Experts say that while 161 women die per 100,000 births is an improvement since 1990, more has to be done.

According to a new study, women in rural India who are poor, uneducated, and marry young have the lowest chances of having a safe birth, such as in a hospital, for every 100,000 live births in the country’s poorer states, 161 women die.

The findings, which were published in the peer-reviewed journal Global Health Action, shed light on maternity care access in nine Indian states. The authors also point to failures in government interventions to reduce deaths associated with pregnancy and childbirth in the first study of its kind.

In India, skilled care in medical facilities such as hospitals and clinics has resulted in a significant decrease in maternal deaths. However, pregnancy-related problems continue to be the leading cause of death among girls aged 15 to 19, and this new study paints an alarming picture of the situation in India’s nine low-performing states (LPS).

This study, which analyzed a national data set of 112,518 women who gave birth in India’s nine lowest performing states (which account for roughly half of the country’s population), discovered that distance, disadvantage, and high cost are additional factors contributing to more than a quarter (26%) of women still delivering at home in LPS, compared to 21% nationally.

The authors caution that cash incentives to promote institutional births are ineffective in these settings. They are advocating for more robust regional policies focused on LPS in order to enhance present rates and outcomes.

“Despite several ‘safe motherhood’ programmes initiated by the government, the maternal mortality rate remains higher in LPS than the nation’s average,” said Paul, co-author Pintu.

“Women expressed distance or lack of transportation and costs to be challenging in accessing health facilities for the delivery. This was along with other reasons like facility closures, poor service/trust issues, and others.

“Delivery at a health institution is a key intervention to avert the risk of maternal mortality due to childbirth-related complications.  

“Strengthening sub-national policies specifically in underperforming states is imperative to improve institutional delivery coverage.”

Maternal deaths account for 13% of all maternal deaths in low-performing states. This accounts for 62% of maternal deaths in India. This area accounts for 71% of infant deaths and 72% of under-five mortality.

Since 1990, significant progress has been made in lowering maternal mortality nationwide, from 556 to 113 deaths per 100,000. India, however, continues to have the 56th worst rate in the world and the 13th worst rate outside of Africa.

However, the government’s aim of 100 fatalities per 100,000 has not been fulfilled, and the rate in LPS continues to be ‘alarmingly high’ (161 deaths per 100,000), according to the study’s authors.

They analyzed data on maternal mortality at the state level (from 2016 to 2018) as well as information from the National Family Health Survey (NFHS) (2015 to 2016). The NFHS data set included 112,518 women aged 15 to 49 who had delivered a live child within the preceding five years.

The researchers questioned individuals about pregnancy difficulties and their frequency of exposure to mass media (such as newspapers).

The study also assessed women’s access to the government’s safe motherhood program, Janani Suraksha Yojana (JSY). The JSY, which began in 2005, encourages institutional delivery by integrating monetary assistance with prenatal and postpartum care for low-income pregnant women.

The study concentrated on states such as Bihar, Jharkhand, and Uttar Pradesh, which have low rates of women giving birth in medical facilities.

In addition to the findings on the place of birth, the study notes that Muslim women (62%) were less likely to deliver in a medical facility than Hindu women (76%) or women from other castes. This was also true for individuals aged 35 to 49 (60%), compared to those aged 15 to 24 (79%).

In all states, women who were completely exposed to mass media used the services at a higher rate (87%) than those who had no exposure at all (61%).

“State-specific intervention should not only focus on increasing the number of public health facilities but also improving its associated quality of care,” co-author Ria Saha, a public health consultant in London, adds.

“Although India has recently institutionalized midwifery care into the health system to strengthen the quality of maternal and new-born services in the birthing centres, inadequate clinical training and insufficient skilled human resources restrained the quality of available maternity services resulting in low coverage of institutional deliveries.

“Efficient and increased investment in the public health system at all tiers is imperative to effectively reduce financial inequities of service use and ensuring optimal care for mothers and new-borns.”

On a more positive note, interaction with community health workers influenced women’s decision to deliver in a safe location. Pregnant women who met one were more likely to give birth in a hospital or other medical facility.

Source: 10.1080/16549716.2021.2001145

Image Credit: Getty

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