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| Wednesday, 20 September 2006 05:30 | |||
The maternal mortality rate (MMR), defined as the number of maternal deaths per 1 lakh live births, has been estimated at 540 by the WHO, much higher than other developing countries
Every year in India, a large number of women die due to various obstetric or pregnancy related reasons. The WHO estimates that in 2000, India led the world in the estimated number of maternal deaths at 1.36 lakh. The maternal mortality rate (MMR), defined as the number of maternal deaths per 1 lakh live births, has been estimated at 540 by the WHO, much higher than other developing countries — MMRs in Sri Lanka and China are just 60. The main reasons behind this high rate lies in the widespread prevalence of anaemia, lack of trained assistance during delivery and inadequate facilities at the place of delivery. Reduction of maternal mortality is one of the Millennium Development Goals and our government has been conducting various programs, along with other organisations, to achieve the target. However, without precise and reliable data on maternal deaths, it is difficult to assess the extent of reduction. One of the accepted statistics to track changes in maternal mortality levels is the “proportion of births attended to by skilled health personnel”, which has been declared the most relevant indicator showing a high correlation with reduction in maternal mortality. Currently, only 42.5 per cent of births in India are attended to by skilled personnel, a far cry from the UN target of 85 per cent to be achieved by 2010. There are significant rural-urban disparities — according to the Reproductive and Child Health Survey (RCHS) of 2003-04, the percentage of live births wherein the mother received trained assistance from health professionals during delivery was just 35.6 per cent for rural and 69.6 per cent for urban areas. Similarly, 28 per cent of rural deliveries take place in hospitals, compared to 61 per cent in urban areas. But this is not all. The RCHS data reveals significant inequity in delivery care across economic classes in both rural and urban areas. About 66 per cent of the deliveries in the richest rural households received trained assistance whereas just about 18 per cent deliveries in the poorest households had trained support. In urban areas, there is a difference of 45 percentage points between the poorest and richest economic quintiles. The rural-urban divide is evident as the poorest of urban households have better access to facilities than the second highest quintile of rural households. Again, looking at the percentage of deliveries taking place in hospitals, the economic status of the household has considerable impact. Comparing the richest and the poorest economic groups, the difference is much starker in urban India compared to rural India. It is evident that income stands out as one of the most important determinants of access to trained assistance during deliveries. Especially in urban areas, where there can be no excuse for inadequacy of infrastructure and staff, such a large percentage of deliveries not getting trained assistance and essential obstetric care is glaring. At the same time, the large divergence between levels of assistance in urban and rural India point to a systemic failure in providing facilities to the vast majority of the population. Deficient infrastructure facilities and staff in primary health care centres is just one aspect of the problem. It is extremely crucial for planners and policy-makers to understand these issues of unequal access and work towards implementing a system which will give the process of birth the dignity and attention it deserves. The author is Senior Analyst at Indicus Analytics and can be contacted at
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