MATERNAL MORTALITY RATE ( MMR) Define . Causes of maternal mortality in India Suggest preventive and control measures for reduction of MMR. National programmes implemented to reduce MMR in India -Spm from park textbook

Reading File

Finding Sources

Reading File

Finding Sources

Reading File

Finding Sources

Reading File

Finding Sources

Reading File

I now have all the information needed from Park's textbook. Let me compile the comprehensive answer.

Maternal Mortality Rate (MMR)

Source: Park's Textbook of Preventive and Social Medicine

1. DEFINITIONS

Maternal Death (WHO Definition)

"The death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from unintentional or incidental causes."

Types of Maternal Deaths

Type	Definition
Direct obstetric deaths	Result from obstetric complications (pregnancy, labour, puerperium), interventions, omissions, incorrect treatment. E.g., haemorrhage, eclampsia, complications of anaesthesia or C-section
Indirect obstetric deaths	Result from pre-existing or newly developed disease aggravated by physiological effects of pregnancy. E.g., pre-existing cardiac or renal disease worsened by pregnancy
Late maternal death	Death from direct or indirect obstetric causes after 42 days but less than 1 year after termination of pregnancy
Pregnancy-related death	Death of a woman while pregnant or within 42 days of termination, irrespective of cause (including accidental/incidental)
Comprehensive maternal death	Maternal deaths + late maternal deaths combined (ICD-11 grouping)

Maternal Mortality Ratio (MMR) - Formula

MMR = (Total maternal deaths in an area during a year / Total live births in the same area and year) × 1,00,000

This quantifies the risk of maternal death relative to the number of live births.

Maternal Mortality Rate (MMRate)

= Number of maternal deaths / Person-years lived by women of reproductive age. This captures both the risk per pregnancy AND the fertility level.

2. CAUSES OF MATERNAL MORTALITY IN INDIA

Medical Causes

Obstetric (Direct) Causes (~80% of deaths):

Cause	Proportion
Obstetric haemorrhage (mainly postpartum)	~25% - single most common cause
Puerperal sepsis / infection	~15% - often due to poor hygiene during delivery
Hypertensive disorders (Eclampsia)	~13%
Obstructed/prolonged labour	~8%
Unsafe abortion	Significant contributor (8.9% in India specifically)
Ectopic pregnancies, embolism	Part of other direct causes

Non-Obstetric (Indirect) Causes (~20% of deaths):

Anaemia - affects ~50% of all pregnant women; contributes to haemorrhage risk
Cardiac diseases
Renal diseases
Hepatic diseases (e.g., viral hepatitis)
Metabolic/endocrine diseases
Infectious diseases: Malaria, Tuberculosis, HIV/AIDS
Malignancy
Accidents

Social/Determinant Causes in India

The major sociocultural determinants are listed in Park's table:

Medical Causes	Social Factors
Toxaemias of pregnancy	Age at childbirth (optimal: 20-30 yrs)
Haemorrhage	High parity
Infection	Too-close pregnancies (short birth intervals)
Obstructed labour	Large family size
Unsafe abortion	Malnutrition
Anaemia	Poverty
Associated diseases (cardiac, renal, hepatic)	Illiteracy and ignorance
Malignancy	Traditional preference for home deliveries
Accidents	Shortage of health manpower
	Delivery by untrained dais
	Poor environmental sanitation
	Poor communications and transport facilities
	Social customs and prejudices
	Low women's empowerment

The social factors "often precede the medical causes and make pregnancy and childbirth a risky venture." - Park's SPM

Current MMR in India (as per Park's)

MMR reduced from 167 per lakh live births (2011-13) to 113 per lakh live births (2016-18)
States of Kerala, Maharashtra, Andhra Pradesh, Gujarat and Tamil Nadu have already achieved the SDG goal of MMR < 100
EAG states (UP, Bihar, MP, Rajasthan, Odisha, Assam, etc.) have an MMR of ~161; Assam highest at 215
UP has MMR of 197 and is among the highest-burden states

3. PREVENTIVE AND CONTROL MEASURES

Park's SPM lists the following measures as essential to reduce MMR:

Early registration of pregnancy
At least 4 antenatal check-ups (currently only 51.2% of mothers receive this per NFHS-4)
Dietary supplementation, including correction of anaemia; Iron and Folic Acid (IFA) supplementation for 100+ days
Prevention of infection and haemorrhage during puerperium (clean delivery practices)
Prevention of complications: eclampsia, malpresentations, ruptured uterus - through careful monitoring and use of anticonvulsants (MgSO4)
Treatment of associated medical conditions: hypertension, diabetes, tuberculosis, etc.
Anti-malaria and tetanus prophylaxis
Clean delivery practice (aseptic technique)
Trained village-level health workers (ASHAs) - a large number of deaths could be prevented this way
Institutional deliveries for women with bad obstetric history and risk factors
Family planning - limiting children to not more than 2, spacing of births
Identification of every maternal death and investigating its cause (maternal death review/audit)
Safe abortion services (MTP Act provisions)
Attack on social and cultural factors - female literacy, nutrition, women's empowerment, poverty reduction
Emergency obstetric care through First Referral Units (FRUs)
Focused antenatal care, birth preparedness and complication readiness, skilled attendance at birth

4. NATIONAL PROGRAMMES TO REDUCE MMR IN INDIA

(A) Janani Suraksha Yojana (JSY) - 2005

Launched 12th April 2005 under the National Rural Health Mission (NRHM)
Objective: Reduce maternal and neonatal mortality by encouraging institutional delivery among BPL families
100% centrally sponsored scheme
Integrates cash assistance with institutional care during antenatal, delivery, and immediate post-partum care
ASHA acts as the link health worker between the poor pregnant woman and the health institution, especially in Low Performing States (LPS)
LPS (10 low-performing states): UP, Uttarakhand, MP, Jharkhand, Bihar, Rajasthan, Chhattisgarh, Odisha, Assam, J&K - benefit extended upto 3rd child if mother opts for sterilization
HPS (High Performing States): Benefit limited to 2 live births, only for BPL/SC/ST women
Cash assistance scale (from 2012-13):
- LPS Rural: Mother gets Rs. 1400 + ASHA gets Rs. 600 = Total Rs. 2000
- LPS Urban: Mother gets Rs. 1000 + ASHA gets Rs. 400 = Total Rs. 1400
~100.41 lakh pregnant women benefitted in 2018-19

(B) Janani-Shishu Suraksha Karyakram (JSSK) - 2011

Launched 1st June 2011 by Government of India
Entitlements for pregnant women delivering in public health institutions:
- Absolutely free delivery including C-section
- Free drugs and consumables
- Free diet: 3 days (normal delivery), 7 days (C-section)
- Free diagnostics and blood transfusion
- Free transport: home to institution, between facilities (referral), and drop-back home
Extended to cover sick newborns in public institutions till 30 days after birth
Also covers complications during ANC, PNC, and sick infants
Estimated to benefit >12 million pregnant women annually

(C) Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA) - 2016

Launched June 2016 by Ministry of Health and Family Welfare
Provides fixed-day, free-of-cost quality ANC to all pregnant women
Minimum package of ANC services (investigations + drugs) on the 9th of every month
Involves private sector volunteers to provide specialist care in government facilities
~2.20 crore ANC check-ups conducted; >11.66 lakh high-risk pregnancy cases identified

(D) SUMAN - Surakshit Matritva Aashwasan - 2019

Launched 10th October 2019
Aims to provide assured, dignified, respectful, quality healthcare at zero cost to every woman and newborn at public health facilities
Zero tolerance for denial of services
Expected outcome: "Zero preventable maternal and newborn deaths"

(E) LaQshya Programme - 2017

Launched by MoHFW to improve quality of care in Labour Rooms and Maternity Operation Theatres in public health facilities
Evidence-based approach for quality maternal and newborn care with respectful care during delivery
Implemented at District Hospitals (DH), Sub-district Hospitals (SDH), high-caseload CHCs, FRUs, and medical colleges
2,445 public health facilities identified (including 193 medical colleges)
Addresses adequate human resources, capacity building, adherence to clinical guidelines

(F) Anaemia Mukt Bharat Programme

Addresses malnutrition/anaemia during pregnancy
Focuses on the first 1000 days of the child

(G) Vandemataram Scheme

Voluntary scheme for obstetricians/gynaecologists to provide safe motherhood services at their clinics
Participating doctors display the 'Vandemataram logo'
Free IFA tablets, oral pills, TT injections supplied by District Medical Officers to these clinics

(H) Safe Abortion Services (Under RCH-II)

Medical method: Mifepristone (RU 486) + Misoprostol upto 7 weeks (49 days) of amenorrhoea
Manual Vacuum Aspiration (MVA): Safe technique feasible at PHC level, piloted with FOGSI/WHO

(I) Other Key Strategies

Village Health and Nutrition Day (VHND): Monthly at Anganwadi centres for ANC/PNC, immunization, FP, health education
Maternal Death Review (MDR): Facility-based and community-based audit to identify causes and improve obstetric care quality
Pregnancy Tracking / Mother and Child Tracking System (MCTS): Universal screening of pregnant women, birth preparedness
Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCH+A): Integrative strategy accelerating decline in MMR
First Referral Units (FRUs): For emergency obstetric care at CHC/district hospital level
Global Strategy for Women's, Children's and Adolescent's Health 2016-2030 (SDG target): Reduce global MMR to <70 per 1,00,000 live births by 2030

All content above is drawn directly from Park's Textbook of Preventive and Social Medicine (ISBN: 9789382219163), pp. 650-654 and 514-516.

This is a shared conversation. Sign in to Orris to start your own chat.