Background
Reduction in maternal and child mortality has been a top priority in India, especially
in light of the commitment on the part of the national government to the reach the
Millennium Development Goals. Despite massive program efforts and availability of
technology needed to avert maternal deaths, the maternal mortality ratio (MMR) in
India continues to be high. Population-based estimates of MMR are lacking, and reliable
evidence of role of socioeconomic determinants and program-related factors that mediate
medical causes is not available. The present study was conducted to develop population-based
estimates of MMR, and to evaluate the primary causes of maternal deaths and factors
associated with excess risk of maternal mortality.
Methods
The study was conducted in the state of Rajasthan in India, covering 25,926 households
in 411 villages. It has two major components: a community-based household survey and
a case-control study with cases and controls sampled from the same population. A total
of 32 maternal deaths and 6,165 live births were identified. The group of women who
died during pregnancy or delivery (cases) is compared with a group of women who gave
birth and survived (controls).
Results
MMR was estimated to be 519 (95% confidence interval [CI], 477–561). Hemorrhage was
the chief cause (31%) of maternal deaths; the other causes were obstructed labor,
severe anemia, puerperal sepsis, and abortion. Young age at child birth (odds ratio
[OR], 2.6; 95% CI, 1.9–3.2) and poverty (OR, 2.5; 95% CI, 1.6–3.4) were independently
associated with increased risk of maternal death. Presence of complications during
antenatal period was an important predictor of maternal death (OR, 7.8; 95% CI, 6.8–8.8).
Childbirth at home (OR, 4.4; 95% CI, 3.3–5.5) was associated with increased risk of
maternal death. The study provides clear evidence for renewed program efforts and
strategies for reducing complications and maternal deaths.
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Biography
Shiv D. Gupta, Fellow of the National Academy of Medical Sciences, India (FAMS), is Director of Institute of Health Management Research, Jaipur (India). He is a public health expert with a distinguished academic and research career. He obtained his PhD (Epidemiology) from Johns Hopkins University, USA.
Biography
Anoop Khanna, with a background in social work and PhD in Sociology, is Associate Professor at Institute of Health Management Research, Jaipur (India). Having worked in health sector for more than fifteen years, he has acquired considerable experience in programme management and research.
Biography
Rajeshwari Gupta is a senior faculty in medical school, Jaipur. She has a large experience of gynecology and obstetrics with about thirty years of experience in maternity care.
Biography
Nand K. Sharma has a background of social sciences, and has been working with Institute of Health Management Research, Jaipur (India) as Lecturer. He has been working on maternal and child health issues, and has gained expertise in community based surveys.
Biography
Narottam D. Sharma is Senior Research Officer at Institute of Health Management Research, Jaipur (India). He has been working in health sector for more than two decades, and developed expertise in community based surveys and implementing health interventions.
Article info
Publication history
Accepted:
October 29,
2009
Received in revised form:
October 28,
2009
Received:
June 5,
2009
Identification
Copyright
© 2010 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.
