Safety in childbirth: can India maintain its momentum?

Last month the United Nations released its latest report on maternal mortality worldwide. It found that despite impressive gains—a 65% reduction since 1990—India still had the most maternal deaths of any country in 2013. An estimated 50 000 women died in childbirth in the country last year, almost a fifth of the global burden.1

With few public health accomplishments to brag about, achieving the fifth millennium development goal (MDG)—to reduce maternal mortality to 109 deaths for every 100 000 live births by 2015—is crucial for India.

Despite economic progress and various interventions, however, at the current pace of decline the nation’s maternal mortality ratio (MMR) in 2015 is expected to be 139 deaths per 100 000 live births. This falls short of the 2015 target by some 30 deaths per 100 000 live births.

India’s MMR is currently 178 per 100 000 live births, considerably better than the current global average of 210, and its average annual drop is 4.5%.1 Sierra Leone is estimated to have the highest MMR at 1100 for every 100 000 live births.

India’s decline in MMR is largely a result of huge improvements in maternal safety in the past decade. The district hospital in Ujjain, a small city in Madhya Pradesh, for example, has witnessed some of the simplest and most effective innovations in India’s maternal safety programmes. These sporadic, innovative, yet poorly …