Despite efforts to improve maternal and child health, maternal mortality continues to be a major problem in India. India has the highest maternal mortality ratio in the world. In fact, 20% of all maternal mortalities worldwide occur in India. Each year, approximately 117,000 women die in India as a result of pregnancy, childbirth, or puerperium (Salvi, 2009).
It is a shame that maternal mortality is such a prevalent issue in India when maternal mortality rates are so low in most developed countries. Most deaths associated with childbearing are preventable making it even more tragic that so many Indian women lose their lives while in labor or shortly after.
Public awareness about the necessity of addressing the maternal mortality problem began with India’s first five-year plan. However, there has been a lack of focus that has lead to many different unorganized strategies and programs that have not been effective rather than focusing on one consistent and successful plan for interventions (Ved).
The fifth Millennium Development Goal created by the United Nations was to improve maternal health. The targets of the goal include reducing the maternal mortality ratio by 75% and providing universal access to reproductive health by 2015. The world is not on track to reach this goal and India’s lack of significant improvements in maternal mortality is a major contributor to the potential failure of reaching the goal (Salvi, 2009).
Although India is significantly behind the millennium goal and maternal mortality in the country is still so high, some slow progress has been made. Both maternal and child mortality ratios have decreased slightly in the country. Two national projects, Child Survival and Safe Motherhood (CSSM) and Reproductive and Child Health-I (RCH-I), have contributed to this marginal improvement. Both programs are aimed at improving maternal mortality ratios through greater access to antenatal care (ANC), safer institutional and domestic delivery services, access to safer abortions, post-partum care, and access to centers that could provide Emergency Obstetric Care (EmOC) (Ved).
One reason that progress has been so slow is related to India’s rapidly growing population. Improvements in childbearing safety have been cancelled out by the expanding population. Most of the growing population is poor which escalates the problem. Even with such an extremely low wage cut off for the poverty line, 300 million Indians are considered to live in poverty (Salvi, 2009).
India’s high rates of poverty play a major role in the poor maternal mortality ratios and lack of access to health care by many Indian women. According to Rajani R. Ved in his article on Reducing Maternal Mortality, poorer women as well as rural women and women who had fewer than twelve years of education did not receive near as much information or services related to antenatal care as other women in India (Ved). Many women give birth while underweight or malnourished, which increases their risk during labor or recovery. Over half of the women in India are iron deficient (Salvi, 2009).
A large percentage of births in India occur in the home and without the assistance of a trained medical personnel (Salvi, 2009). Lack of access often related to poverty is usually the reason for so many births occurring without a skilled attendant. If skilled medical attendants and institutions where women could give birth were more accessible, many lives could be spared, as childbearing would be much safer. Many of the mortalities that occur could be prevented if a trained medical person was present.
Other contributors to the high maternal mortality ratios in India include lack of education of many and young marriages. It is an Indian tradition to marry extremely young especially for the girls who do not complete much schooling. The legal age for marriage in the country is actually 18 years old but most do not observe this law. The median age of a woman’s first time giving birth is about five years lower in uneducated females compared to those who are educated. When girls get married young, they usually have babies at much younger ages. Lack of education and lack of access to contraception in India cause many of the girls to get pregnant early. Younger girls are at increased risk for childbearing complications or death because their bodies are often not fully developed when they get pregnant (Salvi, 2009).
It is evident that the current programs to reduce maternal mortality in India have not been sufficient. These programs need to be better implemented and more actions need to be taken so that women can give birth more safely. Such a preventable cause of death should not be so prevalent as it is in India today. Women need to be given better access to education and access to a medical institution or trained assistance during labor.
Salvi V. Maternal mortality in India: The true killers. J Postgrad Med 2009;55:1-2
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