Maternal Mortality Ratio/Rate | Medical Science Optional Notes for UPSC PDF Download

Introduction

• Maternal Death: Maternal death refers to the death of a woman during pregnancy, childbirth, or within 42 days of termination of pregnancy (puerperal causes).
• Late Maternal Death: Late maternal death occurs between 42 days and one year after termination of pregnancy.
• Maternal Mortality Ratio (MMR): MMR is a key indicator that quantifies the number of maternal deaths per 1,000 (or 100,000) live births in a specific area during a given year.
  • Formula: MMR = (Total maternal deaths / Total live births) * 1000 (or 100,000)
• Maternal Mortality Rate (MMRate): MMRate is defined as the number of maternal deaths in a given period per 100,000 women of reproductive age during the same time period.

Approaches for Measuring MMR

• Civil Registration Systems: Uses official records of births and deaths.
• Household Survey: Gathers data through surveys conducted in households.
• Sisterhood Methods: Involves interviewing a representative sample of respondents about the survival of their adult sisters.
• RAMOS (Reproductive-Age Mortality Studies): Utilizes multiple sources of data to study reproductive-age mortality.
• Verbal Autopsy: Involves interviewing family or community members when medical certification of the cause of death is unavailable.
• Census: Includes population-wide data collection, which can be used to calculate maternal mortality indicators.

RHIME-SRS 

Overview

• Since 2000, the Sample Registration System (SRS) in India has incorporated a method called RHIME (Representative, Re-sampled, Routine, Household Interview of Mortality with Medical Evaluation).

RHIME Characteristics

• RHIME is an advanced version of verbal autopsy, incorporating random re-sampling of fieldwork by an independent team to ensure data quality.

SRS Report Categories

• EAG and Assam:
  • Encompassing Empowered Action Group (EAG) states - Bihar, Jharkhand, Madhya Pradesh, Chhattisgarh, Odisha, Rajasthan, Uttar Pradesh, and Uttarakhand, along with Assam.
  • Maternal Mortality Ratio (MMR) stands at approximately 237 per lakh live births, with Assam reporting the highest MMR.
  • Women in the age group 15-49 face a significantly elevated lifetime risk of maternal death in this category.
• Southern States:
  • Covering Andhra Pradesh, Karnataka, Kerala, and Tamil Nadu.
  • These states exhibit relatively superior health indicators.
• Other States (Remaining States):
  • Encompassing the remaining states in India.

Causes

• Medical Causes: 
  a. Toxemias of Pregnancy
  b. Hemorrhage
  c. Infection
  d. Obstructed Labour
  e. Unsafe Abortion
• Non-Obstetric Causes: 
  a. Anemia
  b. Associated Diseases (Cardiac, Renal, Hepatic, Metabolic, and Infectious)
  c. Malignancy
  d. Accidents
• Social Factors: 
  a. Age at Child Birth
  b. Parity
  c. Too Close Pregnancies
  d. Family Size
  e. Malnutrition
  f. Poverty
  g. Illiteracy
  h. Ignorance and Prejudices
  i. Lack of Maternity Services
  j. Shortage of Health Manpower
  k. Delivery by Untrained Dais
  l. Poor Environmental Sanitation
  m. Poor Communications and Transport Facilities
  n. Social Customs

Measures to reduce MMR

Decline in MMR

• The Maternal Mortality Ratio (MMR) decreased from 167 per lakh live births in 2011-13 to 130 per lakh live births in 2014-16, reflecting a yearly reduction of 22 points as per a special survey.

Reasons for MMR Decline

• The adoption of newer approaches like the risk approach and primary health care has contributed to the decline in MMR.
• Under the Safe Motherhood component of Reproductive and Child Health (RCH), the establishment of First Referral Units (FRUs) for emergency obstetric care has played a pivotal role.

Key Strategies to Accelerate MMR Decline

• Janani Suraksha Yojana
• Janani Shishu Suraksha Karyakram
• MCH Wings
• Mother and Child Tracking Systems
• RMNCH+A (Reproductive, Maternal, Newborn, Child Health + Adolescents)

Challenges Addressed

• Addressing social cultures, ignorance, low levels of female literacy, malnutrition, and poor environmental sanitation is crucial.

Preventive and Social Measures

• Antenatal Care:
  • Early registration of pregnancy.
  • At least four antenatal checkups.
  • Dietary supplementation, including correction of anemia.
  • Treatment of medical conditions like hypertension, diabetes, and tuberculosis.
• Intranatal Care:
  • Prevention of infection and hemorrhage during puerperium.
  • Prevention of complications such as eclampsia, malpresentations, and ruptured uterus.
  • Clean delivery practices.
• Community Measures:
  • Training village-level health workers for institutional deliveries, especially for women with a history of bad obstetrics and risk factors.
  • Promotion of family planning to control the number of children (not more than two) and spacing of births.
  • Identification of every maternal death and thorough investigation into its cause.

Maternal Mortality Ratio/Rate-Repeat

Q: Answer the following questions:
i. How is "Maternal Mortality Rate" (MMR) defined?
ii. State the major causes of maternal mortality in the country.
iii. The recent data indicates a major decline in MMR in the country Briefly state, with due reasons, the various governmental initiatives which have led to this favorable decline in maternal mortality rate in India.
iv. The government has grouped the different states in the country in a specific manner to obtain a greater understanding of the ground situation and to map the changes following its initiatives. Briefly outline this strategy, and its benefits. (2018)