India accounts for 19% of all maternal deaths globally. Maternal mortality is thus one of the most serious public health issues facing India today. During the period 1990-2009, Maharashtra’s Maternal Mortality Ratio (MMR) dropped from around 216 to 104, making it a 52% decrease in 19 years. The MMR in Maharashtra is the third lowest in the country. In 2009 Maharashtra became one of the three states (along with Tamil Nadu and Kerala) in India to have achieved the Millennium Development Goal of an MMR of 109 by the year 2015. This remarkable drop in the MMR deserves to be studied in order to identify the reasons for its occurrence and to see whether it can be replicated in the rest of the country.
Table of Contents
INTRODUCTION
OBJECTIVE
RESEARCH QUESTIONS
RESEARCH METHODOLOGY
LIMITATIONS OF THE STUDY
DEFINITIONS
MAIN CAUSES IDENTIFIED FOR MATERNAL MORTALITY IN MAHARASHTRA
DIRECT CAUSES
INDIRECT CAUSES
SOCIAL AND OTHER CORRELATES OF MATERNAL MORTALITY
TRENDS IN THE DIRECT CAUSES AFFECTING MMR
COMPLICATIONS DURING PREGNANCY AND DELIVERY
MATERNAL NUTRITION
TRENDS IN THE SOCIAL AND OTHER CORRELATES AFFECTING MMR
PARITY
AGE
ACCESS TO HEALTH CARE INSTITUTIONS
GOVERNMENT INTERVENTIONS TO IMPROVE ACCESS TO MATERNAL HEALTH CARE
JANANI SURAKSHA YOJANA
OTHER INTERVENTIONS
ECONOMIC STATUS
EDUCATION LEVELS
CONCLUSION
RECOMMENDATIONS
Research Objectives and Focus Areas
The primary objective of this research is to identify the underlying factors and reasons behind the significant decline in the Maternal Mortality Ratio (MMR) in Maharashtra from 216 to 104 during the period 1990-2009. The study evaluates healthcare trends, infrastructure developments, and socio-economic changes to determine their impact on maternal outcomes.
- Analysis of direct obstetric and indirect medical causes of maternal mortality.
- Evaluation of socio-economic correlates including education, income levels, and parity.
- Assessment of government health interventions, specifically the Janani Suraksha Yojana.
- Investigation into the growth and impact of the private healthcare sector on maternal access.
Excerpt from the Book
MATERNAL NUTRITION
Pregnancy heightens the body’s nutritional demands, requiring additional resources for proper foetal development. It is essential that pregnant women consume additional food to meet their bodies’ heightened requirements. The ICMR recommends that pregnant women consume 2250 kcal/day, an increase of 350 kcal/day over the recommended allowance for non-pregnant women. Pregnant women also require higher levels of protein than non-pregnant women. The ICMR does not provide any more information regarding the special dietary requirements of pregnant women.
According to the table above however, in 2003 pregnant women on an average were consuming only 1500 kcal, which is 70% of the RDA. Similarly, consumption of calcium and iron were also grossly deficient; pregnant women are consuming only one third of the required amount of both these minerals. The SATHI (Support for Advocacy and Training to Health Initiatives) report from which this table is sourced also states that besides general poor availability of food, one of the important reasons for poor nutritional status among pregnant women is the observance of various food related taboos during pregnancy. For example, foods such as papaya, a rich source of b-carotene (vitamin A) is considered to be an abortificient and banana is believed to produce single-child infertility.
Chapter Summaries
INTRODUCTION: Provides context regarding India's maternal mortality rates and highlights the specific progress made by Maharashtra in meeting Millennium Development Goals.
OBJECTIVE: Clearly defines the goal to investigate why Maharashtra's MMR dropped significantly between 1990 and 2009.
RESEARCH QUESTIONS: Outlines the core inquiries regarding factors influencing MMR, their historical trends, and their role in the observed mortality decline.
RESEARCH METHODOLOGY: Details the systematic approach used to select data sources, including secondary data from government reports and international organizations.
LIMITATIONS OF THE STUDY: Acknowledges the scarcity of consistent time-series data and explains the reliance on hospital-based studies to supplement findings.
DEFINITIONS: Offers precise definitions of key terminology like Maternal Mortality Ratio, Maternal Death, and Total Fertility Rate used throughout the paper.
MAIN CAUSES IDENTIFIED FOR MATERNAL MORTALITY IN MAHARASHTRA: Categorizes maternal deaths into direct obstetric causes and indirect factors, highlighting hemorrhage as a leading issue.
SOCIAL AND OTHER CORRELATES OF MATERNAL MORTALITY: Explores socio-economic determinants such as age, parity, economic status, and education levels.
TRENDS IN THE DIRECT CAUSES AFFECTING MMR: Analyzes the statistics regarding pregnancy and delivery complications to see if improvements in these areas drove the MMR decline.
MATERNAL NUTRITION: Examines the nutritional status of pregnant women and the impact of deficiencies and cultural taboos on health outcomes.
TRENDS IN THE SOCIAL AND OTHER CORRELATES AFFECTING MMR: Correlates fertility trends and increased access to healthcare with the overall reduction in maternal mortality.
GOVERNMENT INTERVENTIONS TO IMPROVE ACCESS TO MATERNAL HEALTH CARE: Reviews specific state initiatives like the Janani Suraksha Yojana and structural healthcare improvements.
ECONOMIC STATUS: Discusses the role of rising per capita income in enabling families to afford better maternal healthcare.
EDUCATION LEVELS: Highlights the link between increasing literacy rates among women and better awareness regarding maternal health.
CONCLUSION: Summarizes how combined factors, including private sector growth, education, and government schemes, contributed to the MMR reduction.
RECOMMENDATIONS: Proposes future policy shifts, emphasizing data standardization, regulation of the private sector, and continued investment in reproductive health.
Keywords
Maternal Mortality Ratio, MMR, Maharashtra, Reproductive Health, Janani Suraksha Yojana, Public Health, Healthcare Access, Maternal Nutrition, Total Fertility Rate, Institutional Delivery, Socio-economic Correlates, Government Interventions, Private Healthcare, Pregnancy Complications, Women's Education.
Frequently Asked Questions
What is the primary focus of this research?
The research focuses on analyzing the various factors that contributed to the significant decline in the Maternal Mortality Ratio (MMR) in the state of Maharashtra during the two decades between 1990 and 2009.
What are the key themes addressed in the study?
Central themes include medical causes of mortality, socio-economic factors such as education and income, the growth of healthcare infrastructure, and the role of government-led maternity health schemes.
What is the core research question?
The paper seeks to understand what specific factors affected maternal mortality in Maharashtra, how these factors changed over the study period, and whether these changes were responsible for the improved maternal mortality outcomes.
Which scientific methodology was applied?
The study utilizes a secondary data analysis methodology, reviewing literature and quantitative data from official sources like DLHS, NFHS, and government health reports to establish trends.
What topics are covered in the main body?
The main body covers a thorough analysis of direct obstetric causes, indirect correlates, trends in maternal nutrition, government and private infrastructure growth, and the impact of initiatives like the Janani Suraksha Yojana.
Which keywords define this work?
Key terms include Maternal Mortality Ratio (MMR), Institutional Delivery, Janani Suraksha Yojana, Reproductive Health, and healthcare infrastructure in Maharashtra.
How did private healthcare influence the MMR decline according to the author?
The author concludes that the rapid, large-scale growth of the private healthcare sector in Maharashtra significantly increased the availability of and accessibility to maternity care services, which played a crucial role in reducing MMR.
What does the study suggest regarding data collection?
The study identifies a major paucity of data and a lack of uniformity in methodology, recommending that the government establish a set pattern of indicators to create a more reliable database for future public health analysis.
- Quote paper
- Sanjana Mulay (Author), 2013, Causes for the Decline in the Maternal Mortality Ratio in Maharashtra, India. The Period From 1990-2009, Munich, GRIN Verlag, https://www.hausarbeiten.de/document/1010202
