Few things in science or social science are as incontestable as the importance of maternal health to human development. Maternal mortality indicates a woman’s ability to access health care, contraceptive devices, nutrition, and, in a sense, is a mark of the efficiency of a health-care system in responding to demands made of it. A recent study published in the peer-reviewed journal, PLOS Global Public Health, casts a shadow over the progress of health care targeting women in the country, but also, questions the reliability of the country’s own periodic estimates of maternal mortality ratio, or MMR (number of mothers who die from complications in pregnancy for every one lakh live births.) Researchers from the International Institute for Population Sciences triangulated data from routine records of maternal deaths under the Health Management Information System, with Census data and the Sample Registration System (SRS) to provide the MMR for all States and districts of India. The analysis suggests that 70% of districts (448 out of 640 districts) in India have reported MMR above 70 deaths — a target under the United Nations’ Sustainable Development Goals (SDG). Many of the districts in southern India and Maharashtra have an MMR of less than 70. At the same time, the north-eastern and central regions have the least number of districts (12 and six districts, respectively) with an MMR less than 70. Significantly, it also demonstrates the presence of huge within-State inequalities, even among the better performers — Karnataka, Tamil Nadu, Kerala, Andhra Pradesh, and Telangana. Similar heterogeneity was observed in other States as well. According to the SRS (2016-18), only Assam (215) has an MMR of more than 200, while in this district-level assessment, the indications are that about 130 districts have reported above 200 MMR.
It is ironic that as the nation plans to celebrate the 75th anniversary of Independence grandly, so many districts still show a very high MMR, clearly indicative of the inadequacy of responsiveness of health systems. But that is not the only reason. There is adequate proof that improvements in access to contraceptives, antenatal care, post-delivery health care, body mass index, and the economic status, besides a concerted reduction of higher-order births, births in higher ages, will help reduce MMR. The message during this milestone anniversary year is two pronged: improve overall care for women, and keep real time track of such crucial health data. Immediate action is required to meet the SDG goal regarding MMR. Ultimately, it is more than about just the numbers. There are people — mothers and infants, entire families — behind these numbers who will benefit from such an urgent and intense action on reducing eminently preventable deaths.