India's Maternal Mortality Ratio (MMR) has declined to 93 per 1,00,000 live births during 2019–21 (as per SRS data), but stark regional disparities, persistent systemic delays, and avoidable deaths continue, especially in EAG states.

Persisting Disparities in Maternal Mortality

• Stark Regional Contrasts in MMR:While Kerala reports the lowest MMR at 20, states like Madhya Pradesh (175) and Assam (167) continue to witness alarmingly high maternal deaths. Southern states have consistently performed better than EAG states in maternal health indicators.
• Inadequate Functioning of FRUs:The idea of operationalising four First Referral Units (FRUs) per district has been inadequately implemented. Of the 5,491 CHCs, 66% face specialist shortages, and many lack functional blood banks, undermining emergency obstetric care.
• Need for Cluster-Based Strategy:A differentiated approach is essential—EAG states must focus on basic access, early registration, and institutional deliveries, while southern and western states should emphasize quality improvement in emergency obstetric services.

The Three Delays Leading to Maternal Deaths

• Delay in Decision-Making at Household Level:Families often delay seeking care due to lack of awareness, financial constraints, or cultural inertia. Empowerment through ASHA-ANM networks and JSY incentives has improved outcomes but gaps remain.
• Delay in Reaching Healthcare Facilities:In remote rural and tribal regions, transportation delays can be fatal. While the 108 ambulance system under NHM has improved access, infrastructural limitations still restrict timely referrals.
• Delay in Receiving Adequate Care at Facilities:Hospitals often fail to provide timely interventions due to lack of specialists, OT readiness, blood availability, or absence of anaesthetists—making this the most avoidable but recurring delay.

Clinical Causes and the Way Forward

• Major Medical Causes of Maternal Deaths:Leading causes include postpartum haemorrhage, obstructed labour, hypertensive disorders, sepsis, and unsafe abortions. Poor antenatal care and untreated anaemia exacerbate these risks.
• Technical and Surgical Interventions:Kerala’s model uses uterine artery clamps, suction canulas, and proactive management of complications like amniotic embolism. These innovations reflect high-quality care not yet mainstreamed across India.
• Strengthening Surveillance and Mental Health Care:Mandatory audits under NHM and confidential reviews in Kerala help pinpoint failures. Kerala even integrates care for antenatal depression and postpartum psychosis, underscoring a holistic maternal health approach.

Practice Question:

Despite a decline in India’s Maternal Mortality Ratio, systemic delays and regional disparities remain critical concerns. Examine the causes and suggest targeted policy interventions to address maternal mortality in high-burden states. (250 words)