The document discusses maternal mortality ratio (MMR) and related indicators of maternal and child health. MMR is defined as the number of maternal deaths during a time period per 100,000 live births during the same period. It discusses direct and indirect causes of maternal death according to WHO definitions. The document also outlines approaches for measuring maternal mortality and lists determinants of maternal mortality in India such as medical causes, social factors, and strategies for prevention.

1. MMR
(Maternal
Mortality Ratio)
Dr Jaydeep Ghevariya
Resident Doctor
CM, BJMC, Ahmedabad.

2. Indicator of MCH
1. Maternal Mortality Ratio
2. Mortality in infancy and childhood
a) Perinatal mortality rate
b)Neonatal mortality rate
c) Post-neonatal mortality rate
d)Infant mortality rate
e) 1-4 year mortality rate
f) Under 5 mortality rate
g)Child survival rate

3. Maternal Mortality Ratio
•Number of maternal death during given time
period per 1,00,000 live births during the same
period.

4. Maternal Mortality Ratio
𝑀𝑎𝑡𝑒𝑟𝑛𝑎𝑙 𝐷𝑒𝑎𝑡ℎ 𝑖𝑛 𝑠𝑎𝑚𝑒 𝑦𝑒𝑎𝑟
𝑇𝑜𝑡𝑎𝑙 𝑙𝑖𝑣𝑒 𝑏𝑖𝑟𝑡ℎ 𝑖𝑛 𝑠𝑎𝑚𝑒 𝑦𝑒𝑎𝑟
∗ 1,00,000

5. Maternal Death (as perWHO)
• The death of women while pregnant or within 42 days
of termination of pregnancy, irrespective of duration
and site of pregnancy, from any cause related to or
aggravated by the pregnancy or its management but
not from unintentional or incidental causes.

6. Types of Maternal Death
• Direct
 Obstetric complications,
 Interventions,
 Incorrect treatment, or
 Chain of events resulting from all of the above
 Example: Obstetrics haemorrhage, complication of anaesthesia or CS etc.
• Indirect
 Previous existing disease,
 Disease that developed during pregnancy and which was not due to direct
obstetric cause but aggravated by physiological effect of pregnancy.
 Examples: death due to aggravated cardiac or renal disease.

7. OtherTerminology
• Late maternal death
• Comprehensive maternal deaths
• Pregnancy related deaths
• Maternal mortality rate (MMRate)
• Adult lifetime risk of maternal deaths
• Proportion of maternal deaths of women of
reproductive age

8. Late maternal death
• The death of women from the direct or indirect
causes after more than 42 days but less than
one year after termination of pregnancy.

9. Comprehensive maternal deaths
Maternal Deaths + late Maternal Deaths
As per ICD 11

10. Pregnancy related deaths
•The death of women while pregnant or
within 42 days of termination of pregnancy
irrespective of the cause of death

11. Maternal mortality rate (MMRate)
• Number of maternal deaths divided by 1 lakh women in
reproductive age in a population.

12. Adult lifetime risk of maternal deaths
• Probability that a 15 year old girl will eventually die
from maternal causes.
2017 data
 India = 290
 Pakistan = 140
 Japan = 16700
 Sub Saharan Africa = 37

13. Proportion of maternal deaths of women
of reproductive age (Proportion maternal; PM)
• Number of maternal deaths in given time period divided by
total deaths among the women age 15 to 49 years.

14. Approaches for measuring maternal
mortality
• Civil registration system
• Household survey
• Sisterhood method
• Reproductive age mortality study (RAMOS)
• Verbal autopsy
• Census

15. Severe
bleeding, 25%
Infection, 15%
Eclampsia, 12%
Obstructed
labour, 8%
Unsafe
abortion, 13%
Other direct
causes, 8%
Indirect causes,
20%
Causes of Maternal deaths - Worldwide

16. Hemorrhage,
38%
Sepsis , 11%
Hypertensive
disorders, 5%
Obstructed
labour, 5%
Abortion, 8%
Other condition,
34%
Causes of Maternal deaths – India (2003)

17. Determinants
of
maternal
mortality
in
India
Medical Causes Social Factors
Obstetric causes:
Toxaemia of pregnancy
Haemorrhage
Infection
Obstructed labour
Unsafe abortion
Age at childbirth
Parity
Birth interval
Family size
Malnutrition
Poverty
Illiteracy
Ignorance
Lack of maternity services
Shortage of health manpower
Delivery boy untrained dies
Over environmental sanitation
Poor communication and
transportation facility
Social custom etcetera
Non obstetric causes:
Anaemia
Associated disease e.g.,
cardiac, renal, hepatic,
metabolic
Malignancy

24. Prevention of Maternal Deaths
• Early registration of
pregnancy
• Internal check-up
• Dietary supplementation
• Correction of anaemia
• Postpartum prevention of
infection and haemorrhage
• Prevention of complication
• Treatment of medical
condition
• Tetanus and anti malaria
prophylaxis
• Clean delivery practices
• Train village level health
worker
• Institutional delivery
• Promotion of family planning
• Identification and searching
for cause of maternal death
• Safe abortion practices

25. LAQSHYA
Labour room quality
improvement
initiative

26. • Maternal Mortality Ratio
• Late maternal death
• Comprehensive maternal deaths
• Pregnancy related deaths
• Maternal mortality rate (MMRate)
• Adult lifetime risk of maternal deaths
• Proportion of maternal deaths of women of
reproductive age

27. Sustainable DevelopmentGoals and
Maternal Mortality
 Reducing the global MMR to less than 70
per 100 000 births by 2030.