India has shown an impressive decline in the maternal mortality rate but not enough
Maternal mortality has remained a major challenge despite continuous efforts by the government under the Maternal and Child Health Programme. The maternal mortality ratio (MMR) records the number of maternal deaths per lakh of live births. The World Health Organisation estimates that India has seen a decline of 160 points — from 390 per 100,000 in 2000 to 230 per 100,000 in 2008.
India is among the few countries along with Nepal and Bangladesh to have shown an impressive rate of decline in the last decade. The improving trend is a reflection of increased general awareness and the success of schemes like Janani Suraksha Yojana that entitle all pregnant women delivering in public health institutions to free delivery. However, there is no denying the fact that maternal mortality in India continues to be alarmingly high when compared to countries like China, Brazil and so on. China, the only country with higher population than India, recorded an MMR of 38 in 2008, while Brazil’s MMR was estimated at 58. But with India’s MMR declining at a slow rate of six percentage point annually since 2000, the Millennium Development Goal (MDG) target of 109 per 100,000 live births by 2015 will remain out of reach.
The levels of maternal mortality vary greatly across states. The Sample Registration Survey that provides estimates of the MMR in India does so for only the major states. According to the latest results for 2007-09, the highest MMR has been reported from Assam with an alarmingly high ratio of 390 per 100,000. This is followed by the undivided state of Uttar Pradesh and Uttarakhand with the MMR at 359. (Click here for chart)
Rajasthan is another state where the MMR exceeds 300, while the three other states with MMRS higher than the all-India average are Odisha, the undivided state of Bihar and Jharkhand and the undivided state of Madhya Pradesh and Chhattisgarh. At the other end, the top three performers with the lowest MMRs are Kerala, Tamil Nadu and Maharashtra. In 2004-06, Kerala was the only state to have achieved the MDG target of 109 per 100,000, while Tamil Nadu and Maharashtra are new entrants, registering MMRs below 109 per 100,000. Andhra Pradesh, West Bengal and Gujarat are also relatively close to the MDG target.
It is encouraging to note that the decline in the MMR from 2004-06 to 2007-09 has been significant in the Empowered Action Group (EAG) states and Assam. The drop in MMRs in EAG states was almost 67 points compared to the all-India average of 42 points. The other three states with high MMRs also saw a notable decline in this period. West Bengal stands out as the only state that saw an increase in the MMR, albeit small.
Educating girls goes a long way in improving maternal health. Though several efforts have been made under the National Rural Health Mission to spread awareness and encourage institutional delivery, it is crucial to identify high-risk pregnancies and provide quality care that is accessible to all.
Does bureaucracy ever give up? Not really. Do public-private partnerships take off in delivering essential services? Not if the public partner ends ...