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{{short description|Overview of maternal mortality in India}} | {{short description|Overview of maternal mortality in India}} | ||
[[File:School on a rainy day.jpg|thumb|300px|right|Good health for the mother is good for family and society.]] | [[File:School on a rainy day.jpg|thumb|300px|right|Good health for the mother is good for family and society.]] | ||
'''Maternal mortality in India''' is the [[maternal death]] of a woman in India during pregnancy or after pregnancy, including post-abortion or post-birth periods.<ref>{{Cite web|url=https://data.unicef.org/topic/maternal-health/maternal-mortality/|title=UNICEF Maternal Mortality|website=UNICEF Data}}</ref> Different countries and cultures have different rates and causes for maternal death.<ref>{{Cite web|url=https://www.macrotrends.net/countries/IND/india/maternal-mortality-rate|title=Macrotrends Country - India Maternal Mortality}}</ref> Within India, there is a marked variation in healthcare access between regions and in socioeconomic factors, accordingly, there is also variation in maternal deaths for various states, regions, and demographics of women.<ref>{{Cite journal| | '''Maternal mortality in India''' is the [[maternal death]] of a woman in India during pregnancy or after pregnancy, including post-abortion or post-birth periods.<ref>{{Cite web|url=https://data.unicef.org/topic/maternal-health/maternal-mortality/|title=UNICEF Maternal Mortality|website=UNICEF Data}}</ref> Different countries and cultures have different rates and causes for maternal death.<ref>{{Cite web|url=https://www.macrotrends.net/countries/IND/india/maternal-mortality-rate|title=Macrotrends Country - India Maternal Mortality}}</ref> Within India, there is a marked variation in healthcare access between regions and in socioeconomic factors, accordingly, there is also variation in maternal deaths for various states, regions, and demographics of women.<ref>{{Cite journal|last1=Kaur|first1=Manmeet|last2=Gupta|first2=Madhu|last3=Purayil|first3=Vijin Pandara|last4=Rana|first4=Monica|last5=Chakrapani|first5=Venkatesan|date=2018-10-09|title=Contribution of social factors to maternal deaths in urban India: Use of care pathway and delay models|journal=PLOS ONE|language=en|volume=13|issue=10|pages=e0203209|doi=10.1371/journal.pone.0203209|pmc=6177129|pmid=30300352|bibcode=2018PLoSO..1303209K|doi-access=free}}</ref> | ||
Pregnancy involves a vulnerability that put women at risk of dying, and India is one of many countries who record a high number of pregnancy-related deaths of women each year.<ref>{{Cite journal| | Pregnancy involves a vulnerability that put women at risk of dying, and India is one of many countries who record a high number of pregnancy-related deaths of women each year.<ref>{{Cite journal|last1=Gwatkin|first1=D. R.|last2=Rutstein|first2=S.|last3=Johnson|first3=K.|last4=Suliman|first4=E.|last5=Wagstaff|first5=A.|last6=Amouzou|first6=A.|date=December 2007|title=Socio-economic differences in health, nutrition, and population within developing countries: an overview|journal=Nigerian Journal of Clinical Practice|volume=10|issue=4|pages=272–282|pmid=18293634}}</ref> | ||
Women die as a result of complications during and following pregnancy and childbirth or abortion. Most of these complications develop during pregnancy are easily preventable or treatable. Other complications may exist before pregnancy but are worsened during pregnancy, especially if not managed as part of a woman’s care. | Women die as a result of complications during and following pregnancy and childbirth or abortion. Most of these complications develop during pregnancy are easily preventable or treatable. Other complications may exist before pregnancy but are worsened during pregnancy, especially if not managed as part of a woman’s care. | ||
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Ninety-four percent (94%) of all maternal deaths occur in low and lower middle-income countries.<ref>Trends in maternal mortality: 2000 to 2017: estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Geneva: World Health Organization; 2019</ref><ref>{{Cite web|url=https://www.who.int/news-room/fact-sheets/detail/maternal-mortality|title=Maternal mortality|website=www.who.int|language=en|access-date=2020-03-30}}</ref> In September 2000, the United Nations, faced with the enormous maternal death toll in India and other developing countries, pledged as its fifth Millennium Development Goal (MDG 5) that the global MMR would be reduced to a quarter of its 1990 level by 2015. India is a signatory to the [[Millennium Declaration]] adopted at the United Nations General Assembly in September 2000, and consistently reaffirmed its commitment towards the eight development goals. These MDG targets were in convergence with India’s own national development goals to reduce poverty and other areas of deprivation.<ref>{{Cite web|url=https://www.in.undp.org/content/india/en/home/post-2015/mdgoverview.html|title=Millennium Development Goals|website=UNDP in India|language=en|access-date=2020-03-30}}</ref> | Ninety-four percent (94%) of all maternal deaths occur in low and lower middle-income countries.<ref>Trends in maternal mortality: 2000 to 2017: estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Geneva: World Health Organization; 2019</ref><ref>{{Cite web|url=https://www.who.int/news-room/fact-sheets/detail/maternal-mortality|title=Maternal mortality|website=www.who.int|language=en|access-date=2020-03-30}}</ref> In September 2000, the United Nations, faced with the enormous maternal death toll in India and other developing countries, pledged as its fifth Millennium Development Goal (MDG 5) that the global MMR would be reduced to a quarter of its 1990 level by 2015. India is a signatory to the [[Millennium Declaration]] adopted at the United Nations General Assembly in September 2000, and consistently reaffirmed its commitment towards the eight development goals. These MDG targets were in convergence with India’s own national development goals to reduce poverty and other areas of deprivation.<ref>{{Cite web|url=https://www.in.undp.org/content/india/en/home/post-2015/mdgoverview.html|title=Millennium Development Goals|website=UNDP in India|language=en|access-date=2020-03-30}}</ref> | ||
In 2018 the [[World Health Organization]] (WHO) congratulated India for great reduction in maternal mortality since 2005,<ref>{{Cite web|url=https://www.who.int/southeastasia/news/detail/10-06-2018-india-has-achieved-groundbreaking-success-in-reducing-maternal-mortality|title=India has achieved groundbreaking success in reducing maternal mortality|website=www.who.int|language=en|access-date=2020-03-30}}</ref> especially in recent years, reducing the maternal mortality ratio (MMR) by 77%, from 556 per 100 000 live births in 1990 to 130 per 100 000 live births in 2016, which was considered by WHO to be a remarkable feat in contrast with the global maternal mortality reported to have experienced a decline of 43%. Prior to that, various reports described high rates of maternal mortality in India,<ref name="Prakash 1395–1400">{{Cite journal| | In 2018 the [[World Health Organization]] (WHO) congratulated India for great reduction in maternal mortality since 2005,<ref>{{Cite web|url=https://www.who.int/southeastasia/news/detail/10-06-2018-india-has-achieved-groundbreaking-success-in-reducing-maternal-mortality|title=India has achieved groundbreaking success in reducing maternal mortality|website=www.who.int|language=en|access-date=2020-03-30}}</ref> especially in recent years, reducing the maternal mortality ratio (MMR) by 77%, from 556 per 100 000 live births in 1990 to 130 per 100 000 live births in 2016, which was considered by WHO to be a remarkable feat in contrast with the global maternal mortality reported to have experienced a decline of 43%. Prior to that, various reports described high rates of maternal mortality in India,<ref name="Prakash 1395–1400">{{Cite journal|last1=Prakash|first1=A.|last2=Swain|first2=S.|last3=Seth|first3=A.|date=December 1991|title=Maternal mortality in India: current status and strategies for reduction|journal=Indian Pediatrics|volume=28|issue=12|pages=1395–1400|pmid=1819558}}</ref><ref>{{Cite news|url=https://www.reuters.com/article/us-india-maternaldeaths/india-grapples-with-high-maternal-death-rate-idUSTRE50P05D20090126|title=India grapples with high maternal death rate|last=Dhar|first=Sujoy|date=26 January 2009|website=Reuters}}</ref> from which WHO and other international bodies concluded that India could not reach the Millennium Development Goals (MDG). | ||
[[File:Maternal_Mortality_in_India_-_History_inforgraphic.jpg|thumb|600px|Infographic - History of Maternal Mortality in India]] | [[File:Maternal_Mortality_in_India_-_History_inforgraphic.jpg|thumb|600px|Infographic - History of Maternal Mortality in India]] | ||
Maternal deaths being a rare event require a large sample size to provide robust estimates. In order to enhance the Sample Registration System (SRS) sample size, results were derived by following the practice of pooling three years' data to yield reliable estimates of maternal mortality.<ref>{{Cite news|url=https://economictimes.indiatimes.com/industry/healthcare/biotech/healthcare/india-registers-26-9-per-cent-decline-in-maternal-mortality-rate-since-2013-srs-bulletin/articleshow/71957486.cms|title=India registers 26.9 per cent decline in Maternal Mortality Rate since 2013: SRS Bulletin|date=2019-11-07|work=The Economic Times|access-date=2020-03-30}}</ref> The first report on maternal mortality in India (1997-2003), describing trends, causes and risk factors, was released in October 2006.<ref>{{Cite news|url=https://economictimes.indiatimes.com/industry/healthcare/biotech/healthcare/india-registers-26-9-per-cent-decline-in-maternal-mortality-rate-since-2013-srs-bulletin/articleshow/71957486.cms|title=India registers 26.9 per cent decline in Maternal Mortality Rate since 2013: SRS Bulletin|date=2019-11-07|work=The Economic Times|access-date=2020-03-30}}</ref> | Maternal deaths being a rare event require a large sample size to provide robust estimates. In order to enhance the Sample Registration System (SRS) sample size, results were derived by following the practice of pooling three years' data to yield reliable estimates of maternal mortality.<ref>{{Cite news|url=https://economictimes.indiatimes.com/industry/healthcare/biotech/healthcare/india-registers-26-9-per-cent-decline-in-maternal-mortality-rate-since-2013-srs-bulletin/articleshow/71957486.cms|title=India registers 26.9 per cent decline in Maternal Mortality Rate since 2013: SRS Bulletin|date=2019-11-07|work=The Economic Times|access-date=2020-03-30}}</ref> The first report on maternal mortality in India (1997-2003), describing trends, causes and risk factors, was released in October 2006.<ref>{{Cite news|url=https://economictimes.indiatimes.com/industry/healthcare/biotech/healthcare/india-registers-26-9-per-cent-decline-in-maternal-mortality-rate-since-2013-srs-bulletin/articleshow/71957486.cms|title=India registers 26.9 per cent decline in Maternal Mortality Rate since 2013: SRS Bulletin|date=2019-11-07|work=The Economic Times|access-date=2020-03-30}}</ref> | ||
In 2005, a woman's lifetime risk of maternal death in India was estimated to be 1 in 70. Similarly, the maternal mortality ratio (MMR; number of maternal deaths per 100,000 live births) in India was 450.<ref name="Goldie e1000264">{{Cite journal| | In 2005, a woman's lifetime risk of maternal death in India was estimated to be 1 in 70. Similarly, the maternal mortality ratio (MMR; number of maternal deaths per 100,000 live births) in India was 450.<ref name="Goldie e1000264">{{Cite journal|last1=Goldie|first1=Sue J.|last2=Sweet|first2=Steve|last3=Carvalho|first3=Natalie|last4=Natchu|first4=Uma Chandra Mouli|last5=Hu|first5=Delphine|date=2010-04-20|title=Alternative Strategies to Reduce Maternal Mortality in India: A Cost-Effectiveness Analysis|journal=PLOS Medicine|language=en|volume=7|issue=4|pages=e1000264|doi=10.1371/journal.pmed.1000264|pmc=2857650|pmid=20421922}}</ref> | ||
<br>In 2010, approximately one-quarter of all pregnancy- and delivery-related maternal deaths worldwide occur in India. Statistics showed that up until 2010, more than half a million women—most of them living in developing countries—dies from pregnancy- or childbirth-related complications every year, and about a quarter of these “maternal” deaths occurred in India.<ref name="Goldie e1000264"/> | <br>In 2010, approximately one-quarter of all pregnancy- and delivery-related maternal deaths worldwide occur in India. Statistics showed that up until 2010, more than half a million women—most of them living in developing countries—dies from pregnancy- or childbirth-related complications every year, and about a quarter of these “maternal” deaths occurred in India.<ref name="Goldie e1000264"/> | ||
India showed a steady decline in maternal mortality, from 254 in every 100 000 live births in 2004-06 to 178 in every 100 000 live births in 2010-12.<ref>{{Cite journal|last=Baggchi|first=S.|date=2014-10-06|title=Report shows causes of maternal deaths in India|journal=BMJ|volume=349|issue=oct06 10|pages=g6035|doi=10.1136/bmj.g6035|pmid=25288272}}</ref> | India showed a steady decline in maternal mortality, from 254 in every 100 000 live births in 2004-06 to 178 in every 100 000 live births in 2010-12.<ref>{{Cite journal|last=Baggchi|first=S.|date=2014-10-06|title=Report shows causes of maternal deaths in India|journal=BMJ|volume=349|issue=oct06 10|pages=g6035|doi=10.1136/bmj.g6035|pmid=25288272|s2cid=30640966}}</ref> | ||
As per Sample Registration System (SRS), 2011-13 reports published by Registrar General of India, Maternal Mortality Ratio (MMR) was 167 per 1,00,000 live births in the country. Under the Millennium Development Goal (MDG) 5, the target is to reduce Maternal Mortality Ratio (MMR) by three quarters between 1990 & 2015. This translates to reducing the MMR from 560 in 1990 to 140 in 2015.<ref>{{Cite news|url=https://economictimes.indiatimes.com/industry/healthcare/biotech/healthcare/india-registers-26-9-per-cent-decline-in-maternal-mortality-rate-since-2013-srs-bulletin/articleshow/71957486.cms|title=India registers 26.9 per cent decline in Maternal Mortality Rate since 2013: SRS Bulletin|date=2019-11-07|work=The Economic Times|access-date=2020-03-30}}</ref><ref>{{Cite web|url=https://pib.gov.in/newsite/printrelease.aspx?relid=116061|title=Steps Taken to Reduce IMR and MMR|website=pib.gov.in|access-date=2020-03-30}}</ref> | As per Sample Registration System (SRS), 2011-13 reports published by Registrar General of India, Maternal Mortality Ratio (MMR) was 167 per 1,00,000 live births in the country. Under the Millennium Development Goal (MDG) 5, the target is to reduce Maternal Mortality Ratio (MMR) by three quarters between 1990 & 2015. This translates to reducing the MMR from 560 in 1990 to 140 in 2015.<ref>{{Cite news|url=https://economictimes.indiatimes.com/industry/healthcare/biotech/healthcare/india-registers-26-9-per-cent-decline-in-maternal-mortality-rate-since-2013-srs-bulletin/articleshow/71957486.cms|title=India registers 26.9 per cent decline in Maternal Mortality Rate since 2013: SRS Bulletin|date=2019-11-07|work=The Economic Times|access-date=2020-03-30}}</ref><ref>{{Cite web|url=https://pib.gov.in/newsite/printrelease.aspx?relid=116061|title=Steps Taken to Reduce IMR and MMR|website=pib.gov.in|access-date=2020-03-30}}</ref> | ||
In 2014, India was recognized to have contributed one-fifth of the global burden of absolute maternal deaths, while experiencing an estimated 4.7% decline in its Maternal Mortality Ratio which stood at 174 per 100,000 live births in India.<ref>{{Cite journal| | In 2014, India was recognized to have contributed one-fifth of the global burden of absolute maternal deaths, while experiencing an estimated 4.7% decline in its Maternal Mortality Ratio which stood at 174 per 100,000 live births in India.<ref>{{Cite journal|last1=Montgomery|first1=Ann L.|last2=Ram|first2=Usha|last3=Kumar|first3=Rajesh|last4=Jha|first4=Prabhat|author5=for The Million Death Study Collaborators|date=2014-01-15|title=Maternal Mortality in India: Causes and Healthcare Service Use Based on a Nationally Representative Survey|journal=PLOS ONE|language=en|volume=9|issue=1|pages=e83331|doi=10.1371/journal.pone.0083331|pmc=3893075|pmid=24454701|bibcode=2014PLoSO...983331M|doi-access=free}}</ref> | ||
According to the Office of the Registrar General, the ratio has declined from 130 in 2014-2016 to 122 in 2015-17, registering a 6.15 per cent reduction since the last survey figures of 2014-2016. India’s present MMR is below the Millennium Development Goal (MDG) target and puts the country on track to achieve the Sustainable Development Goal (SDG) target of an MMR below 70 by 2030.<ref>{{Cite web|url=https://www.healthissuesindia.com/2019/11/12/maternal-mortality-ratio-in-decline/|title=Maternal mortality ratio in decline|last=Watts|first=Kerean|date=2019-11-12|website=Health Issues India|language=en-GB|access-date=2020-03-30}}</ref> | According to the Office of the Registrar General, the ratio has declined from 130 in 2014-2016 to 122 in 2015-17, registering a 6.15 per cent reduction since the last survey figures of 2014-2016. India’s present MMR is below the Millennium Development Goal (MDG) target and puts the country on track to achieve the Sustainable Development Goal (SDG) target of an MMR below 70 by 2030.<ref>{{Cite web|url=https://www.healthissuesindia.com/2019/11/12/maternal-mortality-ratio-in-decline/|title=Maternal mortality ratio in decline|last=Watts|first=Kerean|date=2019-11-12|website=Health Issues India|language=en-GB|access-date=2020-03-30}}</ref> | ||
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According to officials of National Health Mission (NHM) in [[Uttarakhand]], the state stood at 8th spot among the 19 top states in the country. Notably the last survey, which clubbed [[Uttarakhand]] and the neighboring [[Uttar Pradesh]] as one, ranked the two states at the 15th spot. It stated that the MMR in the two states (combined) between 2014 and 2016 stood at 201 maternal deaths per lakh births.<ref name="www.ETHealthworld.com"/> | According to officials of National Health Mission (NHM) in [[Uttarakhand]], the state stood at 8th spot among the 19 top states in the country. Notably the last survey, which clubbed [[Uttarakhand]] and the neighboring [[Uttar Pradesh]] as one, ranked the two states at the 15th spot. It stated that the MMR in the two states (combined) between 2014 and 2016 stood at 201 maternal deaths per lakh births.<ref name="www.ETHealthworld.com"/> | ||
The rates for using maternal healthcare is the same for rural and urban women in wealthier Indian states.<ref name="Montgomery 2014">{{cite journal |last1=Montgomery |first1=AL |last2=Ram |first2=U |last3=Kumar |first3=R |last4=Jha |first4=P |author5=for The Million Death Study Collaborators |title=Maternal mortality in India: causes and healthcare service use based on a nationally representative survey |journal=PLOS | The rates for using maternal healthcare is the same for rural and urban women in wealthier Indian states.<ref name="Montgomery 2014">{{cite journal |last1=Montgomery |first1=AL |last2=Ram |first2=U |last3=Kumar |first3=R |last4=Jha |first4=P |author5=for The Million Death Study Collaborators |title=Maternal mortality in India: causes and healthcare service use based on a nationally representative survey |journal=PLOS ONE |date=2014 |volume=9 |issue=1 |pages=e83331 |doi=10.1371/journal.pone.0083331 |pmid=24454701|pmc=3893075 |bibcode=2014PLoSO...983331M |doi-access=free }}</ref> In poorer states, urban women access healthcare much more often than rural women.<ref name="Montgomery 2014"/> | ||
===Healthcare availability and use by region=== | ===Healthcare availability and use by region=== | ||
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Yet, getting these facilities to women is a challenge, especially in poorer states. No more than 3.3 per cent of pregnant women in Bihar reported receiving full antenatal care, lowest among states.<ref name="Taneja"/> | Yet, getting these facilities to women is a challenge, especially in poorer states. No more than 3.3 per cent of pregnant women in Bihar reported receiving full antenatal care, lowest among states.<ref name="Taneja"/> | ||
The rates for using maternal healthcare is the same for rural and urban women in wealthier Indian states. In poorer states, urban women access healthcare much more often than rural women.<ref>{{Cite journal| | The rates for using maternal healthcare is the same for rural and urban women in wealthier Indian states. In poorer states, urban women access healthcare much more often than rural women.<ref>{{Cite journal|last1=Montgomery|first1=Ann L.|last2=Ram|first2=Usha|last3=Kumar|first3=Rajesh|last4=Jha|first4=Prabhat|last5=for the Million Death Study Collaborators|date=2014|title=Maternal mortality in India: causes and healthcare service use based on a nationally representative survey|journal=PLOS ONE|volume=9|issue=1|pages=e83331|doi=10.1371/journal.pone.0083331|pmc=3893075|pmid=24454701|bibcode=2014PLoSO...983331M|doi-access=free}}</ref> | ||
The [[BIMARU states]] experience a range of problems including maternal mortality.<ref>{{cite journal |last1=Dehury |first1=RK |last2=Samal |first2=J |title=Maternal Health Situation in Bihar and Madhya Pradesh: A Comparative Analysis of State Fact Sheets of National Family Health Survey (NFHS)-3 and 4 |journal=Journal of Clinical and Diagnostic Research|date=September 2016 |volume=10 |issue=9 |pages=IE01–IE04 |doi=10.7860/JCDR/2016/19079.8404 |pmid=27790466|pmc=5071966 }}</ref> | The [[BIMARU states]] experience a range of problems including maternal mortality.<ref>{{cite journal |last1=Dehury |first1=RK |last2=Samal |first2=J |title=Maternal Health Situation in Bihar and Madhya Pradesh: A Comparative Analysis of State Fact Sheets of National Family Health Survey (NFHS)-3 and 4 |journal=Journal of Clinical and Diagnostic Research|date=September 2016 |volume=10 |issue=9 |pages=IE01–IE04 |doi=10.7860/JCDR/2016/19079.8404 |pmid=27790466|pmc=5071966 }}</ref> | ||
====Assam==== | ====Assam==== | ||
Assam has the highest rate of maternal mortality in India.<ref name="Cousins 2016">{{cite journal |last1=Cousins |first1=Sophie |title=Assam: India's state with the highest maternal mortality |journal=BMJ |volume=353 |date=5 April 2016 |pages=i1908 |doi=10.1136/bmj.i1908|pmid=27048471 }}</ref> Within Assam, some of the highest rates of maternal mortality are among tea plantation workers.<ref name="Cousins 2016"/> | Assam has the highest rate of maternal mortality in India.<ref name="Cousins 2016">{{cite journal |last1=Cousins |first1=Sophie |title=Assam: India's state with the highest maternal mortality |journal=BMJ |volume=353 |date=5 April 2016 |pages=i1908 |doi=10.1136/bmj.i1908|pmid=27048471 |s2cid=39019791 }}</ref> Within Assam, some of the highest rates of maternal mortality are among tea plantation workers.<ref name="Cousins 2016"/> | ||
====Andhra Pradesh==== | ====Andhra Pradesh==== | ||
A regional program in Andhra Pradesh seeks to ask doctors and nurses about the causes of maternal mortality in local communities.<ref name="Singh 2015">{{cite journal |last1=Singh |first1=S |last2=Murthy |first2=GV |last3=Thippaiah |first3=A |last4=Upadhyaya |first4=S |last5=Krishna |first5=M |last6=Shukla |first6=R |last7=Srikrishna |first7=SR |title=Community based maternal death review: lessons learned from ten districts in Andhra Pradesh, India |journal=Maternal and Child Health Journal |date=July 2015 |volume=19 |issue=7 |pages=1447–54 |doi=10.1007/s10995-015-1678-1 |pmid=25636651}}</ref> The general circumstance is that maternal mortality has different causes in different places, but if clinics knew the common causes for that area, then they would be better prepared to prevent future deaths.<ref name="Singh 2015"/> | A regional program in Andhra Pradesh seeks to ask doctors and nurses about the causes of maternal mortality in local communities.<ref name="Singh 2015">{{cite journal |last1=Singh |first1=S |last2=Murthy |first2=GV |last3=Thippaiah |first3=A |last4=Upadhyaya |first4=S |last5=Krishna |first5=M |last6=Shukla |first6=R |last7=Srikrishna |first7=SR |title=Community based maternal death review: lessons learned from ten districts in Andhra Pradesh, India |journal=Maternal and Child Health Journal |date=July 2015 |volume=19 |issue=7 |pages=1447–54 |doi=10.1007/s10995-015-1678-1 |pmid=25636651|s2cid=10994252 }}</ref> The general circumstance is that maternal mortality has different causes in different places, but if clinics knew the common causes for that area, then they would be better prepared to prevent future deaths.<ref name="Singh 2015"/> | ||
====Bihar==== | ====Bihar==== | ||
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====Uttar Pradesh==== | ====Uttar Pradesh==== | ||
Surveys have found that women in UP who are more educated and have more money tend to use more maternal health services.<ref>{{cite journal |last1=Dey |first1=A |last2=Hay |first2=K |last3=Afroz |first3=B |last4=Chandurkar |first4=D |last5=Singh |first5=K |last6=Dehingia |first6=N |last7=Raj |first7=A |last8=Silverman |first8=JG |title=Understanding intersections of social determinants of maternal healthcare utilization in Uttar Pradesh, India |journal=PLOS | Surveys have found that women in UP who are more educated and have more money tend to use more maternal health services.<ref>{{cite journal |last1=Dey |first1=A |last2=Hay |first2=K |last3=Afroz |first3=B |last4=Chandurkar |first4=D |last5=Singh |first5=K |last6=Dehingia |first6=N |last7=Raj |first7=A |last8=Silverman |first8=JG |title=Understanding intersections of social determinants of maternal healthcare utilization in Uttar Pradesh, India |journal=PLOS ONE |date=2018 |volume=13 |issue=10 |pages=e0204810 |doi=10.1371/journal.pone.0204810 |pmid=30286134|pmc=6171889 |bibcode=2018PLoSO..1304810D |doi-access=free }}</ref> | ||
==Prevention== | ==Prevention== | ||
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Maternal mortality is challenging to study because it is fairly uncommon, it can happen for various reasons, and it is challenging to report.<ref name="Montgomery 2014"/> The first nationally representative study of maternal mortality in all of India was in 2014.<ref name="Montgomery 2014"/> | Maternal mortality is challenging to study because it is fairly uncommon, it can happen for various reasons, and it is challenging to report.<ref name="Montgomery 2014"/> The first nationally representative study of maternal mortality in all of India was in 2014.<ref name="Montgomery 2014"/> | ||
Two major global studies in 2015 report maternal mortality in India and contribute to national planning. One study is the [[Global Burden of Disease Study]], which in 2015 for the first time published a national report about India.<ref name="Global Burden of Disease 2015">{{cite journal |author1=GBD 2015 Maternal Mortality Collaborators |title=Global, regional, and national levels of maternal mortality, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015 |journal=The Lancet |date=8 October 2016 |volume=388 |issue=10053 |pages=1775–1812 |doi=10.1016/S0140-6736(16)31470-2 |pmid=27733286|pmc=5224694 }}</ref><ref>{{Citation |author=Global Burden of Disease Collaborative Network |year=2016 |title=Global Burden of Disease Study 2015 (GBD 2015) Life Expectancy, All-Cause and Cause-Specific Mortality 1980-2015 |publisher=[[Institute for Health Metrics and Evaluation]] |location=Seattle |url=http://ghdx.healthdata.org/record/ihme-data/gbd-2015-life-expectancy-all-cause-and-cause-specific-mortality-1980-2015 |format=dataset}}</ref> The other is the 2015 report of the United Nations Maternal Mortality Estimation Inter-Agency Group (UN MMEIG).<ref>{{cite journal |last1=Alkema |first1=L |last2=Chou |first2=D |last3=Hogan |first3=D |last4=Zhang |first4=S |last5=Moller |first5=AB |last6=Gemmill |first6=A |last7=Fat |first7=DM |last8=Boerma |first8=T |last9=Temmerman |first9=M |last10=Mathers |first10=C |last11=Say |first11=L |author12=United Nations Maternal Mortality Estimation Inter-Agency Group collaborators and technical advisory group |title=Global, regional, and national levels and trends in maternal mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN Maternal Mortality Estimation Inter-Agency Group |journal=The Lancet |date=30 January 2016 |volume=387 |issue=10017 |pages=462–74 |doi=10.1016/S0140-6736(15)00838-7 |pmid=26584737 |pmc=5515236}}</ref> For the earlier 2013 versions of these two studies, researchers noted that they used different data and analysis to come to different conclusions about changes over time of maternal mortality in India.<ref>{{cite journal |last1=Kassebaum |first1=Nicholas J |last2=Lopez |first2=Alan D |last3=Murray |first3=Christopher J L |last4=Lozano |first4=Rafael |title=A comparison of maternal mortality estimates from GBD 2013 and WHO |journal=The Lancet |date=December 2014 |volume=384 |issue=9961 |pages=2209–2210 |doi=10.1016/S0140-6736(14)62421-1|pmid=25625393 }}</ref> | Two major global studies in 2015 report maternal mortality in India and contribute to national planning. One study is the [[Global Burden of Disease Study]], which in 2015 for the first time published a national report about India.<ref name="Global Burden of Disease 2015">{{cite journal |author1=GBD 2015 Maternal Mortality Collaborators |title=Global, regional, and national levels of maternal mortality, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015 |journal=The Lancet |date=8 October 2016 |volume=388 |issue=10053 |pages=1775–1812 |doi=10.1016/S0140-6736(16)31470-2 |pmid=27733286|pmc=5224694 }}</ref><ref>{{Citation |author=Global Burden of Disease Collaborative Network |year=2016 |title=Global Burden of Disease Study 2015 (GBD 2015) Life Expectancy, All-Cause and Cause-Specific Mortality 1980-2015 |publisher=[[Institute for Health Metrics and Evaluation]] |location=Seattle |url=http://ghdx.healthdata.org/record/ihme-data/gbd-2015-life-expectancy-all-cause-and-cause-specific-mortality-1980-2015 |format=dataset}}</ref> The other is the 2015 report of the United Nations Maternal Mortality Estimation Inter-Agency Group (UN MMEIG).<ref>{{cite journal |last1=Alkema |first1=L |last2=Chou |first2=D |last3=Hogan |first3=D |last4=Zhang |first4=S |last5=Moller |first5=AB |last6=Gemmill |first6=A |last7=Fat |first7=DM |last8=Boerma |first8=T |last9=Temmerman |first9=M |last10=Mathers |first10=C |last11=Say |first11=L |author12=United Nations Maternal Mortality Estimation Inter-Agency Group collaborators and technical advisory group |title=Global, regional, and national levels and trends in maternal mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN Maternal Mortality Estimation Inter-Agency Group |journal=The Lancet |date=30 January 2016 |volume=387 |issue=10017 |pages=462–74 |doi=10.1016/S0140-6736(15)00838-7 |pmid=26584737 |pmc=5515236}}</ref> For the earlier 2013 versions of these two studies, researchers noted that they used different data and analysis to come to different conclusions about changes over time of maternal mortality in India.<ref>{{cite journal |last1=Kassebaum |first1=Nicholas J |last2=Lopez |first2=Alan D |last3=Murray |first3=Christopher J L |last4=Lozano |first4=Rafael |title=A comparison of maternal mortality estimates from GBD 2013 and WHO |journal=The Lancet |date=December 2014 |volume=384 |issue=9961 |pages=2209–2210 |doi=10.1016/S0140-6736(14)62421-1|pmid=25625393 |s2cid=205975571 }}</ref> | ||
In 2017 a report found no significant impact following a large study of 160,000 pregnant women who participated in a one-week educational program to improve maternal health and childbirth outcomes.<ref name="Semrau 2017">{{cite journal |last1=Semrau |first1=Katherine E. A. |last2=Hirschhorn |first2=Lisa R. |last3=Marx Delaney |first3=Megan |last4=Singh |first4=Vinay P. |last5=Saurastri |first5=Rajiv |last6=Sharma |first6=Narender |last7=Tuller |first7=Danielle E. |last8=Firestone |first8=Rebecca |last9=Lipsitz |first9=Stuart |last10=Dhingra-Kumar |first10=Neelam |last11=Kodkany |first11=Bhalachandra S. |last12=Kumar |first12=Vishwajeet |last13=Gawande |first13=Atul A. |title=Outcomes of a Coaching-Based WHO Safe Childbirth Checklist Program in India |journal=New England Journal of Medicine |date=14 December 2017 |volume=377 |issue=24 |pages=2313–2324 |doi=10.1056/NEJMoa1701075|pmid=29236628 |pmc=5672590 }}</ref> | In 2017 a report found no significant impact following a large study of 160,000 pregnant women who participated in a one-week educational program to improve maternal health and childbirth outcomes.<ref name="Semrau 2017">{{cite journal |last1=Semrau |first1=Katherine E. A. |last2=Hirschhorn |first2=Lisa R. |last3=Marx Delaney |first3=Megan |last4=Singh |first4=Vinay P. |last5=Saurastri |first5=Rajiv |last6=Sharma |first6=Narender |last7=Tuller |first7=Danielle E. |last8=Firestone |first8=Rebecca |last9=Lipsitz |first9=Stuart |last10=Dhingra-Kumar |first10=Neelam |last11=Kodkany |first11=Bhalachandra S. |last12=Kumar |first12=Vishwajeet |last13=Gawande |first13=Atul A. |title=Outcomes of a Coaching-Based WHO Safe Childbirth Checklist Program in India |journal=New England Journal of Medicine |date=14 December 2017 |volume=377 |issue=24 |pages=2313–2324 |doi=10.1056/NEJMoa1701075|pmid=29236628 |pmc=5672590 }}</ref> | ||