New Delhi: A new study released by medical journal, The Lancet,and funded by the Gates Foundation reports that, maternal deaths worldwide have plummeted over the last 20 years, going from 526,300 in 1980 to approximately 342,900 in 2008.
“The overall message, for the first time in a generation, is one of persistent and welcome progress,” writes Richard Horton, the journal’s editor.
Six countries accounted for more than half of the world’s maternal deaths in 2008: India, Nigeria, Pakistan, Afghanistan, Ethiopia and the Democratic Republic of Congo. However the report also says that from 1990—2008, countries with substantial declines in their Maternal Mortality Ratio (MMR) included Egypt, Romania, Bangladesh, India, and China.
While in 1980, India had the largest number of maternal deaths of any country, the study finds that India has made progress: there were 408 to 1,080 maternal deaths per 100,000 live births in 1980, and by 2008, there were 154 to 395. One significant reason the authors point to is the increase in the number of skilled attendants at birth.
Dr Sanghita. K. Bhattacharyya, a specialist at the Public Health Foundation of India (PHFI) who focuses on maternal health, points to the centrally sponsored Janani Suraksha Yojana (JSY) program as being heavily instrumental in increasing institutional deliveries and hence increasing the number of skilled attendants present at birth. The JSY provides a monetary incentive to both the mother and the Accredited Social Health Activist (ASHA) in order to encourage institutional deliveries.
However Dr Bhattacharyya points out that the flip side of the rising popularity of institutional deliveries is that many hospitals, particularly district level institutions, are unable to handle the increased demand. “The demand for institutional deliveries has increase three to four times, but human resources have not increased comparably,” she says. “The quality of care is suffering because of this and women who give birth often have to lie on the floor or leave the hospital very soon after they deliver, due to overcrowding.”
The authors of the study also point to the fact that India has several data sources available to estimate maternal mortality and that there are “substantial inconsistencies” between these. The authors used national sources with “the least apparent bias” – these being the sample registration system, the National Family Health Surveys (NFHS rounds 1 and 2), and the District Level Household Surveys (DLHS rounds 2 and 3). “Together, these sources suggested a substantial decrease in maternal mortality,” they write.
While the substantial decrease in India’s MMR is of course cause to rejoice, the reality is that various states in the country have seen vastly varying levels of improvement. States like Assam, Bihar/Jharkand, Orissa, Uttar Pradesh and Madhya Pradesh have much higher MMRs than Karnataka, Kerala, Tamil Nadu, Andhra Pradesh, Gujarata, Haryana, West Bengal, Maharashtra and Punjab.