The document discusses maternal mortality and morbidity. It defines maternal mortality as the death of a woman during pregnancy or within 42 days of termination of pregnancy from any cause related to the pregnancy. The global maternal mortality ratio has declined but there remains a large gap between developing and developed countries. The five main causes of maternal death are hemorrhage, sepsis, unsafe abortion, hypertension, and obstructed labor. Maternal mortality can be prevented by increasing access to emergency obstetric care, safe abortion services, and improving health infrastructure in remote areas. Maternal morbidity refers to any illness or disability resulting from pregnancy and childbirth.

1. MATERNAL MORTALITY
MATERNAL MORBIDITY
Dr. Bishmitga Mallick
1

2. MATERNAL MORTALITY
 Death of a woman who is pregnant or within
42 days of termination of pregnancy,
irrespective of the site or duration of
pregnancy, from any cause related to or
aggravated by the pregnancy or its
management
2

3. INTERNATIONAL STATUS
The maternal mortality ratio in developing
countries in 2015 is 239 per 100 000 live
births versus 12 per 100 000 live births in
developed countries.
Between 1990 and 2015, maternal mortality
worldwide dropped by about 44%.
Between 2016 and 2030, as part of the
Sustainable Development Goals, the target is
to reduce the global maternal mortality ratio
to less than 70 per 100 000 live births.
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4. 4

5. 5

6. 6

7. By Dr Poonam Khetrapal Singh, WHO Regional
Director for South-East Asia WHO
commends India for its groundbreaking progress in recent years in reducing
the maternal mortality ratio (MMR) by 77%, from 556 per 100 000 live births
in 1990 to 130 per 100 000 live births in 2016. India’s present MMR is
below the Millennium Development Goal (MDG) target and puts the
country on track to achieve the Sustainable Development Goal (SDG)
target of an MMR below 70 by 2030.
Four key actions are responsible for India’s remarkable achievement.
First, India has made a concerted push to increase access to quality
maternal health services. Since 2005, coverage of essential maternal
health services has doubled, while the proportion of institutional deliveries in
public facilities has almost tripled, from 18% in 2005 to 52% in 2016
(including private facilities, institutional deliveries now stand at 79%).
Second, state-subsidized demand-side financing like the Janani Shishu
Suraksha Karyakram – which allows all pregnant women delivering in
public health institutions to free transport and no-expense delivery, including
caesarian section – has largely closed the urban-rural divide traditionally
seen in institutional births. Overall, 75% of rural births are now supervised,
as compared to 89% of urban deliveries.
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8. Third, India has put significant emphasis on mitigating the social determinants of
maternal health. Women in India are more literate than ever, with 68% now
able to read and write. They are also entering marriage at an older age, with just
27% now wedded before the age of 18. These factors alone have enabledIndian
women to better control their reproductive lives and make decisions that reflect
their own interests and wants.
Finally, the governmenthas put in substantive efforts to facilitate positive
engagement between public and private health care providers. Campaigns
such as the Pradhan Mantri Surakshit Matritva Abhiyan have been introduced
with great impact, allowing women access to antenatal check-ups, obstetric
gynecologists and to track high-risk pregnancies – exactly what is needed to
make further gains and achieve the SDG targets.
India’s achievements are already having wide-ranging human impact, and are of
immense inspiration to WHO Member States, both in the Region and beyond. As
per WHO South-East Asia’s Flagship Priority of advancing maternal, newborn,
child and adolescent health, the Organization will continue to provide technical
and operational support as and where needed in India and across the Region to
end preventable deaths due to pregnancy and childbirth and to ensure every
woman has full control over her reproductive life.
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9.  MATERNAL MORTALITY- IT’S CAUSES
1. DIRECT
2. INDIRECT
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10. DIRECT OBSTETRIC CAUSES
 The deaths resulting from obstetric
complications of the pregnant state
(pregnancy, labour and the puerperium), from
interventions, omissions, or incorrect
treatment, or from a chain of events resulting
from any of the above are called direct
obstetric deaths.
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11. Indirect obstetric causes
 Those resulting from previous existing disease or
disease that developed during pregnancy and that
was not due to direct obstetric causes but was
aggravated by the physiological effects of
pregnancy.
1. Anemia
2. Cardiac disease
3. Diabetes
4. Thyroid disorders
5. Viral hepatitis etc.
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12. Late maternal death Late maternal is
death of a woman from direct or indirect
obstetric causes, more than 42 days but less
than one year, after termination of pregnancy.
Pregnancy related death defined as : the
death of a woman while pregnant or within 42
days of termination of pregnancy, irrespective
of the cause of death.
To facilitate the identification of maternal death in
circumstances in which cause of death attribution is
inadequate, ICD-10 introduced a new category, that
of “pregnancy-related death
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13. MEASUREMENT OF MATERNAL
MORTALITY
 There are three main measures of maternal
mortality-
1. maternal mortality ratio
2. maternal mortality rate
3. lifetime risk of maternal death.
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14. MATERNAL MORTALITY
RATIO
 This represents the risk associated with each
pregnancy, i.e. the obstetric risk.
 It is calculated as the number of maternal
deaths during a given year per 100,000 live
births during the same period. This is usually
referred to as rate though it is a ratio.
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15. The appropriate denominator for the maternal
mortality ratio would be the total number of
pregnancies (live births, fetal deaths or stillbirths,
induced and spontaneous abortions, ectopic and
molar pregnancies).
However, this figure is seldom available and thus
number of live births is used as the denominator. In
countries where maternal mortality is high
denominator used is per 1000 live births but as this
indicator is reduced with better services, the
denominator used is per 1,00,000 live births to avoid
figure in decimals.
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16. MATERNAL MORTALITY RATE
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 It is calculated as number of maternal deaths
in a given period per 100000 women of
reproductive age (15-49yrs).
 It measures both the obstetric risk and the
frequency with which women are exposed to
this risk.

17. RESPONSIBLE FACTORS
 Delay in seeking care
 Delay in transport to appropriate health facility
 Delay in provision of adequate care
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18. FIVE MAJOR
CAUSES
1.Hemorrhage
2.Anemia
3.Sepsis
4.Eclampsia
5.Obstructed labour
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19. 19
CAUSES PERCENTAGE PROVEN
INTERVENTIONS
HEMORRHAGE 20-25% Treat anemia
Skilled birth attendant
Oxytocics
Replace fluid loss
Blood transfusion
Infection 15-30% Skilled birth attendant
Clean practices
Antibiotics
Hypertension in
pregnancy
12-15% Early detection
Appropriate referral
Antiseizure prophylaxis
like MGSO4
Unsafe abortion Skilled birth attendant
Access to family
planning and safe
abortion
Antibiotics
Obstructed labour 8% Partograph
Early referral and CS
Anemia 15-20% IFA, Antihelminths

20. UNDERLYING CAUSES
 Marriage and childbirth at an early age.
 Lack of access to Emergency Obstetric Care
(EmOC).
 Inadequate nutrition
 Due to six medical causesHemorrhage, sepsis,
unsafe abortion, obstructed labour, eclampsia, pre-
existing anemia, malaria
 Absence of skilled personnel at delivery
 Short birth intervals- 30% births at < 24 months
interval
 High parity- 25% births in parity 4 or more
 Lack of blood transfusion facilities in rural areas
 Lack of support from men and family
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21. IMPACT OF MATERNAL
DEATH
 Children who lost their mothers are more
likely to die within two years of maternal death
 10 times the chance of death for the neonate
 7 times the chance of death for infants older
than one month
 3 times the chance of death for children 1 to5
years
 Enrolment in school for younger children is
delayed and older children often leave school
to support their family
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22.  ARE THESE CAUSES PREVENTABLE?
 YES
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23. 1. HEALTH EDUCATION
 Age at marriage
 Utilization of RCH services
 Prevention and treatment of anemia
 Awareness of antenatal care
 Nutritional education
 Importance of Immunization
 Spacing / Limitation of births
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24. 2.SAFE ABORTION SERVICES
Prevention of unwanted pregnancy and unsafe abortion.
Post abortion care with proper confentiality.
3. IMPROVING THE
INFRASTRUCTURE
 Provision of RCH services at remote rural
areas / urban slums
 Improved staffing
 Facilities for Essential / Emergency obstetric
care
 Training of birth attendants
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25. 4.HEALTH CARE DELIVERY
 Emergency management of APH/PPH/Eclampsia
/ Third stage complications at PHC level
 Early referral
 Eshtablishment of FRUs and availability of
caesarean section in peripheral hospitals
 Decentralisation of healthcare to make them
available to all women
 100% assisted delivery by a trained birth
attendant
 Flying squad services
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26. NON HEALTH STRATEGIES
 Poverty eradication
 Improvement of literacy
 Women’s empowerment measures
 Improved communications
 Improved transport facilities
 Regular health eduction programme among
service providers, acceptors and community.
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27. INITIATIVES TAKEN IN INDIA
 FP program – 1952
 MTP Act -1971
 Family welfare -1977
 CSSM -1992
 RCH
 NHM
 JSY
 radhan Mantri Surakshit Matritva Abhiyan
&Vandemataram scheme
 EmOC
 EOC
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28. ESSENTIAL OBSTETRIC
CARE
 Registration of pregnancy in the first 12- 16
wks
 At least 3 prenatal check ups
 Assistance during delivery.( Skilled Birth
Attendant)
 At least 3 postnatal check ups.
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29. EMERGENCY OBSTETRIC
CARE
 A total of 1748 FRUs - provisioning of drug kits, laparoscope,
blood transfusion and employing contractual staff like
PHN/ANM/Lab Asst and anaesthesiologist.
 24 Hour Delivery Services at PHCs/CHCs For this doctor
could be paid Rs 200/- per delivery & other staff could be
hired on contractual basis.
 Referral Transport to Indigent Families through Panchayats
In category C districts of eight weakly performing states,
issue addressed by providing financial assistance to
Panchayats through District Family Welfare Officers.
 Blood Supply available in FRUs/PHCs
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30. MATERNAL MORBIDITY
 Maternal Morbidity: Maternal morbidity can be
conceptualized as a spectrum ranging, at its
most severe, from a “maternal near miss” –
defined by the World Health Organization
(WHO) as the near death of a woman who has
survived a complication occurring during
pregnancy or childbirth or within 42 days of the
termination of pregnancy – to non-life-
threatening morbidity, which is more common
by far.
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31. MATERNAL MORBIDITY
CONT...
 It refers any physical or mental illness or
disability directly related to pregnancy and/or
child birth.
 Acute maternal morbidities.
 Postpartum maternal morbidities and
disabilities.
 Chronic morbidities
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32. ACUTE MATERNAL
MORBIDITIES
 Obstetric complications
 Maternal complications
 Absolute maternal indications’ (AMIs)
 Severe acute maternal morbidities’ (SAMMs)
 Near-miss’
 Other acute problems
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33. POSTPARTUM MATERNAL
MORBIDITY
 Postpartum maternal morbidities and
disabilities • Postpartum maternal morbidities
and disabilities are the long-term physical or
mental consequences resulting from
pregnancy, childbirth, acute maternal
morbidities, or the management thereof, and
most often referred to as long-term chronic
morbidities and other problems experienced
postpartum
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34. CHRONIC MORBIDITY
 • Chronic morbidities are conditions caused by
the birthing process and are not life-
threatening but greatly impair the quality of life,
such as fistula, uterine prolapse, and
dyspareunia.
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35. -
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