India Missed Nadda's MMR Target, But UN Goal Attainable if Some States Buck Up
While India's maternal mortality rate has fallen by 70% in the last two decades, achieving the UN target of 70 can only be done if poorer states drastically scale up efforts
The COVID-19 pandemic significantly affected health care systems resulting in an increase in maternal deaths and stillbirths across the world. According to a March 2021 study published in The Lancet Global Health Journal, there was a 28% increase in the odds of stillbirth and more than 30% of mothers faced a risk of dying during pregnancy or childbirth.
In India, there was a 27% drop in pregnant women receiving four or more ante-natal check-ups, a 28% decline in institutional deliveries and 22% decline in prenatal services, showed a Population Foundation of India's analysis of Health Management Information System (HMIS) data. "We estimated that 1.3 million Indian women died from maternal causes over the last two decades. Although maternal mortality rates have fallen by 70% overall, the poorer states lag behind," wrote researchers in an August 2021 study published in BJOG, an international journal of obstetrics & gynaecology.
On the other hand, physical violence upon pregnant women saw a decline — from 3.9% in 2016 to 3.1% in 2020. Southern states such as Karnataka (5.8%), Telangana (4%) and Andhra Pradesh (3.8%) account for the highest violence against pregnant women while union territories such as Chandigarh and Lakshadweep reported zero violence.
Every year, April 11 is observed as National Safe Motherhood Day to highlight that pregnant women need access to proper prenatal and postnatal care. This year's theme focuses on protecting pregnant and new mothers from the COVID-19 virus. FactChecker looked at 9 indicators of maternal health to know where India stands in providing safe maternal health:
1. Maternal Mortality Ratio.
2. Mothers who had antenatal check-ups in the first trimester.
3. Mothers who had at least four antenatal visits
4. Mothers who got post-natal care from health personnel within 2 days of delivery
5. Total institutional births
6. Home births conducted by skilled health personnel
7. Births attended by skilled health personnel
8. Anaemic pregnant women
9. Total unmet need for family planning
Maternal Mortality and its Causes
India accounted for 12% of the world's total maternal deaths in 2017, according to a WHO report. The major complications that account for nearly two-thirds of all maternal deaths are severe bleeding (mostly bleeding after childbirth), infections (usually after childbirth), high blood pressure during pregnancy, complications from delivery and unsafe abortions, according to United Nations Children's Fund (UNICEF).
Sustainable Development Goals (SDGs), set by the United Nations, aim at reducing the global Maternal Mortality Ratio (MMR) to less than 70 per 1,00,000 live births by 2030. Currently, India's MMR is declining from 113 in 2016-18 to 103 in 2017-19, as per Sample Registration System.
In June 2018, JP Nadda, the then Union Minister of Health & Family Welfare and current president of the Bharatiya Janata Party, claimed that India would achieve the SDG target of 70 by 2022, ahead of the target timeline of 2030. However, with an MMR of 103, India has miles to go in meeting the UN target.
"India could achieve the UN 2030 MMR goals if the average rate of reduction is maintained. However, without further intervention, the poorer states will not," concluded researchers in the August 2021 study.
Besides, certain states such as Assam (205), Uttar Pradesh (167), Madhya Pradesh (163) and Chhattisgarh (160) are significantly higher than India's MMR. Whereas, seven states — Kerala (30), Maharashtra (38), Telangana (56), Andhra Pradesh and Tamil Nadu (58), and Jharkhand (61) — have managed to achieve the international target to reduce the MMR to less than 70 per 100,000 live births.
Antenatal Care
Antenatal care is the care provided by healthcare professionals during a person's pregnancy. FactChecker looked at two indicators under this section, namely, "mothers who had antenatal check-ups in the first trimester" and "mothers who had at least four antenatal visits."
Overall, the proportion of pregnant women receiving antenatal check-ups have improved. Pregnant women who had antenatal check-ups in the first trimester increased from 58.6% in 2016 to 70% in 2020, according to National Family Health Surveys (NFHS). Similarly, pregnant women with four antenatal visits also moderately increased from 51.2% in 2016 to 58.1% 2020.
Goa (93%), Tamil Nadu (89.9%) and Lakshadweep (88.3%) and Puducherry (86.9%) account for the highest antenatal check-ups, whereas Nagaland (20.7%), Bihar (25.2%), Arunachal Pradesh (36.5%) and Jharkhand (38.6%) figure in the bottom.
Delivery and Postnatal Care
Nearly 90% of births happen in a health facility — an increase from 78.9% in 2016 to 88.6 % in 2020. However, while births attended by skilled health professionals increased from 81.4% to 89.4%, home births conducted by skilled professionals marginally decreased from 4.3% in 2016 to 3.2% in 2020.
Further, 78% of mothers received post-natal care from health personnel within two days of delivery. While states such as Goa, Kerala and Tamil Nadu have fared well in postnatal care, north-eastern states such as Nagaland (43.9%), Meghalaya (43.9%) and Arunachal Pradesh (56.4%) fell in the lowest rung.
While Nagaland's figures related to postnatal care have significantly risen from 22.3% in 2016 to 43.9% in 2020, Meghalaya's has reduced from 47.5% to 43.9% during the same period.
FactChecker also looked at unmet need for family planning, anaemic rate and pregnant women who have experienced physical violence. The total unmet need for family planning has reduced from 12.9% to 9.4%. More than half of pregnant women are still anaemic. Moreover, this figure has increased — from 50.4% in 2016 to 52.2% in 2020.
