well placed to undertake
Health system related factors
Anemia and unsafe abortion are deserving of special note, as these two
causes of maternal death
are more common in India than they are in much of the world.
anaemia-Pregnant women who are anemic, face multiple health risks
in addition to the risk of maternal death. Anemic women are
increasingly susceptible to communicable diseases such as
tuberculosis (TB) and malaria, which are associated with adverse
outcomes during andafter pregnancy.
Anemia is a contributory factor in maternal deaths caused by
hemorrhage, septicemia and eclampsia,and when severe can even
cause cardiac arrest.
Unsafe abortion-Complications from unsafe abortion account for a
significant proportion of maternal deaths inIndia.
According to the government, around 9% of total maternal deaths
are caused by unsafe abortion,but medical experts put the figure at
almost 18% higher than the global average of13%.
Although abortion is legally permitted on several grounds, each year
approximately 6.7 million abortions occur outside of governmentrecognized health centers, often in unhygienic conditions or by
untrained abortion providers. This problem disproportionately
affects adolescents, as unsafeabortions account for half of all
maternal deaths of women aged 15-19.
A higher incidence of mortality and morbidity is
found to occur among woman and girls who are
poor or low-income,
less educated and belong to socially disadvantaged
castes and tribes.
Child marriage puts young girls and adolescents at
significant risk of pregnancy-related complications
Pregnant women living with HIV/AIDS experience an
increased risk of pregnancy-related fatalities due
to outright discrimination
Geographical vastness and socio-cultural diversity in India indicates that maternal
mortality varies across the states, and therefore uniform implementation of
health-sector reforms is a tall task.
Maintaining healthcare standards at the grassroots level requires
interdisciplinary cooperation and collaboration among doctors, midwives,
auxiliary nurses and other paramedical staff.
The provision of healthcare at the terminal end of healthcare system in the rural
areas urgently requires a well intended political drive to improve the present
The high MMR is due to large number of deliveries conducted at home by
unskilled persons with zero compliance to basic hygiene standards.
Added to this, lack of adequate referral facilities to provide emergency obstetric
care for complicated cases also contribute to high MMR.
The three delays
Most maternal deaths are attributable to the ‘three delays’: the delay in
deciding to seek care, the
delay in reaching the appropriate health facility, and
the delay in receiving quality care once inside an institution.
the declining numbers of MMR within the states of Maharashtra, West Bengal,
Tamil Nadu, and Kerala, indeed brings some respite.
National Targets and Initiatives
Strengthened ante-natal care (ANC): This was done by conducting
maternal medical campaign that included early registration of ante-natal
case (i.e. pregnant mother) before 12 weeks, conducting baseline
investigations – haemoglobin, blood pressure, weight, height, body-mass
index, urine-albumin/sugar, HIV testing, sonography. These investigations
are done for identifying high risk factors such as high BP, protienuria,
anaemia, twins, hydramnios, IUGR etc.
Distributing free medicines, conducting screening programmes for high
risk pregnancies such as short stature, multipara, elderly primigravida,
through clinical examination of ANC is done during these ANC visits and
by creating a mother & child tracking system (MCTS) wherein all mothers
and children are tracked and provided services from time to time, resulting
in increasing ANC coverage.
Strengthen intra-natal care and post natal care (PNC): This was done
by ensuring 100 per cent deliveries at institutions by micro – birth planning
by way of keeping a track of the mother throughout the pregnancy term and
well up following up with the delivered mother on 2nd, 7th, 10th Day and
for baby on Day – 7, 14, 21, 28 and 42 day
Infrastructure strengthening: The government has mapped all
health facilities available in the state. The government has also
strengthenied sub centres, primary health centres (658) as per Indian
Public Health Standard (IPHS) norms, strengthening of first referral
units (220). In addition, the government has also provided for blood
transfusion facilities at most of these centres, free referral transport
services for these women, free diagnostics and medicines, free diet
during stay, and adequate PNC care is being implemented across the
Strengthening of manpower: The government of Maharashtra
provides forvarious trainings are being taken such as,skilled
attendant at birth - (ANM/LHV/Staff Nurse): 7038 trained
Basic emergency obstetric care training: 4372 trained
Comprehensive emergency obstetric care training:133 trained
Life saving anaesthesia skill training of MOs:173 trained
Maternal death review is a tool used to review all facility-based
and community-based maternal death. Started in the state since 2010
as per government regulation dated May 28, 2010. This process has
helped the state in identifying the type of delays, reasons for delay
and the system gaps which are responsible for maternal death. State
has been identifying gaps and implementing the corrective measures.
Suraksha Yojana (JSY): Under the JSY, the
state provides for conditional cash transfer scheme. The
beneficiaries must be BPL. In case of SC and ST,
benefit should be given to all pregnant women
(including non BPL). The age of pregnant mother
should not be less than 19 years. The benefit should be
given to the beneficiaries up to two living children. For
home delivery, Rs 500 is to be given to the BPL
beneficiary only. The beneficiary from urban area, if
she delivered in a health institution gets an amount of
Rs 600 within seven days and those from rural areas get
Rs 700 within seven days. In case of Lower Segment
Cesarean Section (LSC S), Rs 1500 is to be given to
the beneficiary if she has undergone caesarean section
delivery in private accredited hospital.
scale of maternal mortality is an
affront to humanity…The time has come to
treat this issue as a human rights violation,
no less than
and prisoners of conscience.” – Mary
Robinson, former UN High Commissioner
for Human Rights