Health experts across the world have a reason to cheer as far as maternal deaths are concerned. In a global data released by the United Nations, maternal deaths have witnessed a decline from 5.2 lakhs reported in 1990 to 2.89 lakhs in 2013– a significant drop by 45 per cent.
In 2013, the global maternal mortality ratio (MMR) was 210, down from MMR of 380 in 1990. MMR refers to the number of women who die as a result of complications due to pregnancy or childbearing in a given year per one lakh live births in that year.
While there is enough reason to celebrate globally, India needs to take some heavy measures to bring its MMR under control. The report gives a worrying figure- India, along with Nigeria, accounts for one-third of total maternal deaths. India accounted for 50,000 maternal deaths and Nigeria had 40,000 maternal deaths respectively in 2013.
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While India has fared well in terms of reducing MMR by 16 per cent in 2011-12 from 2007-09, it is still miles away from achieving the Millennium Development Goal (MDG) mandates. According to the report, India along with nine other countries accounts for 60 per cent global maternal deaths. The other countries are—Nigeria, Ethiopia, Democratic Republic of the Congo, Indonesia, Pakistan, United Republic of Tanzania, Kenya, China and Uganda
The rate at which the MMR is declining is slower than anticipated, says the report. The global reduction of MMR in 2000-2013 stood at 3.5 per cent of annual decline, higher than 1990-2000 with 1.4 per cent. However, at current trends, most countries will not be able to achieve the MDG target of a 75 per cent reduction in MMR from 1990 to 2015. An average decline of 5.5 per cent or more every year since 1990 is needed to meet the target on time.
The report also laid stress on new emerging reasons for maternal deaths which need to be dealt with. A World Health Organisation (WHO) study, called Global causes of maternal death: a WHO systematic analysis, stated that more than one in four maternal deaths are caused by pre-existing medical problems like diabetes, HIV, malaria and obesity. More than 60 000 maternal deaths in 115 countries were due to these pre-existing medical conditions which got intensified due to pregnancy.
Dr Marleen Temmerman, Director of Reproductive Health and Research at WHO and co-author of the study, said, “Integrated care for women with conditions like diabetes and obesity will reduce deaths and prevent long-lasting health problems.”
“Together, the two reports highlight the need to invest in proven solutions, such as quality care for all women during pregnancy and childbirth, and particular care for pregnant women with existing medical conditions,” said Dr Flavia Bustreo, Assistant Director-General, Family, Women’s and Children’s Health, WHO.
It further added that despite advances in the last 20 years, there has been too little progress in preventing adolescent pregnancies, abortions, maternal deaths, sexually-transmitted infections and HIV, and there are significant gaps in availability, quality and access to comprehensive sexuality education and services for young people, especially in low-income countries.
“More than 15 million girls aged 15 to 19 years give birth every year – one in five girls before they turn 18 – and many of these pregnancies result from non-consensual sex,” said Kate Gilmore, Deputy Executive Director, United Nations Population Fund (UNFPA). “Relatively simple and well-known interventions, like midwifery services and gender-based violence prevention and response, can make a huge difference if scaled up and coupled with investments in innovations, especially in the area of contraceptives,” she added.
According to the global report, Sub-Saharan Africa is at the highest risk of deaths due to complications in childbirth and pregnancy. Somalia and Chad, where women face a one in 18 and one in 15 lifetime risk respectively, are also at high risk of maternal deaths.