Chhattisgarh has shown a big jump of 18 points in the maternal mortality ratio (MMR) in the duration of two years—the highest among all states in the country—indicating deteriorating safety conditions for childbirth and poor health of mothers-to-be in the state.
MMR is the number of women succumbing to childbirth-related complications per lakh live births, and high MMR indicates poor health infrastructure and overall poor health conditions of pregnant women.
According to the recently released special bulletin under the Sample Registration System (SRS) by the Registrar General of India (RGI), Chhattisgarh reported MMR of 159 per lakh live births for the time period of 2016-18—a big rise from MMR of 141 in 2015-17.
Meanwhile, Rajasthan has performed the best in this two-year overlapping duration (2015-17 to 2016-18) with a 22 point decline in the MMR—from 188 to 164 per lakh live births.
On average, India has shown a nine-point decline in MMR in the two-year overlapping duration, and the national average now stands at 113. This would mean that for every one lakh children born, 113 mothers died during the childbirth process or immediately after due to post-birth complications.
Big northern states like Uttar Pradesh and Madhya Pradesh have also shown sharp decline in MMR. Uttar Pradesh has reported MMR of 197 for 2016-18 duration—the second highest in the country, but 19 points lower than the MMR reported in 2015-17.
Madhya Pradesh has reported MMR of 173—third highest in the country, but 15 points lower than MMR of 2015-17 (188).
Assam has reported the highest MMR in the country at 215 per lakh live births, though it has also shown a decline of 14 points compared to 2015-17 time period.
Kerala has the lowest MMR in the country at 43 per lakh live births, though there has been an increase of one point compared to 2015-17.
Statistical discrepancy?
While the sharp rise in Chhattisgarh and also Uttarakhand (10 point rise) look apparently worrying, health experts and officials see some statistical discrepancy in the figures.
The states of Chhattisgarh and Uttarakhand were carved out of Madhya Pradesh and Uttar Pradesh respectively in 2000, but till the time period of 2014-16, the SRS special bulletin on MMR gave a combined figure for the states.
Health and nutrition activist Sachin Jain pointed out that separate figures for these two smaller states as well as Jharkhand that was carved out of Bihar in 2000 too, was given for the first time in the 2015-17 special bulletin on MMR.
In that bulletin, Chhattisgarh (141 from 173) and Uttarakhand (89 from 201) showed significant dip in MMR while the parent states MP (188 from 173) and UP (216 from 201) showed a jump in the figures.
In the current bulletin for the time period 2016-18, MP and UP have shown decline in figures, while Chhattisgarh and Uttarakhand have shown a rise, Jain pointed out.
However, the case of Bihar and Jharkhand are a bit different. In the combined bulletin of 2014-16, Bihar (with Jharkhand) had an MMR of 165 and when separate figures for Jharkhand were released for first time in 2015-17, Bihar’s MMR remained at 165, while that for Jharkhand was significantly lower at 76.
This time (2016-18), Bihar has shown a decline of 16 points to register MMR of 149, while Jharkhand has shown a decline of five points to register MMR of 71.
“There seems to be some kind of error or discrepancy in the figures, especially in the case of these bifurcated states and there is a need to go deeper into this,” Jain said.
Health secretary of Chhattisgarh, Niharika Barik, while speaking to THE WEEK, also mentioned that the comparative MMR figures indicate some statistical discrepancy. “This needs to be checked, as we have achieved a decline compared to 2014-16 figures. However, having said that, we are taking due steps to make motherhood more safe. One of the big focuses is to control infection at hospital and especially labour room level during and after childbirth,” the officer said.
She added that a hand holding programme for nurses and auxiliary nurse midwives (ANMs) posted at primary and community health centres level has also been approved under the National Health Mission, and this will help in improving capabilities of the health workers and minimizing any mistakes.
