Kerala has yet again emerged on top when it comes to maternal and child health, with the State recording the lowest Maternal Mortality Ratio (MMR) of 30 (per one lakh live births) in the country. This puts Kerala way ahead of the national MMR of 103.
According to the latest Sample Registration System (SRS) special bulletin on maternal mortality in India (2017-19), brought out by the office of the Registrar General of India, Kerala’s MMR has dropped by 12 points. The last SRS bulletin (2015-17) had put the State’s MMR at 42 (later adjusting it to 43).
“This is an exciting moment for us, because Kerala has already achieved the target it had set for itself, based on the U.N. Sustainable Development Goals, of an MMR of 30 by 2020, that too, one year ahead. We have to acknowledge the contribution of the private health sector too, where 65% of the deliveries take place, even though all complicated deliveries finally end up at public sector tertiary care maternity hospitals,” a senior health official said.
“COVID-19 has claimed over 90 mothers in Kerala in the past two years. This will reflect badly in our figures next year. But the State has made substantial investments in setting up high dependency units in every district and in improving 39 delivery points under the Union Health Ministry’s LaQshya (a quality improvement initiative in labour room & maternity operation theatres) and hence everything looks bright for us to achieve the next SDG target of an MMR of 20 by 2030,” he said.
Kerala’s achievement is a result of a decade of sustained efforts at properly assessing the cause of maternal mortality in the State and taking up targeted initiatives to tackle each of these.
It developed the Quality Standards in Obstetric Care, in partnership with the NICE International and leading specialists in 2012-13 and focussed on the management of some of the common causes of maternal deaths -- postpartum haemorrhage (PPH), pregnancy-induced hypertension (PIH), sepsis, and amniotic fluid embolism.
“The implementation of these quality standards changed obstetric practice in many delivery points. There has been a substantial reduction in deaths due to sepsis, PIH and PPH, even though postpartum haemorrhage continues to be a serious concern. Depressive disorders amongst young pregnant women leading to suicides is another major concern we need to address,” V.P. Paily, senior obstetrician and the master trainer in safe obstetric practices for the Kerala Federation of Obstetrics and Gynaecologists (KFOG), said.
“Confidential Review of Maternal Deaths, an initiative diligently done by KFOG since 2004-05 and which laid the foundation for all maternal health improvement initiatives later, was strengthened by maternal near-miss audits in all districts, to analyse the critical events which resulted in near maternal deaths. Kerala is perhaps the only State to have acted upon the operational guidelines released by the Union Health Ministry for Maternal Near Miss Review (MNMR) in 2014. This got the districts involved, along with much hand-holding for the private sector too,” an official said.
Improvement of the health system’s emergency or rapid response during obstetric emergencies, especially in secondary care hospitals, including provision of emergency transport system, could go a long way in reducing maternal deaths further, Dr. Paily said.