More Indian mothers are dying in childbirth than experts had hoped would be the case by now. While there has been a reduction of the maternal mortality rates, this decline has occurred at a slower rate than was predicted. Despite the decrease in maternal deaths, India is unlikely to be able to meet World Health Organization (WHO) standards due to an absence of antenatal care, according to an analysis from the advocacy group, IndiaSpends.
The rate of decline is quite impressive. Between 2007 and 2009 this rate was 212 deaths in every 100,000 live births, falling to 167 per 100,000 in 2011 to 2013. This is a reduction of 21 percent in just a few years.
But, other countries are doing better. The maternal mortality rate in India for 2011-12 was 178 deaths per 100,000, worse than neighbouring countries such as Sri Lanka (30), Bhutan (148) and Cambodia (161). This figure is again very high compared to BRICS countries: Russia (25), China (27), Brazil (44), and South Africa (138).
Health Minister J P Nadda himself seems confused over India’s progress. He said on the 18th of February, “IMR and maternal mortality (MMR)
are declining at a faster rate in India than in other parts of the world”.
This statement was fact checked and found to be incorrect, India’s MMR was 174 in 2015, decreasing 53 percent from 374 in 2000, though concerningly showing a rise from the 2011-2013 period. Many other countries showed a larger reduction than India. Rwanda showed the largest reduction, though differs from India in that its initial number of mortalities was considerably higher, at 1020 in 2000, falling by 71 percent to 290 in 2015.
Other countries to reduce MMR at a faster rate include Bangladesh, with a 56 percent reduction, Afghanistan at 64 percent and Liberia at 58 percent. India’s MMR reduction rate of 53 percent is, though, the average of the South Asia region for the 2000 to 2015 period.
While the WHO sets out a number of guidelines to further reduce MMR in India, an emphasis is placed on antenatal care. Programmes are in place to provide government funded antenatal care. On paper, these would would make sure that this issue is being covered; in practice, there are huge discrepancies in those receiving this care.
These discrepancies are drawn along state lines, and the number of women receiving care is correlated with the wealth of the state. In wealthier states such Tamil Nadu (81.2 percent), Maharashtra (72.2 percent) and Andhra Pradesh (76 percent) the number of women receiving four antenatal visits is very high. On the opposite end of the scale, in the poorer state of Bihar only 14.4 percent of women receive four visits.
According to the WHO antenatal care, specifically numerous visits across the course of the pregnancy, is an efficient way of reducing MMR. A minimum of eight antenatal visits may reduce maternal deaths by up to eight per 1000 births compared to only four visits according to the WHO. If this is the case then improving access to antenatal care may provide a means for India to further reduce MMR.