India's Maternal Mortality Ratio dips to 97 in 2018-20 from 130 in 2014-16

Many women of reproductive age die due to complications during and following pregnancy and childbirth or abortion

India’s maternal mortality ratio has dropped below 100 for the first time with eight large states including Karnataka already achieving a target set by the United Nations as a mark of improved health outcomes for the developing world.

The Registrar General of India on Tuesday released its latest bulletin on MMR showing India’s maternal mortality ratio falling to 97 per 100,000 live births in 2018-20 from 103 in 2017-19.

Eight states including each of the five southern ones have reached the UN Sustainable Development Goal target of reaching an MMR of 70 per 100,000 births much before the 2030 deadline.

Karnataka has just made the cut with an MMR of 69 as against Andhra Pradesh (45), Telangana (43), Kerala (19) and Tamil Nadu (54). Other performing states are Jharkhand (54), Gujarat (57) and Maharashtra (33).

Maternal mortality - the death of a woman while pregnant or within 42 days of termination of pregnancy - is a measure of the reproductive health of women and is considered as a key health indicator because many women of reproductive age die due to pregnancy-related complications.

“The southern states are doing especially well. If we can reduce the disparities between states to accelerate the progress of those who are lagging, we can reach the SDG target of 70 even before 2030," said K Srinath Reddy, former president of the Public Health Foundation of India.

"The impact of ASHAs has been commendable in providing antenatal services. Increase in institutional deliveries, improvement in emergency medical transport and enhanced anaesthetic facilities in primary care settings have helped to improve maternal outcomes. It is a reminder that we must invest in strong primary healthcare systems.”

India's MMR was more than 400 in the early 1990s but declined to 398 in 1997 – nowhere close to the sub-100 target that was to be achieved by 2000. But with interventions designed under India’s first national health mission, the MMR’s downward trajectory continued.

"The National Rural Health Mission finally fulfilled its promise. The strategies that were put in place under the NRHM led to the success, even though it materialised 22 years after the original target,” T Sundararaman, former Executive Director of National Health Systems Resource Centre in New Delhi told DH.

"One of the most successful interventions was the introduction of community health workers, who triggered behavioural changes among women. Nearly 100% deliveries are now institutional, thanks to the workforce of one million ASHA workers,” he said.

The MMR figure slid down to 254 in 2006 and subsequently 212 in 2009 and 167 in 2013. It stood at 130 in 2014-16 when the Narendra Modi government came to power and continued its southern movement recording an MMR of 122 in 2015-17; 113 in 2016-18 and 103 in 2017-19.

However, despite the drop, the numbers are still large in 11 states with Assam (195), Madhya Pradesh (173), Uttar Pradesh (167), Chhattisgarh (137) and Bihar (118) being the worst performers.

According to the World Health Organisation, the seeds of the change were sown in the last decade as coverage of essential maternal health services doubled, while the proportion of institutional deliveries in public facilities almost tripled, from 18% in 2005 to 52% in 2016 (including private facilities, institutional deliveries now stand at 79 per cent),” the WHO noted in a 2018 report.