- There is reason to celebrate the drop of India’s maternal mortality rate: the decline is consistent and continuous, indicating that the reproductive health of India’s women is getting better.
- However, a closer look at the state-level MMR data reveals that the all-India three-year average of maternal deaths camouflages the performance of some states.
- We can predict that the Empowered Action Group states and Assam will have to redouble their efforts if India is to meet the 2030 target of an MMR lower than 70.
There is reason to celebrate the drop of India’s maternal mortality rate (MMR) to 113. This decline is consistent and continuous, indicating that the reproductive health of India’s women is getting better.
However, a closer look at the state-level MMR data reveals that the all-India three-year average of maternal deaths (113) camouflages the performance of some states. A few states have performed exceedingly well and pulled their MMR down much below the UN Sustainable Development Goal of fewer than 70 deaths per one lakh live births in a year. These states are Kerala (43), Maharashtra (46), Telangana (63), Andhra Pradesh (65) and Tamil Nadu (60). Four of these states are in the south.
Jharkhand (71) is very close to joining these four. Its case is unique: its performance stands in stark contrast to its three neighbouring states of Bihar, Odisha and West Bengal. The fifth National Family Health Survey (NFHS) data showed that although the state doesn’t do a good job of schooling its girl children as compared to its three neighbours, it is still able to provide 10 or more years of schooling to 33.2% of women – which is the highest among these four states.
There is no gainsaying that the longer the girls remain in school, the more likely they will marry late and have fewer children.
In addition, along with Bihar, Jharkhand has drastically reduced the percentage of women aged 20-24 years who marry before the age of 18. The state has also reduced the more intractable under-5 infant mortality rate by 39 points (Odisha did even better, reducing this figure by 43%).
Antenatal care (ANC) registration is an important indicator of maternal health. Ideally, registration for ANC should happen in the first trimester of a pregnancy. This was not so for a long time, largely because women were reluctant to announce their pregnancy so early. However, improvements in the quality of service, safety, the involvement of ASHA workers and multiple government schemes in support of expecting women have changed the situation.
In India, ANC registration has risen consistently in the last few years. According to the data put together in NFHS-5 (2019-2021), the percentage of mothers who had an antenatal check-up in the first trimester improved from almost 59% in NFHS-4 (2015-2016) to 70%.
Overall, the decline in maternal mortality rate is part of the decline of an array of interrelated demographic factors, including, notably, the fertility rate, the birth rate, the infant mortality rate and the population growth rate. At the same time, the rate of institutional deliveries as well as the country’s average life expectancy have been rising.
Second, the decline in MMR in India is also part of a world-wide phenomenon. According to the WHO, the global MMR has fallen substantially, from 342 in 2000 to 211 in 2017; maternal deaths in this period fell from 4.51 lakh to 2.95 lakh. India alone accounted for about 40% of this absolute decline.
India’s performance is laudable, no doubt, but it also has a long way to go before it can seek any international recognition of its own. According to a WHO report that recorded trends in maternal mortality between 1990 and 2015, 10 countries account for nearly 59% of maternal deaths worldwide. Of these, two – Nigeria (58,000) and India (45,000) – account for more than a third of all estimated global maternal deaths in 2015.
India’s tally of maternal deaths is also greater than the combined tallies of Pakistan, Bangladesh, Indonesia and the Congo – these four countries being some of the remaining eight countries where such deaths are the highest.
Going ahead, India could pay attention to the fact that, according to a ‘Special Bulletin’ of the Sample Registration System (SRS), 2016-2018, the fraction of maternal deaths is the lowest among women older than 40 years of age and younger than 19 years. It is the highest among women aged 20-24 years and 25-29 years – 65%. After that, the percentage of maternal deaths continues to decline rather drastically as the age increases all the way to the 45-49 years group, among whom the rate is lowest (2%).
On the other hand, the percentage of deaths in each age group of non-maternal deaths is the reverse of maternal deaths. That is, while the percentage of maternal deaths decreases as the age increases, the percentage of non-maternal deaths increases as the age increases.
Second, recent SRS data also shows that the MMR per one lakh live births dropped by more than 70% from 398 in 1997-1998 to 113 in 2016-2018, with an average annual decline of 6.3%. If the same long-term trend were to continue for the next two years, we could estimate an MMR of 99 by 2020.
In this period, 1997-2020, about 13 lakh maternal deaths would have occurred. The Empowered Action Group states (Bihar, Chhattisgarh, Jharkhand, Madhya Pradesh, Odisha, Rajasthan, Uttar Pradesh and Uttarakhand) and Assam will then account for 9.52 lakh maternal deaths. These states will then have to redouble their efforts to match the performance of other states and help bring India’s MMR close to 70 by or before 2030.
Without this effort, India likely won’t meet the 2030 goal of 70 or fewer maternal deaths per lakh live births.
Pradeep Krishnatray is professor of marketing at ICFAI Business School, Hyderabad, and former director, Johns Hopkins Center for Communication Programs, New Delhi.