Article| Volume 20, ISSUE 1, P80-85, January 2010

Maternal Mortality Ratio and Predictors of Maternal Deaths in Selected Desert Districts in Rajasthan

A Community-Based Survey and Case Control Study


      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.


      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).


      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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      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.


      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.


      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.


      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.


      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.