GOVERNMENT OF INDIA

MINISTRY OF HEALTH AND FAMILY WELFARE

DEPARTMENT OF  HEALTH AND FAMILY WELFARE

 

RAJYA SABHA

UNSTARRED QUESTION NO.3105

TO BE ANSWERED ON 31ST  JULY, 2009

 

Infant and maternal mortality in the country

 

3105. DR. GYAN PRAKASH PILANIA:

          SHRI LALIT KISHORE CHATURVEDI:

 

          Will the Minister of HEALTH AND FAMILY WELFARE be pleased to state:

 

(a) the detailed findings of UNICEF's ‘the State of the world's children 2009,

maternal and newborn health’ Report;

 

(b) whether child birth becomes a death sentence for 78,000 mothers, in the country annually, where a pregnant woman dies every 7 minutes;

 

(c) whether 50 per cent pregnancy deaths are of SC/ST mothers;

 

(d) whether 2.1 million children dies before their fifth birthday in the country; and

 

(e) if so, how horrendous is the scenario of IMR and MMR in India/States and how they compare with other countries?

 

ANSWER

  THE MINISTER OF HEALTH AND FAMILY WELFARE

(SHRI GHULAM NABI AZAD)

 

(a)    The key findings of the UNICEF’s  Report, ‘The State of the world’s children 2009’  are given  in Statement I

 

(b) The Ministry relies on the reports released by the Registrar General of India (RGI) for estimates on maternal mortality. There are no official estimates on absolute number of maternal deaths in the country. However, the sample Registration System (SRS) conducted by RGI captures Maternal Mortality Ratio through periodic surveys.  Based on the official estimates of Registrar General of India (RGI), the Maternal Mortality Ratio (MMR) for India has shown a substantial decline from 301 per 100,000 live births (RGI-SRS, 2001-03) to 254 per 100,000 live births (RGI-SRS, 2004-06).  This

 

 

 

 

 

 

translates into an approximate number of 67,000 maternal deaths.

 

(c )    RGI-SRS does not provide disaggregated data, class wise or caste wise, for Maternal Deaths.

 

(d)            The Under Five Mortality Rate for the country as per National Family Health Survey 2005-06 is 74 per 1000 live births. As per UNICEF report ‘State of World Children 2009’ 1.95 million children dies annually in the country before attaining their fifth birthday.

 

(e)      The IMR and MMR for India State wise  and the MMR & IMR for some other countries are given in Statement II, III and IV

……

 

Statement I

State Of the World’s Children 2009

 

General Maternal Mortality Data

 

In India, during 2001-2003, an estimated 78 thousand[1] women died annually from causes related to pregnancy and childbirth. This means on an average, every seven minutes, one woman dies from complications related to pregnancy and childbirth. The average lifetime risk of a woman in a least developed country dying from complications related to pregnancy or childbirth is more than 300 times greater than for a woman living in an industrialized country. No other mortality rate is so unequal. In Uttar Pradesh, a woman has a 1 in 42 lifetime risk of maternal death, compared with a probability of just 1 in 500 for women in Kerala.  For every mother who dies, an estimated 20 others suffer pregnancy-related illness or experience other severe consequences.  Some 10 million women each year experience such adverse outcomes.

 

In industrialized countries, the maternal mortality ratio (MMR) remained broadly static between 1990 and 2005, at a low rate of 8 per 100,000.  In developing countries overall MMR rises to 450 per 100,000 TK. And in Sierra Leone – the country with the highest rate of maternal death, it is 2100 maternal deaths per 100,000 live births. Millennium Development Goal 5 calls for a reduction of the maternal mortality rate to 109 by 2015. In order to meet this target, India will have to achieve about two-thirds reduction in maternal mortality rate from 301 estimated for the period 2001-2003.

 

Neonatal Mortality

 

Babies whose mothers die during the first 6 weeks of their lives are far more likely to die in the first 2 years of life than babies whose mothers survive. In a study in Afghanistan, for example, about three-quarters of infants born alive to mothers who died of maternal causes also subsequently died.  A child born in a least developed country is almost 14 times more likely to die during the first 28 days of life than one born in an industrialized country. In India, the states with the top five neonatal mortality rates – measuring deaths within the first 28 days of life – are: Orissa (52 deaths per 1,000 live births), Madhya Pradesh (51), Uttar Pradesh (46), Rajasthan (45), and Chhattisgarh (43)[2]. (2006)

 

          Regional patterns of neonatal death correlate closely to those for maternal death.  Among the top ten countries with the highest neonatal mortality rates, five of them (Liberia, Afghanistan, Sierra Leone, Angola and Mali) also fall in the top ten countries for highest maternal mortality or lifetime risk of maternal death rates. In industrialized countries, the neonatal mortality rate in 2004 was just 3 per 1000 live births.  The global neonatal mortality rate declined by one-quarter between 1980 and 2000, but its rate of reduction was much slower than that of the overall U5 mortality rate, which fell by one-third.  In India, almost 50 percent of under-five deaths occur in the first 28 days of life. Neonatal mortality rates are around 20-50 percent higher for the poorest 20 percent of households than for the richest quintile.  Similar inequities are also prevalent for maternal mortality. Like maternal deaths, 98 percent of neonatal deaths occur in low and middle-income countries, and most are preventable.

 

Direct and Underlying Causes of Maternal and Neonatal Death

 

          Three quarters of all maternal deaths in India occur from complications either during delivery or in the immediate post-partum period. These complications include: hemorrhage (38 percent of maternal deaths); infections (11%); unsafe abortion (8 %); eclampsia or related hypertensive disorders (5 %); and obstructed labour (5%). Some 82 percent of newborn deaths in India are the direct result of three main causes: 1) infections, including sepsis/pneumonia, tetanus and diarrhea, 2) asphyxia, and 3) preterm births.

·        Infections account for 24 percent of all newborn deaths.

·        Asphyxia causes 23 percent of newborn deaths.

·        Preterm birth causes 35 per cent of newborn deaths.

 

Child Marriage as a factor in Maternal Mortality:

·        Girls who give birth before the age of 15 are five times more likely to die in childbirth than women in their 20s.

·        If a mother is under the age of 18, her infant’s risk of dying in its first year of life is 60 percent greater than that of an infant born to a mother older than 19.

·        In India almost half the women age 20-24 were married before they were 18. In Bihar 69% women age 20-24 were married before 18 years. Worldwide, more than 60 million women age 20-24 were married before they were 18.

 

Factors Influencing Maternal and Neonatal Health

 

Signs of Progress:

·        Substantial progress has been made in a number of key maternal health areas. For example, 77 per cent of women in India now receive antenatal care from a skilled provider at least once during pregnancy.

·        South Asia’s progress is particular striking, from 46 percent in around 1995 to 65 per cent in 2005. 

·        There has been a marked increase in skilled delivery attendance in all regions of the dev world over the last decade, with the notable exception of sub-Saharan Africa.

 

          Research has shown that approximately 80 percent of maternal deaths could be averted if women had access to essential maternity and basic health-care services. Three quarters of all maternal deaths occur from complications either during delivery or in the immediate post-partum period. Skilled health workers with access to essential drugs, supplies and equipment to provide adequate care could prevent the vast majority of these deaths.  A quarter of the world’s unattended deliveries take place in India, which is 1 of 10 countries which together account for 2/3 of births not attended by skilled health workers.

 

          Within countries, the likelihood of being attended during delivery varies widely depending on a woman’s geographic location and economic status. In 2000, a skilled attendant was present at just 20 percent of deliveries in rural communities, compared to 69 percent in urban areas. And, for the developing world as a whole, the deliveries of women from the poorest fifth of households are half as likely to be attended by skilled health workers as those from the richest households. The world is facing a shortage of 4.3 million health workers, with every region except Europe showing a shortfall. There are not enough skilled health workers – doctors, nurses or midwives – to attend all the world’s births. 

 

          A study found that countries need an average of 2.28 health-care professionals per 1000 people to achieve the minimum desired level of coverage for skilled attendance at delivery.  Fifty-seven countries fall below this threshold, 36 of which are in sub-Saharan African. The countries with the largest shortages of health workers in absolute numbers are in Bangladesh, India and Indonesia. However, the largest relative need is in sub-Saharan Africa, where the number of health workers would have to rise 140 percent to achieve the requisite density.

 

          Many women in developing countries have no say in their own health-care needs. In Mali, Burkina Faso, Nigeria, and Malawi, for example, more than 70 percent of women say their husbands alone make the decisions regarding their health care. Studies conducted throughout the developing world (with the exception of Latin America) showed that more than one-third of women surveyed said their husband alone made the decisions regarding their health care.

 

 

 

Statement II

Infant Mortality Rate

 

 

 

 

 

 

2007

 

Sl.

    States

No.

 

 

ALL INDIA

55

1

Andhra Pr.

54

2

Assam

66

3

Bihar

58

4

Chhatisgarh

59

5

Gujarat

52

6

Haryana

55

7

Jharkhand

48

8

Karnataka

47

9

Kerala

13

10

Madhya Pr.

72

11

Maharashtra

34

12

Orissa

71

13

Punjab

43

14

Rajasthan

65

15

Tamil Nadu

35

16

Uttar Pr.

69

17

W. Bengal

37

18

Arunachal Pr

37

19

Delhi

36

20

Goa

13

21

Himachal Pr .

47

22

J & K

51

23

Manipur

12

24

Meghalaya

56

25

Mizoram

23

26

Nagaland

21

27

Sikkim

34

28

Tripura

39

29

Uttaranchal

48

30

A&N Islands

34

31

Chandigarh

27

32

D&N Haveli

34

33

Daman & Diu

27

34

Lakshadweep

24

35

Pondicherry

25

  (Source: RGI, (SRS) 2007

    Statement III

 

Maternal Mortality Ratio

        India and State wise

 

Major State

MMR

(2004-06)

India Total

254

Assam

480

Bihar/ Jharkhand

312

Madhya Pradesh/ Chhattisgarh

335

Orissa

303

Rajasthan

388

Uttar Pradesh/ Uttaranchal

440

Andhra Pradesh

154

Karnataka

213

Kerala

95

Tamil Nadu

111

Gujarat

160

Haryana

186

Maharashtra

130

Punjab

192

West Bengal

141

Others

206

                                        (Source: RGI, (SRS) 2004 - 06

 

 

 

Statement IV

 

Comparative IMR and MMR of Some Neighbouring & Western countries

Neighbouring countries

IMR

MMR

Western countries

IMR

MMR

Afghanistan

165

1800

Ireland

4

1

Nepal

43

830

Germany

4

4

Bangladesh

47

570

United kingdom

5

8

Bhutan

56

440

France

4

8

Pakistan

73

320

United State of America

7

11

Sri Lanka

17

58

Russian Federation

13

28

 

Source -  State of the World’s Children 2009

 

 

 

 

 

 


[1] Maternal Mortality in India 1997-2003, Sample Registration System, Office of the Registrar General, India

[2] Annual Statistical Report : Sample Registration System 2006