India has the highest number of maternal deaths in the world. The national Maternal Mortality Ratio (MMR) is 212 deaths per 100,000 live births. Some states, such as Assam and Uttar Pradesh, India’s most populous state, far exceed this ratio with MMRs of 390 and 359, respectively. India’s infant mortality rate is 44 deaths per 1,000 live births, placing it significantly behind other emerging economies such as China (IMR of 16), Brazil (IMR of 17) and Russia (IMR of 9). India’s infant mortality rate is also significantly higher than neighbouring Sri Lanka (IMR of 14). Most of these deaths are preventable.
As per World Health Statistics report 2012, India is ranked 2nd rank in the field of underweight children below the age of five years and 47th in terms of Infant Mortality rate in world. More than two million children die every year from preventable infections. Children in India continue to lose their life to vaccine-preventable diseases.
The main causes for infant deaths in India are perinatal conditions (46%), Respiratory infections (22%), Diarrhoeal disease (10%), other infectious and parasitic diseases (8%) and Congenital anomalies (3.1%). Factors contributing to above causes are home delivery by unskilled persons, lack of essential new born care for asphyxia and hypothermia, poor child care practices, lack of early detection of sick new-born, inadequate/delayed referral mechanisms and inadequate infrastructure at health care facilities for specialized care of sick new born.
It is difficult to delineate one cause of maternal deaths as there are various factors that indirectly and directly impact it. Some of the major causes of maternal deaths are unsafe abortions, ante and post-partum haemorrhage, anaemia, obstructed labour, hypertensive disorders and post-partum sepsis. Majority of deaths occur among low-income women reveal a need for greater inclusivity of healthcare services.
According to National Human Rights Commission only 30% of the population receives services through the public health system. Unavailability of pre and postnatal care and obstetric care as well as delays in approaching for institutional care coupled with poor quality of service in government hospitals contributed have contributed to maternal deaths. The physician density in India is just 6.49 per 10,000 population which coupled with poor quality of healthcare and its rural urban disparity further accentuates the problem of rural population.
Deaths due to anaemia, obstructed labour, hypertensive disorders and sepsis are preventable with provision for proper antenatal care, referral and timely treatment of complications of pregnancy, promoting institutional delivery and postnatal care. It is vital to screen all pregnant women, identify women with compilations and health problems, and taking corrective action including referring them to institutions at higher levels.
The geographic and financial access to health information and primary healthcare is critical to achieve health equity. By providing right information at the right time through experts many health problems pertaining to mother and child care can be solved. Service delivery at the doorstep to unserved and underserved rural population goes a long way in screening risky pregnancy cases and solving such issues proactively. Such services can be further enhanced in remote rural areas by providing specialist access through Information and Communication Technologysolutions like Telemedicine. A combination of all these initiatives can help bridge the gap in healthcare services especially between rural and urban areas.