The maternal mortality rate is the number of maternal deaths in a population divided by the number of women of reproductive age. It captures the likelihood of both becoming pregnant and dying during pregnancy (including deaths up to six weeks after delivery).

1. Submitted by
Annwesha Mridha
Post Basic 2nd year
College of Nursing Asia
Heart Foundation

2. INDEX
 INTRODUCTION
 DEFINITION
 CALCULATION
 CLASSIFICATION
 STATISTICAL MEASURES
 APPROACHES TO MEASURE
MMR
 CAUSES
 PREVENTION

3. INTRODUCTION
Death of a women due to obstetric causes is called
maternal death . This includes reasons related to
pregnancy or childbirth . Thus ,maternal mortality rate
is the number of women who die of causes related to
childbirth for every 1000 live births in a given year.
Refer book – keshav swarnkar

4. DEFINITION OF MMR:
According to WHO a maternal death is defined as “ the death
of a women while present or within 42 days of termination of
pregnancy , irrespective of the duration and site of
pregnancy, from any causer related to or aggravated by the
pregnancy or its management but not from accidental or
incidental causes “
Refer book – k . park

5. CALCULATION OF MMR:
Maternal mortality ratio measures women dying
from puerperal causes and is defined as :
Maternal
mortality =
rate
1000
or
100,000
x
Total no of live births in the
same area and year
Total no of female deaths due to
complication of pregnancy, child
birth or within 42 years of delivery
a given year
Refer book – k . park

6. CLASSIFICATION OF MATERNAL
MORTALITY:
Late maternal death : Complication of pregnancy or
childbirth can also lead to death beyond the 6 weeks
postpartum period .
An alternative concept to late maternal death
was included in ICD 10
1. Direct : Deaths resulting from obstetric complications in
pregnancy, labour and puerperium.
Exam: Thromboembolism , Haemorrhage , Ectopics ,
Sepsis, Amniotic Fluid embolism.
2. Indirect : Deaths resulting from previous existing disease
or disease that developed during pregnancy and which was
aggravated during pregnancy.
Cont ….

7. Direct and Indirect are also death occur more than 42 days
but less than one year after termination of pregnancy .
3. Pregnancy related death : A pregnancy related
death is the death of a women while pregnant or within 42
days of termination of pregnancy , irrespective causes of
death .
Exam: Epilepsy, Anemia, Cardiac disease,
Malaria, Hepatic and Renal failure .
Refer book – k . park

8. STATISTICAL MEASURE OF MATERNAL
MORTALITY:
1. Maternal mortality ratio
2. Maternal mortality rate
3. Adult lifetime risk of maternal death
4. The proportion of maternal deaths of women of reproductive
age.
5. ICD 10 has recommended that maternal deaths may be
disaggregated in to two groups
6. Direct obstetric death
7. Indirect obstetric death Refer book – k . park

9. APPROACHES TO MEASURE MATERNAL
MORTALITY:
i. Civil Registration system: Routine registration of birth
and death .
ii. Household Survey: Where civil registration data are not available.
iii. Sisterhood Methods: Interviewing a representative
sample of respondents about the survival of all their adult sister.
iv. Reproductive age mortality studies: Use triangulation of
different sours of data on death of women of reproductive age group
coupled with record review .
cont…

10. And verbal autopsy to identify maternal death.
v. Verbal Autopsy: Used to assign cause of death through
interview with family or community member.
vi. Census: National census with addition of a limited
number of questions.
Refer book – k . park

11. 1. Obstetric Causes :
.Toxemia of pregnancy
. Hemorrhage
. Infection
. Obstruction Labour
. Unsafe abortion
2. Diseases :
. Anaemia and related diseases
. Cardiac disease
. Reenal and hepatic diseases
. Cancer
. Accidents
cont…
CAUSES OF MATERNAL MORTALITY:

12. 3. Social and other causes :
. Early and late pregnancy
. Multipara
. Lesser period between the
pregnancies, carelessness, unclear
environment , poverty, illiteracy etc.
. Misconception to childbirth
e.g desire for son , social customs etc.
. Pregnant mothers suffering from
malnutrition .
cont…

13. . Delivery by untrained Dais (TBAS)
etc.
. Insufficient number of health centers
and personnel .
. Lack of proper maternal services
. Shortage of equipment and other
resources at mother and child health
centers.
Refer book – keshav swarnkar

14. Maternal mortality is considered a key health indicator and the
direct causes of maternal deaths are well known and largely
preventable and treatable.
The major complications that account for nearly two-thirds of all
maternal deaths are severe bleeding (mostly bleeding after childbirth),
infections (usually after childbirth), high blood pressure during pregnancy
(pre-eclampsia and eclampsia), complications from delivery and unsafe
abortions.
Maternal Mortality Ratio(MMR) of India for the period 2016-18, as per
the latest report of the national Sample Registration system (SRS) data is
113/100,000 live births, declining by 17 points, from 130/ 100,000 live
births in 2014-16.
This translates to 2,500 additional mothers saved annually in 2018 as
compared to 2016. Total estimated annual maternal deaths declined from
33800 maternal deaths in 2016 to 26437 deaths in 2018.

15. The Government of India has been focusing on initiatives to improve
maternal health indicators. Much progress has been made in ending
preventable maternal deaths in the past two decades: Globally the number
of women and girls who die each year due to issues related to pregnancy
and childbirth has dropped considerably, from 451,000 in 2000 to
295,000 in 2017, a 38 per cent decrease.
UNICEF works with the Ministry of Health and Family Welfare
(MoHFW), Ministry of Women and Child Development (MWCD),
NITI Aayog and state governments to support planning, budgeting,
policy formulation, capacity building, monitoring, and demand
generation. It supports the capacities of health managers and supervisors
at district and block-level to plan, implement, monitor and supervise
effective maternal health care services with a focus on high-risk pregnant
women and those in hard-to-reach, vulnerable and socially
disadvantaged communities. UNICEF supports the implementation of
various interventions by Government of India, including:

16. 1. Reaching every mother
2. Antenatal care
3. The Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA)
4. Janani Shishu Suraksha Karyakaram (JSSK)
Reference to
https://www.unicef.org/india/what-we-
do/maternal-health

17. PREVENTION AND SOCIAL
MEASURES OF MMR:
1. Early registration of pregnancy .
2. At least three antenatal check-up.
3. Dietary supplementation, including correction of anaemia.
4. Identifying the risk group mothers at the earliest.
5. Treatment of medical conditions eg. Hypertension,
Diabetes, Tuberculosis etc.
6. Prevention of infection and haemorrhage during
puerperium .
cont…

18. 7. Prevention of complications, eg. Eclampsia ,
Malpresentation , Ruptured uterus .
8. Anti-malaria and Tetanus prophylaxis clean delivery
practice in India .
9. Making arrangements for clean and hygienic delivery,
training of TBAs .
10. Promotion of family planning to control the number of
children to not more than two and spacing of birth.
11. Identification of every maternal death and searching for
its cause.
cont…

19. 9. Education the mother herself and the family members
about maternal health.
10. Making efforts to improve the social and economic level
of community.
Refer book – k . park

20. 1. Gulani k k . Community Heath Nursing . 2nd
Edition . Delhi : Kumar Publication House .
2013. Page No – 276-277
2. Park k . Park’s Text Book of Preventive and
Social Medicine . 22nd Edition. Jabalpur : M/S
Banarsidas Bhanot Publication . 2013. Page No –
516-520
3. Swarnkar k. Community Health Nursing. 2nd
Edition. Indore: N.R. Brothers Publication.2006.
Page No – 93-95
Bibliography :