Data: SRS Bulletin Highlights the Wide Variation of MMR Across States, Assam’s MMR 10 Times That of Kerala’s.
Sai Krishna Muthyanolla
December 9, 2022
The Registrar General of India (RGI) recently released the annual Special Bulletin on Maternal Mortality in India for the period 2018-2020. At the national level, the MMR has dropped from 103 during 2017-19 to 97 during 2018-20. However, there are wide variations across state. Assam’s MMR is 10 times that of Kerala’s.
Maternal mortality reflects the capacity of health systems to effectively prevent and address the complications occurring during pregnancy and childbirth. Apart from being used as a measure of the quality and access to the health care system, maternal mortality-related indicators also reflect the state of nutrition, health, and empowerment of women. Recently, the Registrar General of India (RGI) released the annual Special Bulletin on Maternal Mortality in India for the period 2018-2020. The report is based on RGI’s Sample Registration System (SRS) which is one of India’s largest demographic sample surveys. The survey takes into account a nationally representative sample for providing direct estimates of maternal mortality in the country. As maternal deaths are considered a rare event, the estimates have been calculated by pooling in the data for three years.
The World Health Organization (WHO) defines maternal death as the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes. The maternal Mortality Ratio (MMR) is defined as the number of maternal deaths during a given time period per 100,000 live births during the same time period.
MMR has dropped significantly since independence
As per the Central government’s Health Survey and Development Committee report of 1946, popularly known as the Bhore Committee report, the MMR in the country was around 20 deaths per thousand live births or 2,000 deaths per 100,000 livebirths in the mid-1940s before India became an independent country. According to the Health Survey and Planning Committee’s report headed by L Mudaliar, India’s MMR decreased to 10 per thousand live births or 1000 per 100,000 live births in 1959. After nearly three decades, in 1990, India’s MMR was 556. Approximately, 1.38 lakh women died every year due to complications related to pregnancy and childbirth back then. This improvement may be attributed to the overall improvement in access to healthcare such as institutional births, pre-ante-natal care, education, and other factors which have also improved over the years.
India has achieved the NHP target of MMR
In the recent years, India has made considerable progress in reducing MMR. From 327 in 1999-01, there has been a gradual decline in the MMR over the last two decades, according to the SRS’s data on maternal mortality. It should be noted that the years for which the ratio has been published are not continuous. The MMR dropped by 230 points between 1999-01 and 2018-20 recording a decrease of more than 70% in 20 years. In 2018-20, the MMR dropped below 100 for the first time. With this, India has achieved the National Health Policy (NHP)’s target for MMR of less than 100 per lakh live births. India’s next target would be to achieve the Sustainable Development Goal (SDG)’s target of MMR less than 70 per lakh live births by 2030.
High Variance of MMR across states
While the NHP target has been achieved at the national level, MMR at the state level is vastly different. Assam’s MMR (195) was more than ten times that of Kerala (19), in 2018-20. It must be noted that the report categorizes states into three groups to understand the maternal mortality situation in the country better. These are:
The report presents data only for major states. The value for smaller states and UTs is clubbed together.
Southern states have achieved SDG target already while some states are far above the national average
The MMR was the highest in Assam with 195, followed by Madhya Pradesh and Uttar Pradesh with 173 and 167 respectively. These values are comparable with the national MMR over a decade ago. In 2018-20, eight states had achieved the SDG target- Kerala (19), Maharashtra (33), Telangana (43), Andhra Pradesh (45), Tamil Nadu (54), Jharkhand (56), Gujarat (57) and Karnataka (69) with MMR less than 70. All the southern states have achieved the SDG target. Unlike its neighbouring states, Jharkhand had a low MMR, lower than that of even Karnataka. The MMR was 77 for smaller states and UTs and was above 100 in all the remaining major states. Meanwhile, the MMR in Haryana, Madhya Pradesh, and Uttarakhand has increased in 2018-20 as compared to the previous survey in 2017-19.
MMR in Haryana, West Bengal, and Uttarakhand has increased in the last few years
The trend in MMR across the major states reveals that there has been significant improvement in MMR across all the states in the last two decades. The MMR in Rajasthan and Uttar Pradesh has dropped by nearly 400 points while that in Odisha has fallen by more than 300 points. In Assam, Bihar, and Madhya Pradesh, the MMR had fallen by over 200 points. However, in terms of percentage drop in MMR, the improvement has been the best in Kerala by 87% from 149 in 1999-01 to 19 in 2018-20 followed by Maharashtra with 80% (169 in 1999-01 to 33 in 2018-20).
Kerala was the first state to record a two-digit MMR with 95 in 2004-05 followed by Tamil Nadu with 97 in 2007-09. Kerala had already achieved the SDG target set for 2030 even before the goals came into force. By 2015-17, Andhra Pradesh, Gujarat, Haryana, Jharkhand, Karnataka, Maharashtra, Tamil Nadu, Telangana, Uttarakhand, West Bengal, and ‘Others’ had also registered MMR below 100 in 2015-17. However, the MMR in West Bengal, Uttarakhand, and Haryana has increased since then and crossed 100 again by 2018-20.
India would achieve SDG target before 2030, but not all states will
At the current rate of progress, India might reach the SDG target of 70 deaths per lakh live births before 2030. However, this need not be the case across all the states. States like Assam, Madhya Pradesh, and Uttar Pradesh are still over a decade behind with respect to the status of MMR compared to the national average. Studies have also highlighted how the pandemic resulted in increased maternal mortality and stillbirth, maternal stress, and ruptured ectopic pregnancies due to the inability of healthcare systems to cope.
Numerous measures are being implemented to bring down the MMR. These include schemes and outreach programs such as Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA), Pradhan Mantri Matru Vandana Yojana (PMMVY), Labour Room Quality Improvement Initiative (LaQshya), Janani Suraksha Yojana (JSY), Surakshit Matratva Ashwasan (SUMAN), etc. which provide awareness, financial assistance, nutrition, and healthcare to pregnant women. India also has Maternal Death Surveillance Review (MDSR) which is implemented both at facilities and at the community level to identify and study the causes and other factors contributing to maternal death. Through this, targeted interventions may be rolled out to address the issue.
It is evident from the data that some states will have to put in double the effort to achieve the SDG target before 2030.
Featured Image: Maternal Mortality in India