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Maternal Mortality ratio (MMR) reflects the risk to mothers during
pregnancy and childbirth. It is influenced by general
socioeconomic conditions, nutrition and sanitation, as well as by
maternal health care. It is expressed by the number of deaths
attributed to complications of pregnancy and childbirth occurring
over a year, divided by the total number of live-births in the
year. It is often expressed as the number of maternal deaths per
1000 live-births or per 100000 live births. Deaths due to abortion
are sometimes excluded. Developed countries achieved MMR as low as
10 per 100000.
It is estimated that nearly 75 percent of maternal deaths are
due to five causes namely hemorrhage, sepsis or infection toxemia,
obstructed labor and complication of unsafe abortions. The
remaining 25 percent of deaths are due to indirect causes such as
communicable diseases. Cultural restrictions on mobility of women
limit her access to health care. This is further complicated by
the fact many programmers do not have sufficient number of well
qualified female health care providers (Padma, 2000).
Computation of MMR requires data on the number of deaths of
women of reproductive age (15-49 years) and information on the
cause of death as well as whether the woman was pregnant at the
time of death, or had recently been so (Brundtland, 2000). In the
absence of complete and reliable vital registration and
cause-of-death data, the measurement of maternal mortality ratios
is difficult. Because the event is relatively rare. Very large
sample sizes are required to capture sufficient numbers of
maternal deaths to give a reasonably accurate estimate of the
maternal mortality ratio. These difficulties with estimation call
for caution in the interpretation of data on maternal mortality
ratios - either the ratio is based on incomplete information, or
is at best a rough estimate. (Brundtland, 2000).
Precise estimates of maternal mortality rate (MMR) in Andhra
Pradesh is not available. The NFHS did collect data to estimate
maternal mortality rates. Both NFHS- 1&2 give MMR estimates at
the national level. All India estimates of MMR ranges from 400 to
500 deaths per 100000 live births (IIPS, 2000). Mahapatra (2000)
studied causes of death patterns in Andhra Pradesh (Table 1). We
have computed MMR using estimates of maternal deaths in AP during
the 1990s by Mahapatra (2000), and an estimate of live births in
AP on 1991 census population and SRS estimates of CBR. This would
imply that MMR in AP may be around 260 per 100000 live births.
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| Table 1: Major
causes of death among women in reproductive age group of
15-44 years, for the year 1991 in AP. |
| Cause
of death |
Number of female
deaths |
| Rural |
Urban |
Total |
| All causes |
44109
|
8049
|
52158
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| Maternal Causes |
| Maternal Hemorrhage |
462
|
82
|
544
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| Maternal sepsis |
462
|
118
|
580
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| Hypertensive disorders of
pregnancy |
599
|
4
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603
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| Obstructed labour |
308
|
7
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315
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| Abortion |
1044
|
56
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1100
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| Other maternal conditions |
890
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389
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1279
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| Other major
causes |
| Self-inflicted
injury (suicides) |
8544
|
94
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8638
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| Fire accidents |
1763
|
1645
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3408
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| Violence |
1215
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349
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1564
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| Estimated
maternal deaths |
3765
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656
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4421
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| Estimated births in
1991 |
1288453
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436446
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1729208
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| Maternal
Mortality Ratio |
292/ 100000
live births |
150/ 100000 live births
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256/ 100000 live births
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| Source:
Mahapatra, Estimating National Burden of Disease, 2000,
Appendix: 3-7.1 and 3-8.1. |
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A more interesting aspect of the cause of death
estimates shown in Table 1 is the large number of deaths of young
and adult women due to non maternal causes. About 4400 woman die
of maternal causes. But 8500 women commit suicide every year. This
is about twice the number of maternal deaths. Another 3000 women
die on account of fire accident or violence. These deaths have
intricate relationship with status of women, socioeconomic
vulnerability and poor power equation of women. |
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| Figure 1: Maternal
causes of deaths among women in reproductive age group of
15-44 years, for the year 1991 in AP. |
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Source: Mahapatra,
Estimating National Burden of Disease, 2000, Appendix:
3-7.1 and 3-8.1. |
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A recent study (Mahapatra, Rao and Kumar, 2000)
gives indirect estimates of MMR using the sisterhood method.
Indirect estimates of MMR from this District Family Health Survey
(DFHS) is shown in Table 2. According to this study MMR around the
late 1980s was about 258/100000 live births. The MMR increased to
about 321/100000 live births around the early 1990s. |
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| Table 2: Indirect
estimates of maternal mortality in three districts of AP. |
| Time
location of estimates |
District - MMR per
100000 live births |
| Nellore |
Chittoor |
Mahboobnagar |
Pooled |
| 12 years ago i.e. around 1988 |
264 |
211 |
202 |
258 |
| 6 year 10 months ago, i.e.
around 1993-94 |
248 |
651 |
169 |
321 |
| 5 year 8 months ago, i.e. around 1994-95 |
790 |
234 |
1,775 |
997 |
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Source: Mahapatra, Rao,
Kumar, District Family Health Survey, IHS RP 08/2001. |
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So far the estimates from this study are consistent
with the estimate derived from cause of death pattern estimated by
Mahapatra (2000). These estimates are also consistent with
national level estimates from NFHS. The puzzling part of MMR
estimate from the DFHS study, shown in table-9 is the very high
level of MMR, (about 997 maternal deaths/100000 live births)
estimated for more recent periods i.e late 1990s. More over,
according to these estimates MMR appear to be increasing. Maternal
mortality is a major cause of death for woman in reproductive age
group. In figure 2 we have plotted the time trend of the female
death rate in 15-44 years age group for the years 1970-98. These
estimates are from SRS. We can see that there has been a gradual
and sustained decrease in this age sex specific death rates from
1973 to 98. The maternal deaths could be included in this envelop
of all cause mortality of 15-49 years females. The SRS provides
direct estimates of age specific death rates. Hence we attach more
importance to the SRS estimates. Since the all cause mortality has
shown sustained decline, large scale increase in maternal
mortality values not appear plausible.
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| Figure 2: Female
death rate in 15-49 years age group for the years 1970-98 |
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| Source:
Computed from SRS estimates of female age-specific death
rates of 15-19 years age group to 45-49 years age group and
SRS estimates of female population for the years 1970-98. |
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The Commissioner Family Welfare collects
information about maternal deaths in the state through the ANMs
posted at subcentres. Each ANM is expected to report maternal
deaths in her subcentre area. These are consolidated at the state
level. As per these reports the no.of maternal deaths in the year
2000-2001 and 2001-2002 is 710 and 527 respectively. The MMR for
2000-2001 year is 56/100000 live births and 60/100000 live births
for the year 2001-2002. Obviously, this is a gross under estimate
of the time situation in the state.
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Updated by
Samatha Reddy
Dated: 18/08/2003 |
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