Audits, kits, accessibility and more! Here’s how the southern states brought maternal mortality rate down by 36%

South First takes a quick look at the initiatives that have helped the five southern states post an overall MMR of 49.

BySumit Jha

Published Dec 01, 2022 | 9:08 AM Updated Dec 01, 2022 | 1:07 PM

Maternal Mortality Rate

Several initiatives rolled out by respective state governments have brought down the Maternal Mortality Rate (MMR) in South India.

The latest Sample Registration System (SRS) report by the Registrar General of India has revealed a sharp decline in the MMR in the southern states, compared to their northern counterparts.

The five states — Telangana, Andhra Pradesh, Karnataka, Tamil Nadu and Kerala — together reported a 36.36 percent decline in the MMR during 2018-2020 from 2014-2016, the report revealed.

The latest survey (2018-20) also put the overall MMR in the southern states at 49, compared to 77 in 2014-16.

MMR represents the risk associated with each pregnancy. It signifies the health of pregnant women as well as the resources she gets during pregnancy and the health infrastructure of the state.

It is defined as the number of maternal deaths per 1,00,000 live births during a specific period. Sustainable Development Goals set by the United Nations aimed at bringing the global MMR below 70 per 1,00,000 live births.

According to the World Health Organisation, maternal death is, “The annual number of female deaths from any cause related to or aggravated by the pregnancy or its management (excluding accidental or incidental causes) during pregnancy and childbirth or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy.”

Kerala’s MMR lowest in India

The SRS reported that Kerala has the lowest MMR of 19, which is also the lowest in the country. Telangana reported an MMR of 43, followed by Andhra Pradesh (45), Tamil Nadu (54) and Karnataka (69) during the 2018-20 survey period.

The 2014-16 survey had put Kerala’s MMR at 46, Tamil Nadu, 66, Andhra Pradesh, 74, Telangana, 81, and Karnataka, 108.

Besides the five southern states, only three more states reported an MMR of less than 70 during 2018-20: Maharashtra, 33, Jharkhand, 56, and Gujarat, 57.

Effective auditing 

Though the southern states have several programmes to check MMR, Kerala and Tamil Nadu can boast of their auditing practices for reducing the mortality rate.

“Kerala has a system under each district medical officer (DMO) to audit any maternity-related death. Besides, the system has a team of doctors in all districts to conduct the audit. The officers will try to find the cause of the death and will report their findings to the state nodal officer. The audit is done for every maternal death in the state. Once the report reaches the nodal officer, we take up targeted initiatives to tackle each reason,” an official with Kerala's Health Department told South First.

Tamil Nadu, meanwhile, has a multi-level auditing system. “We do an individual audit of all maternal deaths at three levels: at the community, institution and state level. Lapses identified are rectified then and there,” Dr B Shanthi, Deputy Director, Maternal Care, National Health Mission, Tamil Nadu, told South First.

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KCR Kits in Telangana

Telangana has witnessed a sharp decline in MMR ever since the formation of the state in 2014. The credit goes to various government programmes.

“Women who have enrolled themselves in the KCR kit scheme have allowed the government to periodically monitor their health. This helps in paying special attention to the health of pregnant women. As part of the KCR kit scheme, monthly checkups and quality services are provided to pregnant women at each stage,” T Harish Rao, Telangana's Health Minister said in a statement.

The government has its focus on preventable maternal deaths. Four antenatal care (ANC) checkups are mandatory for every pregnant woman. Supplementary tablets are provided free of cost to those suffering from anaemia. ASHA (Accredited Social Health Activists) and Auxiliary Nursing Midwifery (ANM) personnel provide iron supplements to pregnant women and create awareness of their correct use.

The health department said ASHA and ANMs are trained to identify pregnant women in the high-risk category early and provide them with the necessary support. The government has also started a midwifery system to promote normal births.

Trained nurses are made available in government hospitals. Additionally, 207 midwifery nurses provide counselling, exercise tips, and mentally prepare pregnant women.

To encourage deliveries in government hospitals, ANMs alert pregnant women in their assigned areas on the date of delivery and ensure they are admitted to hospitals, besides providing adequate support.

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Tamil Nadu: Conditional cash transfer

Tamil Nadu's Dr Muthulakshmi Maternity Benefit Scheme provides optimum nutrition for pregnant and lactating women. It also compensates for the wage loss during pregnancy.

“We have the Dr Muthulakshmi Maternity Benefit Scheme which provides each mother ₹18,000 and nutrition kits. This is a conditional cash transfer scheme. The money is distributed in instalments," Dr Shanthi said.

The conditions include five antenatal checkups and scans, and all necessary investigations. The woman will receive ₹2,000 on meeting each condition. The final condition is the measles-rubella vaccination between the ninth and 12th month of infants.

Dr Shanthi said that the state has set a target of bringing the MMR down to 40 by 2030. “We have a long way to go,” she added.

Kerala: Setting standards

Kerala developed quality obstetric care standards to check MMR in the state.

“The health department has a maternal mortality programme. The National Health Mission and Kerala Federation of Obstetricians and Gynecology (KFOG) also have different programmes to reduce the mortality rate,” said the health official from Kerala.

The programmes cover the labour room and even the psychiatric ward. “We train doctors, nurses, and individuals who take care of the mother. We train them in postpartum haemorrhage, sepsis, amniotic fluid embolism, and pregnancy-induced hypertension,” the health official, who did not wish to be identified, said.

He said such programmes helped Kerala meet its 2030 target of achieving an MMR of 20 much in advance. "There are various other issues — such as depressive disorder in young pregnant women — that have to be addressed,” he added.

Karnataka: Accessibility is the key

A senior health official in Karnataka told South First that the state has made hospitals accessible to pregnant women.

“The response time earlier was three to four hours for a woman in labour. It has come down a lot after hospitals were made available near their homes,” Dr Rajkumar N, Karnataka's Deputy Director (Maternal Health) told South First.

He said that the quality of care provided under LaQshya (Labour room quality improvement) and Kayakalpa schemes are also helping in decreasing the MMR.

“ASHA workers voluntarily identify all the high-risk patients and ensure that they reach the institutions for deliveries on time. The number of institutional deliveries, too, has shown a remarkable increase,” he said.

Dr Rajkumar said Karnataka is aiming to bring the MMR on par with Kerala. “We are looking at providing 24x7 service at taluka (block) hospitals where complicated deliveries, too, could be handled.

He also said that the chief minister holds a monitoring and review meeting every six months, and the focus is on reducing MMR and IMR. "All district medical officers and heads of hospitals attend the half-yearly review meeting," he said.

“Besides the half-yearly meeting, the health minister holds a review meeting on every Monday,” he added.

Karnataka, meanwhile, has decided to set up more mother and child hospitals across the state.

“Our efforts to build more Mother and Child Hospitals across the state and recruit obstetricians and anaesthetists for government hospitals in rural areas have significantly enhanced the maternity care infrastructure and quality of institutional delivery,” Dr K Sudhakar, Health Minister, said in a statement.

He added that the establishment of dedicated Women's Clinics and Namma Clinics in urban areas will further improve prenatal and postnatal care.