• India has witnessed a significant improvement in key maternal and child health indicators between 2014 and 2021, reveals the Sample Registration System (SRS) Report 2021 released by the Registrar General of India (RGI).

• As per the Special Bulletin on Maternal Mortality in India (2019-21) based on the Sample Registration System (SRS), the Maternal Mortality Ratio (MMR) of the country has shown a marked reduction, declining by 37 points from 130 per lakh live births in 2014–16 to 93 in 2019–21.

• Similarly, the downward trend of child mortality indicators continued.

What is Maternal Mortality Ratio (MMR)?

• Maternal mortality in a region is a measure of the reproductive health of women in the area. Many women in reproductive age-span die due to complications during and following pregnancy and childbirth or abortion. 

• As per the World Health Organisation (WHO), “maternal death is the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes”.

• One of the key indicators of maternal mortality is the Maternal Mortality Ratio (MMR) which is defined as the number of maternal deaths during a given time period per 100,000 live births during the same time period. 

• The target 3.1 of Sustainable Development Goals (SDG) set by the United Nations aims at reducing the global maternal mortality ratio to less than 70 per 100,000 live births.

Sample Registration System (SRS)

• The Office of the Registrar General, India under the Ministry of Home Affairs, apart from conducting the Population Census and monitoring the implementation of the Registration of Births and Deaths Act in the country, has been giving estimates on fertility and mortality using the Sample Registration System (SRS). 

• SRS is one of the largest demographic sample surveys in the country that, among other indicators, provide direct estimates of maternal mortality through a nationally representative sample.

• The present bulletin provides the level of maternal mortality for the period 2019-2021. 

Key points of the report:

• The Infant Mortality Rate (IMR) has dropped from 39 per 1,000 live births in 2014 to 27 per 1,000 live births in 2021.

• The Neonatal Mortality Rate (NMR) has declined from 26 per 1,000 live births in 2014 to 19 per 1,000 live births in 2021. 

• Under-Five Mortality Rate (U5MR) has also improved, dropping from 45 in 2014 to 31 per 1,000 live births in 2021.

• The Sex Ratio at Birth also improved between 2014 and 2031, getting better from 899 to 913, respectively. 

• Total Fertility Rate is consistent at 2.0 in 2021, which is a notable progress from 2.3 in 2014.

• According to the SRS 2021 Report, eight states have already attained the Sustainable Development Goals (SDGs) target of MMR (less than or equal to 70 by 2030). 

• Kerala (20), Maharashtra (38), Telangana (45), Andhra Pradesh (46), Tamil Nadu (49), Jharkhand (51), Gujarat (53), and Karnataka (63) are among the top performers.

• As many as 12 states and UTs have attained SDG target of U5MR (less than 25 by 2030): Kerala (8), Delhi (14), Tamil Nadu (14), Jammu & Kashmir (16), Maharashtra (16), West Bengal (20), Karnataka (21), Punjab (22), Telangana (22), Himachal Pradesh (23), Andhra Pradesh (24) and Gujarat (24).

• Besides, six states and one UT have already attained the SDG target of NMR (less than 12 by 2030): Kerala (4), Delhi (8), Tamil Nadu (9), Maharashtra (11), Jammu & Kashmir (12) and Himachal Pradesh (12).

• Further, India’s progress in the reduction of maternal and child mortality indicators has outpaced global averages.

• As per the current United Nations Maternal Mortality Estimation Inter-agency Group (UN-MMEIG) Report 2000-2023, India’s MMR has reduced by 23 points from 2020 to 2023.

• By this achievement, MMR of India has now declined by 86 per cent compared to the global reduction of 48 per cent over the past 33 years from 1990 to 2023.

Govt interventions for improving Maternal Mortality Rate (MMR):

• Janani Suraksha Yojana (JSY), a demand promotion and conditional cash transfer scheme, was launched in April 2005 with the objective of reducing Maternal and Infant Mortality by promoting institutional delivery among pregnant women.

• The Pradhan Mantri Matru Vandana Yojana (Maternity Benefit Programme) is a direct benefit transfer (DBT) scheme under which cash benefits are provided to pregnant women in their bank account directly to meet enhanced nutritional needs and partially compensate for wage loss. Under PMMVY, a cash incentive of Rs 5,000 is provided in three instalments directly to the bank/post office account of pregnant women and lactating mothers for the first child in the family.

• Labour Room Quality Improvement Initiative (LaQshya), launched in 2017 aims to improve the quality of care in labour room and maternity operation theatres to ensure that pregnant women receive respectful and quality care during delivery and immediate post-partum period.

• Anaemia Mukt Bharat (AMB) strategy as a part of POSHAN Abhiyan aims to strengthen the existing mechanisms and foster newer strategies to tackle anaemia which include testing & treatment of anaemia in school going adolescents & pregnant women, addressing non nutritional causes of anaemia and a comprehensive communication strategy. The strategy is estimated to reach out to 450 million beneficiaries including 30 million pregnant women.

• Surakshit Matritva Aashwasan (SUMAN) aims to provide assured, dignified, respectful and quality healthcare at no cost and zero tolerance for denial of services for every woman and newborn visiting the public health facility to end all preventable maternal and newborn deaths.

• Janani Shishu Suraksha Karyakram (JSSK) aims to eliminate out-of-pocket expenses for pregnant women and sick infants by entitling them to free delivery including caesarean section, free transport, diagnostics, medicines, other consumables, diet and blood in public health institutions.

• Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA) provides pregnant women fixed day, free of cost assured and quality antenatal care on the ninth day of every month.

• Comprehensive Abortion Care services are strengthened through trainings of health care providers, supply of drugs, equipment, Information Education and Communication (IEC) etc.

• Midwifery programme is launched to create a cadre for nurse practitioners in midwifery who are skilled in accordance to International Confederation of Midwives (ICM) competencies and capable of providing compassionate women-centred, reproductive, maternal and new-born health care services.

• Over 25,000 ‘Delivery Points’ across the country are strengthened in terms of infrastructure, equipment, and trained manpower for provision of comprehensive Reproductive Maternal Newborn Child Adolescent Health Plus Nutrition (RMNCAH+N) services.

(The author is a trainer for Civil Services aspirants.)