Haemorrhage, hypertension, sepsis, anaemia and medical disorders continue to be major maternal killers in developing world
The article on maternal mortality by Brettingham that depression and
obesity are emerging as major causes of maternal mortality in UK shows a
changing trend in causes of maternal deaths in all developed world.
Unfortunately maternal mortality continues to be unacceptably high in
developing countries like India due to avoidable causes.
In an Indian
Council of Medical Research Task Force Study by Bedi et al (1) in 31
teaching hospitals from 16 states and Union Territories of India and over
1,66,996 live borths, there were 973 maternal deaths with maternal
mortality ratio of 582 per 100,000 live births. As expected maternal
mortality was higher in rural areas (53%), in uneducated women (62%) and
was highest in women admitted in postnatal period and 70 % deaths were due
to direct causes.
The main causes of mortality were hypertension(24%),
haemorrhage (23.6%), abortion (12.2%)(septic abortion was responsible for
83% of abortion deaths), anaemia (11%), viral hepatitis (7.1%)and
puerperal sepsis (3.7%). India has one of the highest maternal mortalities
in the world with 100,000 maternal death per year with maternal mortality
rate of 437 per 100,000 births(2). However,mortalitie only repreent tip of
iceberg. For every death, many more live with permanent injury and chronic
disability. Thus in an Indian study for each death, there were 541
morbidities: 46% were life threatening and 25% women suffered chronic
Maternal education and empowerment are two most important
tools to reduce maternal mortality as an educated woman is more likely to
accept contraception and small family norm, is more likely to eat
nutritious diet and is more amenable to receive antenatal and labour care
as has been the case with Sri Lanka and Kerala state in India which have
one of the best maternal and perinatal outcomes of developing world(4-6).
There is a need to create social,economical and cultural environment in
which freedom and choice are given concrete meaning(4). Government and non
-goverment organisations,donor and society must work together to design
delivery systems to make the services more responsive to the need of the
women(4). Safe motherhood is an achievable and worthwhile goal and is the
right of every woman(6).
1. Bedi N, Kambo I, Dhillon BS, Saxena BN, Singh P. Maternal deaths
in India-Preventable Tragedies. An ICMR Task Force Study. J Obstet Gynec
2.International Institute for Population Sciences. National Family
Health Survey,1992-93,India Introductory Report. Mumbai: International
Institute of Population Sciences,1994.
3.Fortney JA,Jason BS (eds). The base of the iceberg. Prevalence and
perceptions of maternal morbidity in four developing countries. The
Maternal Morbidity Network. Research Triangle Park:Family
4. Pachauri S. Preventing maternaal mortality:Right to safe
pregnancy. Nat Med J Ind 2003;16 Suppl 2:24-27.
5.Sharma JB. Nutritional anaemias during pregnancy in non-
industrialised countries. In Studd J (ed) Progres in Obstetrics and
Gynaecology, 15th edition, Edinburgh, Churchill Livingstone, 2003:103-122.
6. Pitroff R, Johanson R. Safe motherhood:an achievable and
worthwhile aim. In Studd J (ed) Progress in Obstetrics and Gynaecology,
13th edition,Edinburgh, Churchill Livingstone, 1996:47-57.
Competing interests: No competing interests