Maternal Mortality Ratio (MMR) is defined as the number of maternal deaths during a given time per 1,00,000 live births during the same time. A maternal death is “the death of a woman from direct or indirect obstetric causes, more than 42 days but less than one year after termination of pregnancy”. India’s MMR has dropped by ten points.

From 113 in 2016-18 to 103 in 2017-19, it has decreased (8.8 percent decline). The MMR had been steadily decreasing throughout the country, from 130 in 2014-2016 to 122 in 2015-17, 113 in 2016-18, and 103 in 2017-19.

Causes for increase in MMR

• Maternal mortality is an indicator of a region’s women’s reproductive health.
• Severe bleeding, infections, high blood pressure throughout pregnancy, anaemia, delivery problems, and unsafe abortions are the leading causes of maternal death, according to the United Nations Children’s Fund (UNICEF).
• Child marriage, which is still practised in certain regions of India despite being deemed illegal, worsens pregnancy-related difficulties in young females.
• Pregnancy between the ages of 15 and 19, while the teenage females are still growing, can result in a variety of difficulties, including the mother’s death.
• These issues are the result of a combination of social, cultural, and medical factors.
• A lot of these problems may be solved with the right medical help, which isn’t always simple to come by.
• Other factors that contribute to maternal fatalities include a lack of required medical treatment during childbirth or financial restraints.

Initiatives by government to reduce MMR

• Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA) provides a regular day for pregnant women to get free, comprehensive, and high-quality prenatal care.
• The National Health Mission’s Janani Suraksha Yojana aims to link monetary support to institutional delivery.
• Pradhan Mantri Matru Vandana Yojana
• LaQshya guidelines
• Poshan Abhiyan
• Anmol app
• Anaemia Mukt Bharat (AMB)
• Surakshit Matratva Ashwasan (SUMAN)

Challenges

• Data discrepancies: Data quality issues are common, especially when it comes to underreporting and misclassification of maternal fatalities. This creates an inaccurate image, sometimes exaggerating or underestimating MMR.
• Doctors, nurses, and other skilled workers are in limited supply, particularly in rural areas. This makes it difficult to keep track of women and send them to emergency obstetric treatment when issues arise.
• Economic constraints: According to the Tendulkar committee, over 22% of Indians live in poverty. Poor women do not have access to proper nutrition throughout pregnancy, which leads to difficulties.
• Lack of Infrastructure: In tier 3 cities and villages, the quality of healthcare infrastructure is poor in various areas. Ultrasound machines, diagnostic labs, and other state-of-the-art technological equipment and resources are not available in healthcare institutions. This makes it difficult for women to receive high-quality maternity care.
• Social Evils: Child marriage is still highly common in India, resulting in early pregnancy that many young girls are unable to handle, culminating in their deaths. Similarly, the desire to have a certain number of male offspring leads to an increase in pregnancy cycles, even in old age, which has a negative influence on mother health.
• Knowledge Gap: The great majority of the population still lives in rural regions, and their lack of education leads them to place more confidence in traditional midwives (birth attendants or dais) than in contemporary healthcare.

Innovative Measures

• Over the years, the government has used data from the Maternal Death Surveillance and Response (MDSR) to plan and implement corrective actions to minimise maternal death in India.
• MMR in India may be greatly reduced by improving and building healthcare facilities in rural and remote locations.
• Data collecting is a systematic process that begins at the block level and progresses to districts and states. The Indian government has devised a sophisticated method for analysing the information gathered.
• To include the government, NGOs, and IMA in a public awareness campaign on reproductive health care and the harmful impacts of drugs, smoking, and drinking in schools, colleges, and religious settings.
• To enlist the help of health-care professionals to conduct community studies, household surveys, and other measurements, as well as reproductive-age mortality surveys.
• It is critical to enlist the help of an obstetrician, a midwife, and paramedical workers to identify and treat any pregnancy issues.
• Based on the prevalence of maternal fatalities, states were divided into three groups: high MMR, moderately high MMR, and low MMR.Different rules have been put in place by the government to lower MMR in these specific populations.
• Because many women are unable to access sufficient healthcare facilities owing to cultural norms or societal taboos, raising public knowledge is also a vital step in reducing maternal mortality.
• Early intervention and prevention should be implemented:
  • To safeguard against child and adolescent health problems.
  • Preventing pregnancy problems via early identification and treatment.
  • To provide in a clean and safe manner.
  • To encourage people to use family planning services.
  • Early detection of post-reproductive illness prediction.
  • Institutional delivery is encouraged.

https://www.thehindu.com/news/national/explained-what-are-the-major-causes-of-maternal-mortality/article65237100.ece

How to structure

1. Give an intro about MMR and give data related to it
2. Discuss the major causes of MMR
3. Mention the government initiatives related to it
4. Mention the challenges faced
5. Suggest innovative measures
6. Conclude