Maternal death is defined as “the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and the site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes.” ICD-10,WHO, 1994.

It has been said that being pregnant and giving birth to a child is a joyous moment in a woman’s life. However where I come from, the prospect of dying during childbirth is an imminent threat that looms over every pregnant woman’s mind. It does not help that in India, even today, a large number of women deliver at home, with much higher figures in rural and remote areas.

When a woman dies during childbirth, she leaves behind more than a motherless child. The family is at risk of disintegration as a ripple effect. “Studies in developing countries indicate that the risk of death for children under five years doubles or even triples if their mother dies. Motherless children are likely to get less healthcare and education as they grow up. Girls, in particular, suffer because they are forced to drop out of school to look after their younger siblings. Maternal death is thus, almost inevitably, a double tragedy.” [1]

For many maternal mortality is a particularly sensitive indicator of inequality. It is considered as a litmus test of the status of women, their access to healthcare, and the adequacy of the healthcare system in responding to their needs.

Jharkhand is one of the most underperforming states of the country. The maternal mortality ratio (MMR) in the state is much higher than the national average. In recent years there has been a drop in the MMR of the state of about 44%. [2,3,4]

However there is still a long way to go. According to the third National Health and Family Survey in Jharkhand one could clearly see a gap in the health seeking behaviour among the women in different social groups during the antenatal care period. [5] More than a third of the marginalized groups do not have a single antenatal check-up during their pregnancy. Although more than half of women from the urban areas visit some type of healthcare facility (public, private, or trust) for delivery, in rural areas the percentage is only about 10 percent. This gap is also visible during the post natal care period. In rural areas in more than 80% of cases no pregnant women receives postnatal care services. This signifies that a major portion of the women do not undergo any type of postnatal check up, a period when the mortality rates are high.

When compared to other states in India, Jharkhand is amongst the ten worst performing states. Comparison with states which have a better MMR shows that a large number of deliveries in the better states are conducted by skilled birth attendants. This is not the case in Jharkhand. In addition to poor medical care, before, during, and after pregnancy, several factors play an important role in this situation. Low importance is given to women including reproductive care, and unfair customary practices which deprive pregnant women, lactating mothers, and infants of nutrition and food are prevalent in many areas of Jharkhand.

The definition above for maternal death is universally accepted and used for statistical enumeration. However more often than not the faces behind these numbers are forgotten. The agony women face during labour gets lost behind a big pile of paperwork. States like Jharkhand still suffer from problems that are not only due to medical methods.

Although at a national level we are improving in terms of the MMR and other maternal health indicators there are still states that are severely lagging behind. There are key equity issues such as social, economical, and geographical backgrounds that play important roles in maternal deaths. To nationally bring a change with respect to maternal deaths, the need of the hour is to help these low performing states improve and perform on par with other developed states.

Sharat Panday is a student of e-learning in Public Health Management (ePHM) course by Institute of Public Health, Bangalore.

Competing interests: None declared. 

References:

1. WHLP Safe Motherhood Studies Safe motherhood: social, economic, and medical determinants of maternal mortality by B.S. Garg, Professor and Head, Department of Community Medicine, Mahatma Gandhi Institute of Medical Sciences, Sewagram, Wardha
District, Maharashtra, India.

2. Maternal Mortality Ratio (MMR) India and Other States (2001-2003, 2004-06 and 2007-09)
Registrar General of India Report (RGI).

3. Maternal Mortality Ratio(MMR), Maternal Mortality Rate and Life Time Risk; India, EAG & Assam, South and Other states, 2011-13, Registrar General of India Report (RGI).

4. Special bulletin on maternal mortality in India 2010-12, Sample Registration System, Office of Registrar General, India.

5. Jharkhand National Family Health Survey, (NFHS 3) India.