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30 Nov

Maternal Mortality Ratio

Maternal Mortality Ratio
The Maternal Mortality Ratio (MMR) is the number of women who die from any cause related to or aggravated by pregnancy or its management (excluding accidental or incidental causes) during pregnancy and childbirth or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, per 100,000 live births.
The problem in estimating MMR is due to the comparative rarity of the event, necessitating large sample size. However, even with this constraint, Sample Registration System (SRS) data indicates India has recorded a deep decline of 45.6% in MMR from 327 in 1999-2001 to 178 in 2010-12 and a fall of about 30% happened during 2006-12. The decline in MMR from 1990 to 2012 is 59%. This can be attributed to the increase in awareness and the intensive efforts being taken throughout the country in improving healthcare especially that of pregnant women and mothers. 100,000 live births in 1990, India is
From an estimated MMR level of 437 per required to reduce the MMR to 109 per 100,000 live births by 2015. At the historical pace of decrease, India tends to reach MMR of 140 per 100,000 live births by 2015, falling short by 31 points. However, the bright line in the trend is the sharper decline i.e. 16% during 2009-12, 17% during 2006-09 and 16% during 2004-06 compared to 8% decline during 2001-2003. Mortality Ratio
As per SRS 2010-12, among the major States, Maternal Mortality Ratio is lowest in Kerala (66) and highest in Assam (328). During 2010-12, the Maternal Mortality Ratio higher than the national level estimate in the States of Bihar/ Jharkhand, Madhya Pradesh/ Chhattisgarh, Odisha, Rajasthan, Uttar Pradesh/ Uttarakhand and Assam.
The present status of MMR along with the extent of progress achieved in the one decade, give a better picture of the performance of the States in reducing maternal mortality ratio. The States which showed highest points of decline during 1999-2012 are Uttar Pradesh/ Uttarakhand (declined by 247 points), Rajasthan (declined by 246 points), Odisha (declined by 189 points), Bihar/Jharkhand (declined by 181 points), Madhya Pradesh/ Chhattisgarh (declined by 177 points) where as at all India level, the decline was 149 points
Thus, most of the States with highest level of MMR in 2010 – 12, have shown maximum points of decline.
It is worrying that more young mothers in the age group 20-29 years die due to maternal causes and the proportion increased in 2010-12 from that of 2007-09. The proportion of maternal deaths in the age group 20-29 years stood at 67% in 2010-12, whereas the corresponding figure in 2007-09 is 63%. Further, the age group, 20-24 years are more susceptible to maternal death as deaths due to maternity causes are highest in this group. During 2010-12, the maternal deaths are highest in the age group 20-24 years (39%) followed by 25-29 years (28%), whereas the corresponding figures for 2007-09 were 36% and 27% respectively.
In addition to Maternal Mortality Ratio (MMR), the Maternal Mortality Rate (MMR rate) (Number of maternal deaths in a given period per 100000 women of reproductive age during the same time period) and Adult lifetime risk of maternal death (The probability that a 15-year-old women will die eventually from a maternal cause) are important statistical measures of maternal mortality.
The maternal mortality rate at all India level has come down from 20.7 in 2004-05 to 12.4 in 2010 -12. All the major States have also shown a decline in MMR during this period. The MM Rate is lowest in Kerala (3.3) and highest in Uttarpradesh/ Uttarakhand (28.7) in 2010-12. At all India level, lifetime risk declined from 0.7% in 2004-06 to 0.4% 2010-12 and all the major States have shown decline during this period. In 2010-12. lifetime risk was lowest in Kerala 0.1% and highest in Uttar Pradesh/ Uttarakhand (1%).
Gaps still persisting in ensuring safe delivery:
Proportion of births attended by skilled health personnel Safe motherhood depends mainly on delivery by trained /professional personnel, particularly through institutional facilities. Among other things, ensuring ante-natal care of prospective mothers at health centres and recommended doses of IFT are important factors that help improve maternal health and reduce life risk during pregnancy. The National Family Health Survey (NFHS-2005-06) and District Household Survey (DLHS 2007-08) revealed the trend in institutional deliveries and safe deliveries and pointed towards the need for more focused and accelerated initiatives to improve the situation. The institutional deliveries in India increased from 40.9% in 2002-04 (District level Household Survey) to 72.9% in 2009 (Coverage Evaluation Survey). As per Coverage Evaluation Survey (CES), 2009, delivery attended by skilled personnel is 76.2% which was 47.6% as per District level Household Survey (DLHS-2002-04). With the existing rate of increase in deliveries by skilled personnel, the likely achievement for 2015 is only to 77.29%, which is far short of the targeted universal coverage. As per CES 2009, the percentage of deliveries attended by skilled health personnel ranges from 43.8% (Nagaland) to 100% (Kerala). 21:
Going by the historic rate of coverage increase in deliveries assisted by trained/ professional persons, 7 States namely andhra Pradesh, Goa, Jammu & Kashmir, Kerala, Madhya Pradesh, Orissa, Rajasthan, Sikkim and Tamil Nadu are likely to reach universal coverage or close to it (achievement of 90%& above) by the year 2015. For the other States, shortfall from universal coverage tends to vary from 11 to 61 percentage points.
The maternal health care services for antenatal care includes at least three antenatal care visits, iron prophylaxis for pregnant and lactating women, at least one dose of tetanus toxoid vaccine, detection and treatment of anaemia in mothers and management and referral of high-risk pregnancies and natal care. The status of major indicators related to maternal health:

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