**Maternal Mortality in India ** Current Status (2015-21)
- MMR (Maternal Mortality Ratio): 97 deaths per 1 lakh live births (declined from 130 in 2014-16).
- State-wise Variation:
- Lowest: Kerala (19), Maharashtra (33), Tamil Nadu (54)
- Highest: Assam (195), Madhya Pradesh (173), Uttar Pradesh (167)
Causes of Maternal Deaths
- Postpartum Hemorrhage (PPH): Leading cause (35% deaths) due to blood loss after delivery.
- Obstructed Labor: Malnourished mothers + stunted pelvis → fetal distress.
- Hypertensive Disorders: Eclampsia/pre-eclampsia (high BP complications).
- Sepsis: Infections from unsafe deliveries or abortions.
Three Delays Model (Columbia University)
| Delay | Issue | Solutions |
|---|---|---|
| 1. Decision-making | Family hesitance, lack of awareness | ASHA workers, financial incentives (Janani Suraksha Yojana) |
| 2. Transportation | Remote areas, poor ambulance access | 108 ambulance services (NHM) |
| 3. Hospital Care | Specialist shortages, blood bank gaps | Strengthen FRUs (First Referral Units) |
Government Initiatives
- National Health Mission (NHM):
- Janani Suraksha Yojana (JSY): Cash incentives for institutional deliveries.
- Janani Shishu Suraksha Karyakram (JSSK): Free delivery care, drugs, and transport.
- LaQshya Program: Quality improvement in labor rooms.
- SUMAN Initiative: Zero-cost maternal healthcare.
Challenges
- Human Resources: 66% specialist vacancies in CHCs.
- Infrastructure: Only 2,856 of 5,400 CHCs operate as FRUs.
- Anemia: 52% pregnant women anemic (NFHS-5).
Way Forward
- Kerala Model:
- Confidential Death Reviews to analyze each case.
- Advanced techniques: Uterine artery clamps, suction cannulas.
- EAG States Focus:
- Address anemia (iron-folic acid distribution).
- Increase institutional deliveries.
- Policy Actions:
- Mandatory maternal death audits under NHM.
- Expand 108 ambulance coverage.
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Case Study: Kerala’s MMR reduction (19 vs. national 97) through community health workers.
Optional Add-ons:
- GS-IV (Ethics): Equity in healthcare access.
- Global Comparison: Sri Lanka’s MMR (36) vs. India (97).