Good health for the mother is good for family and society.

Maternal mortality in India is the maternal death of a woman in India during pregnancy or after pregnancy, including post-abortion or post-birth periods.[1] Different countries and cultures have different rates and causes for maternal death.[2] Within India, there is a marked variation in healthcare access between regions and in socioeconomic factors, accordingly, there is also variation in maternal deaths for various states, regions, and demographics of women.[3]

Pregnancy involves a vulnerability that put women at risk of dying, and India is one of many countries who record a high number of pregnancy-related deaths of women each year.[4]

Women die as a result of complications during and following pregnancy and childbirth or abortion. Most of these complications develop during pregnancy are easily preventable or treatable. Other complications may exist before pregnancy but are worsened during pregnancy, especially if not managed as part of a woman’s care.

History

India contributes one-fifth of the global burden of absolute maternal deaths; however, it has experienced an estimated 4.7% annual decline in maternal mortality ratio (MMR),[5][6] and 3.5% annual increase in skilled birth attendance since 1990.[5][7]

Ninety-four percent (94%) of all maternal deaths occur in low and lower middle-income countries.[8][9] In September 2000, the United Nations, faced with the enormous maternal death toll in India and other developing countries, pledged as its fifth Millennium Development Goal (MDG 5) that the global MMR would be reduced to a quarter of its 1990 level by 2015. India is a signatory to the Millennium Declaration adopted at the United Nations General Assembly in September 2000, and consistently reaffirmed its commitment towards the eight development goals. These MDG targets were in convergence with India’s own national development goals to reduce poverty and other areas of deprivation.[10] In 2018 the World Health Organization (WHO) congratulated India for great reduction in maternal mortality since 2005,[11] especially in recent years, reducing the maternal mortality ratio (MMR) by 77%, from 556 per 100 000 live births in 1990 to 130 per 100 000 live births in 2016, which was considered by WHO to be a remarkable feat in contrast with the global maternal mortality reported to have experienced a decline of 43%. Prior to that, various reports described high rates of maternal mortality in India,[12][13] from which WHO and other international bodies concluded that India could not reach the Millennium Development Goals (MDG).

Infographic - History of Maternal Mortality in India

Maternal deaths being a rare event require a large sample size to provide robust estimates. In order to enhance the Sample Registration System (SRS) sample size, results were derived by following the practice of pooling three years' data to yield reliable estimates of maternal mortality.[14] The first report on maternal mortality in India (1997-2003), describing trends, causes and risk factors, was released in October 2006.[15]

In 2005, a woman's lifetime risk of maternal death in India was estimated to be 1 in 70. Similarly, the maternal mortality ratio (MMR; number of maternal deaths per 100,000 live births) in India was 450.[16]
In 2010, approximately one-quarter of all pregnancy- and delivery-related maternal deaths worldwide occur in India. Statistics showed that up until 2010, more than half a million women—most of them living in developing countries—dies from pregnancy- or childbirth-related complications every year, and about a quarter of these “maternal” deaths occurred in India.[16]

India showed a steady decline in maternal mortality, from 254 in every 100 000 live births in 2004-06 to 178 in every 100 000 live births in 2010-12.[17]

As per Sample Registration System (SRS), 2011-13 reports published by Registrar General of India, Maternal Mortality Ratio (MMR) was 167 per 1,00,000 live births in the country. Under the Millennium Development Goal (MDG) 5, the target is to reduce Maternal Mortality Ratio (MMR) by three quarters between 1990 and 2015. This translates to reducing the MMR from 560 in 1990 to 140 in 2015.[18][19]

In 2014, India was recognized to have contributed one-fifth of the global burden of absolute maternal deaths, while experiencing an estimated 4.7% decline in its Maternal Mortality Ratio which stood at 174 per 100,000 live births in India.[20]

According to the Office of the Registrar General, the ratio has declined from 130 in 2014-2016 to 122 in 2015-17, registering a 6.15 per cent reduction since the last survey figures of 2014-2016. India’s present MMR is below the Millennium Development Goal (MDG) target and puts the country on track to achieve the Sustainable Development Goal (SDG) target of an MMR below 70 by 2030.[21]

By medical condition

From 1980-2015 eclampsia is the cause of 1.5% of maternal deaths in India.[22] Over that time, the number of women who experience this disease has been the same, but also there has been a slight reduction in the number of maternal death from the condition.[22]

Causes

Approximately two-thirds of all maternal deaths are primarily caused by major complications, including severe bleeding (typically occurring after childbirth), infections (commonly arising after childbirth), high blood pressure during pregnancy (pre-eclampsia and eclampsia), delivery-related complications, and unsafe abortions.[23] Between 50% and 98% of maternal deaths result from direct obstetric causes such as hemorrhage, infection, hypertensive disorders, ruptured uterus, hepatitis, and anemia. Additionally, around 50% of maternal deaths caused by sepsis are associated with illegal induced abortions. [24]

Prevalence

According to the Sample Registration System Bulletin-2016, India has registered a 26.9 per cent reduction in maternal mortality ratio (MMR) since 2013. The MMR has declined from 167 in 2011-2013 to 130 in 2014-2016, to 122 in 2015-17, to 113 in 2016-2018. According to the National Health Policy (NHP) 2017, India set a goal to reduce its Maternal Mortality Rate (MMR) to below 100 per lakh live births by the year 2020. The SRS estimates that India had an MMR of 97 per lakh live births during the period of 2018-2020, accomplishing this target within the specified timeframe.[25]

MMR (per 100,000 live births) 2004-06[26] 2007-09[27] 2010-12[28] 2011-13[29] 2014-16[30] 2015-17[31] 2016-18[32] 2018-20[33]
India Total 254 212 178 167 130 122 113 97
Assam 480 390 328 300 237 229 215 195
Bihar 312 261 219 208 165 165 149 118
Jharkhand 76 71 56
Madhya Pradesh 335 269 230 221 173 188 173 173
Chhattisgarh 141 159 137
Odisha 303 258 235 222 180 168 150 119
Rajasthan 388 318 255 244 199 186 164 113
Uttar Pradesh 440 359 292 285 201 216 197 167
Uttarakhand 89 99 103
EAG & Assam Subtotal 375 308 257 246 188 175 161 137
Andhra Pradesh 154 134 110 92 74 74 65 45
Telangana 81 76 63 43
Karnataka 213 178 144 133 108 97 92 69
Kerala 95 81 66 61 46 42 43 19
Tamil Nadu 111 97 90 79 66 63 60 54
South Subtotal 149 127 105 93 77 72 67 49
Gujarat 160 148 122 112 91 87 75 57
Haryana 186 153 146 127 101 98 91 110
Maharashtra 130 104 87 68 61 55 46 33
Punjab 192 172 155 141 122 122 129 105
West Bengal 141 145 117 113 101 94 98 103
Other States 206 160 136 126 97 96 85 77
Other Subtotal 174 149 127 115 93 90 83 76

RBI categorization of states are usually organized into three groups, especially at the regional level, to understand the maternal mortality situation in the country better and to map the changes that have taken place: EAG, southern states and "other" states.

EAG states comprise Bihar, Jharkhand, Madhya Pradesh, Chhattisgarh, Odisha, Rajasthan, Uttar Pradesh, Uttarakhand, and Assam. The southern states are Andhra Pradesh, Telangana, Karnataka, Kerala and Tamil Nadu and the "other" states categories cover the remaining states and Union territories.

Kerala, Maharashtra and Tamil Nadu have already met the sustainable development goals target of 70 per 100,000 MMR, while Andhra Pradesh and Telangana are within range.

Among southern states, the decline in MMR has been from 77 to 72 per 100,000 live births, from 93 to 90 in the other states. The decline has been most significant in empowered action group (EAG) states and Assam from 188 to 175.[34]

In the recently released report on maternal mortality ratio (MMR) prepared by the union government, Uttarakhand has fared significantly well recording 89 deaths per lakh deliveries between 2015 and 2017 as against the national average of 122.[35]

According to officials of National Health Mission (NHM) in Uttarakhand, the state stood at 8th spot among the 19 top states in the country. Notably the last survey, which clubbed Uttarakhand and the neighboring Uttar Pradesh as one, ranked the two states at the 15th spot. It stated that the MMR in the two states (combined) between 2014 and 2016 stood at 201 maternal deaths per lakh births.[35]

The rates for using maternal healthcare is the same for rural and urban women in wealthier Indian states.[36] In poorer states, urban women access healthcare much more often than rural women.[36]

Healthcare availability and use by region

In November 2016, the government launched the Pradhan Mantri Surakshit Matritva Abhiyan, or the Prime Minister Safe Pregnancy Scheme, which aims to provide free and comprehensive care on the ninth day of every month during pregnancy. Pregnant women are provided special, free ante-natal checks in their second or third trimester at government health care facilities, including ultrasounds, blood and urine tests.[37]

Full ANC refers to at least four antenatal visits, one tetanus toxoid (TT) injection and iron folic acid tablets or syrup taken for 100 or more days. Yet, getting these facilities to women is a challenge, especially in poorer states. No more than 3.3 per cent of pregnant women in Bihar reported receiving full antenatal care, lowest among states.[37]

The rates for using maternal healthcare is the same for rural and urban women in wealthier Indian states. In poorer states, urban women access healthcare much more often than rural women.[38]

The BIMARU states experience a range of problems including maternal mortality.[39]

Assam

Assam has the highest rate of maternal mortality in India.[40] Within Assam, some of the highest rates of maternal mortality are among tea plantation workers.[40]

Andhra Pradesh

A regional program in Andhra Pradesh seeks to ask doctors and nurses about the causes of maternal mortality in local communities.[41] The general circumstance is that maternal mortality has different causes in different places, but if clinics knew the common causes for that area, then they would be better prepared to prevent future deaths.[41]

Bihar

As compared to other states, Bihar has relatively low rates for use of medical care services.[42]

West Bengal

A 2019 survey in rural West Bengal reported that the "three delays" caused maternal death.[43] Those are delay in deciding to go to the clinic, delay in actually arriving at the clinic, and delay in getting care at the clinic.[43]

Karnataka

Karnataka has the highest rate of maternal mortality in South India.[44] In interviews, mothers reported that when they did not use healthcare services, their reasons included lack of access to transport to the clinic, the cost of care, and low value in a clinic visit.[44] When a mother dies in this region it is often in the postpartum period.[44]

Uttar Pradesh

Surveys have found that women in UP who are more educated and have more money tend to use more maternal health services.[45]

Prevention

In India, among other factors, coordination between levels in the delivery system and fragmentation of care account for the poor quality of maternal health care, which is worsened by mass illiteracy.[12] Most maternal deaths are preventable, as the health-care solutions to prevent or manage complications are well known. All women need access to high quality care in pregnancy, and during and after childbirth.[46]

Various civil organizations have suggested effective strategies for reducing MMR in India:

  • place a high priority on maternal and child health (MCH) services and integrate vertical programs (e.g., family planning) related to MCH;
  • give attention to care during labor and delivery, the most critical period for complications;
  • provide community-based delivery huts which can provide a clean and safe delivery place close to home, and maternity waiting rooms in hospitals for high risk mothers;
  • improve the quality of MCH care at the rural community level (proper history taking, palpation, blood pressure and fetal heart screening, risk factor screening, and referral);
  • improve quality of care at the primary health care level (emergency care and proper referral);
  • include in the postpartum program MCH and family planning services;
  • examine the feasibility of a national blood transfusion service network;
  • educate young girls on health and sex and informally educate the masses on MCH;
  • research reproductive behavior and focus obstetrics and gynecology training primarily on practical skills in management of labor and delivery;
  • assure every woman of the right to safe motherhood and improve transportation.

In 2018 the World Health Organization noted four recent changes in India which had lowered maternal mortality:[47]

  1. the government has increased the available of healthcare for pregnant women and new mothers
  2. finance programs like Janani Shishu Suraksha Karyakram have paid for transport to hospital and costs of childbirth
  3. Investments in women's education improve health outcomes along with other benefits
  4. the government promotes collaboration between private and government clinics through the Pradhan Mantri Surakshit Matritva Abhiyan program

Before 2017 the government focus on maternal mortality was learning about the causes of death to develop a plan for prevention.[48] In 2017 the Indian government shifted focus in its programs to instead detect risks then offer healthcare to prevent the death.[48]

A 2016 national survey expected to find that if a household loses a woman to maternal death, then other women in the household will seek more clinic services during pregnancy and after childbirth.[49] Contrary to expectation, the study instead found that after a maternal death, women instead avoid hospitals and instead seek support from a traditional birth attendant.[49] Reasons for this vary, but part of the explanation is that many of these women could go to the hospital for care but choose to avoid doing so.[49]

Social factors which influence maternal mortality in India are income inequality in India; level of access to Prenatal care and care in the postpartum period; level of woman's education; the position of the mother's community in the regional rural-urban divide; the mother's access to nutrition during pregnancy; the degree of local sanitation; and the caste position of the mother.

The same health monitoring systems which track maternal mortality could also ask women to report other problems, such as lack of good treatment from hospital staff. Healthcare in India measures and reports maternal mortality.[50] Offering general support services to women could improve many aspects of health care.[50]

Public health initiatives

From 2000-2015 India participated in the Millennium Development Goal to improve maternal health.

The Government of India has started various public health initiatives to provide a safe and secure environment. Some of these initiatives are -

Government have also taken initiatives on improving the infrastructure of the country by improving roads and providing free ambulance services at PHC.[55]

History

In 2018 the World Health Organization congratulated India for great reduction in maternal mortality since 2005.[47]

Previous to that, various reports described high rates of maternal mortality in India.[56][57]

Research

Maternal mortality is challenging to study because it is fairly uncommon, it can happen for various reasons, and it is challenging to report.[36] The first nationally representative study of maternal mortality in all of India was in 2014.[36]

Two major global studies in 2015 report maternal mortality in India and contribute to national planning. One study is the Global Burden of Disease Study, which in 2015 for the first time published a national report about India.[58][59] The other is the 2015 report of the United Nations Maternal Mortality Estimation Inter-Agency Group (UN MMEIG).[60] For the earlier 2013 versions of these two studies, researchers noted that they used different data and analysis to come to different conclusions about changes over time of maternal mortality in India.[61]

In 2017 a report found no significant impact following a large study of 160,000 pregnant women who participated in a one-week educational program to improve maternal health and childbirth outcomes.[62]

References

  1. ↑ "UNICEF Maternal Mortality". UNICEF Data.
  2. ↑ "Macrotrends Country - India Maternal Mortality".
  3. ↑ Kaur, Manmeet; Gupta, Madhu; Purayil, Vijin Pandara; Rana, Monica; Chakrapani, Venkatesan (2018-10-09). "Contribution of social factors to maternal deaths in urban India: Use of care pathway and delay models". PLOS ONE. 13 (10): e0203209. Bibcode:2018PLoSO..1303209K. doi:10.1371/journal.pone.0203209. PMC 6177129. PMID 30300352.
  4. ↑ Gwatkin, D. R.; Rutstein, S.; Johnson, K.; Suliman, E.; Wagstaff, A.; Amouzou, A. (December 2007). "Socio-economic differences in health, nutrition, and population within developing countries: an overview". Nigerian Journal of Clinical Practice. 10 (4): 272–282. PMID 18293634.
  5. 1 2 RGI (2006) Registrar General/Centre for Global Health Research, University of Toronto. New Delhi: Registrar General of India
  6. ↑ WHO, UNICEF, UNFPA, World Bank (2012) Trends in maternal mortality: 1990 to 2010. Geneva: World Health Organization
  7. ↑ IIPS (2010) District level household and facility survey (DLHS-3) 2007–2008: India. Mumbai: International Institute for Population Sciences
  8. ↑ Trends in maternal mortality: 2000 to 2017: estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Geneva: World Health Organization; 2019
  9. ↑ "Maternal mortality". www.who.int. Retrieved 2020-03-30.
  10. ↑ "Millennium Development Goals". UNDP in India. Retrieved 2020-03-30.
  11. ↑ "India has achieved groundbreaking success in reducing maternal mortality". www.who.int. Retrieved 2020-03-30.
  12. 1 2 Prakash, A.; Swain, S.; Seth, A. (December 1991). "Maternal mortality in India: current status and strategies for reduction". Indian Pediatrics. 28 (12): 1395–1400. PMID 1819558.
  13. ↑ Dhar, Sujoy (26 January 2009). "India grapples with high maternal death rate". Reuters.
  14. ↑ "India registers 26.9 per cent decline in Maternal Mortality Rate since 2013: SRS Bulletin". The Economic Times. 2019-11-07. Retrieved 2020-03-30.
  15. ↑ "India registers 26.9 per cent decline in Maternal Mortality Rate since 2013: SRS Bulletin". The Economic Times. 2019-11-07. Retrieved 2020-03-30.
  16. 1 2 Goldie, Sue J.; Sweet, Steve; Carvalho, Natalie; Natchu, Uma Chandra Mouli; Hu, Delphine (2010-04-20). "Alternative Strategies to Reduce Maternal Mortality in India: A Cost-Effectiveness Analysis". PLOS Medicine. 7 (4): e1000264. doi:10.1371/journal.pmed.1000264. PMC 2857650. PMID 20421922.
  17. ↑ Baggchi, S. (2014-10-06). "Report shows causes of maternal deaths in India". BMJ. 349 (oct06 10): g6035. doi:10.1136/bmj.g6035. PMID 25288272. S2CID 30640966.
  18. ↑ "India registers 26.9 per cent decline in Maternal Mortality Rate since 2013: SRS Bulletin". The Economic Times. 2019-11-07. Retrieved 2020-03-30.
  19. ↑ "Steps Taken to Reduce IMR and MMR". pib.gov.in. Retrieved 2020-03-30.
  20. ↑ Montgomery, Ann L.; Ram, Usha; Kumar, Rajesh; Jha, Prabhat; for The Million Death Study Collaborators (2014-01-15). "Maternal Mortality in India: Causes and Healthcare Service Use Based on a Nationally Representative Survey". PLOS ONE. 9 (1): e83331. Bibcode:2014PLoSO...983331M. doi:10.1371/journal.pone.0083331. PMC 3893075. PMID 24454701. {{cite journal}}: |author5= has generic name (help)
  21. ↑ Watts, Kerean (2019-11-12). "Maternal mortality ratio in decline". Health Issues India. Retrieved 2020-03-30.
  22. 1 2 Nobis, P. N.; Hajong, Anupama (8 January 2016). "Eclampsia in India Through the Decades". The Journal of Obstetrics and Gynecology of India. 66 (S1): 172–176. doi:10.1007/s13224-015-0807-5. PMC 5016424. PMID 27651598.
  23. ↑ "UNICEF's concerted action to increase access to quality maternal health services". UNICEF. Retrieved 31 July 2023.
  24. ↑ A Prakash 1, S Swain, A Seth (1991). "Maternal mortality in India: current status and strategies for reduction". Indian Pediatrics. 28 (12): 1395–1700. PMID 1819558. Retrieved 31 July 2023.{{cite journal}}: CS1 maint: multiple names: authors list (link) CS1 maint: numeric names: authors list (link)
  25. ↑ "Significant Decline in Maternal Mortality in India". PIB.GOV.IN. Retrieved 31 July 2023.
  26. ↑ "Special Bulletin on Maternal Mortality in India 2004-06" (PDF). Census of India website. Office of Registrar General, India. Retrieved 18 June 2021.
  27. ↑ "Special Bulletin on Maternal Mortality in India 2007-09" (PDF). Census of India website. Office of Registrar General, India. Retrieved 18 June 2021.
  28. ↑ "Special Bulletin on Maternal Mortality in India 2010-12" (PDF). Census of India website. Office of Registrar General, India. Retrieved 18 June 2021.
  29. ↑ "Special Bulletin on Maternal Mortality in India 2011-13" (PDF). Census of India website. Office of Registrar General, India. Retrieved 18 June 2021.
  30. ↑ "Special Bulletin on Maternal Mortality in India 2014-16" (PDF). Census of India website. Office of Registrar General, India. Retrieved 18 June 2021.
  31. ↑ "Special Bulletin on Maternal Mortality in India 2015-17" (PDF). Census of India website. Office of Registrar General, India. Retrieved 18 June 2021.
  32. ↑ "Special Bulletin on Maternal Mortality in India 2016-18" (PDF). Census of India website. Office of Registrar General, India. Retrieved 18 June 2021.
  33. ↑ Office of the Registrar General & Census Commissioner, India (ORGI) (28 November 2022). "SAMPLE REGISTRATION SYSTEM (SRS)-SPECIAL BULLETIN ON MATERNAL MORTALITY IN INDIA 2018-20" (PDF).
  34. ↑ "India registers 26.9 per cent decline in Maternal Mortality Rate since 2013: SRS Bulletin". The Economic Times. 2019-11-07. Retrieved 2020-03-31.
  35. 1 2 www.ETHealthworld.com. "Uttarakhand improves maternal mortality, ranked 8th best in country in MMR - ET HealthWorld". ETHealthworld.com. Retrieved 2020-03-31.
  36. 1 2 3 4 Montgomery, AL; Ram, U; Kumar, R; Jha, P; for The Million Death Study Collaborators (2014). "Maternal mortality in India: causes and healthcare service use based on a nationally representative survey". PLOS ONE. 9 (1): e83331. Bibcode:2014PLoSO...983331M. doi:10.1371/journal.pone.0083331. PMC 3893075. PMID 24454701. {{cite journal}}: |author5= has generic name (help)
  37. 1 2 Taneja, Richa (2017-02-23). "Analysis: Why India Cannot Follow New WHO Guidelines To Protect Mothers". Everylifecounts.NDTV.com. Retrieved 2020-03-31.
  38. ↑ Montgomery, Ann L.; Ram, Usha; Kumar, Rajesh; Jha, Prabhat; for the Million Death Study Collaborators (2014). "Maternal mortality in India: causes and healthcare service use based on a nationally representative survey". PLOS ONE. 9 (1): e83331. Bibcode:2014PLoSO...983331M. doi:10.1371/journal.pone.0083331. PMC 3893075. PMID 24454701. {{cite journal}}: |last5= has generic name (help)
  39. ↑ Dehury, RK; Samal, J (September 2016). "Maternal Health Situation in Bihar and Madhya Pradesh: A Comparative Analysis of State Fact Sheets of National Family Health Survey (NFHS)-3 and 4". Journal of Clinical and Diagnostic Research. 10 (9): IE01–IE04. doi:10.7860/JCDR/2016/19079.8404. PMC 5071966. PMID 27790466.
  40. 1 2 Cousins, Sophie (5 April 2016). "Assam: India's state with the highest maternal mortality". BMJ. 353: i1908. doi:10.1136/bmj.i1908. PMID 27048471. S2CID 39019791.
  41. 1 2 Singh, S; Murthy, GV; Thippaiah, A; Upadhyaya, S; Krishna, M; Shukla, R; Srikrishna, SR (July 2015). "Community based maternal death review: lessons learned from ten districts in Andhra Pradesh, India". Maternal and Child Health Journal. 19 (7): 1447–54. doi:10.1007/s10995-015-1678-1. PMID 25636651. S2CID 10994252.
  42. ↑ Kumar, G Anil; Dandona, Rakhi; Chaman, Priyanka; Singh, Priyanka; Dandona, Lalit (17 October 2014). "A population-based study of neonatal mortality and maternal care utilization in the Indian state of Bihar". BMC Pregnancy and Childbirth. 14 (1): 357. doi:10.1186/1471-2393-14-357. PMC 4287469. PMID 25326202.
  43. 1 2 Sk, MIK; Paswan, B; Anand, A; Mondal, NA (28 August 2019). "Praying until death: revisiting three delays model to contextualize the socio-cultural factors associated with maternal deaths in a region with high prevalence of eclampsia in India". BMC Pregnancy and Childbirth. 19 (1): 314. doi:10.1186/s12884-019-2458-5. PMC 6712765. PMID 31455258.
  44. 1 2 3 Vidler, Marianne; Ramadurg, Umesh; Charantimath, Umesh; Katageri, Geetanjali; Karadiguddi, Chandrashekhar; Sawchuck, Diane; Qureshi, Rahat; Dharamsi, Shafik; Joshi, Anjali; von Dadelszen, Peter; Derman, Richard; Bellad, Mrutyunjaya; Goudar, Shivaprasad; Mallapur, Ashalata (8 June 2016). "Utilization of maternal health care services and their determinants in Karnataka State, India". Reproductive Health. 13 (S1): 37. doi:10.1186/s12978-016-0138-8. PMC 4943501. PMID 27356502.
  45. ↑ Dey, A; Hay, K; Afroz, B; Chandurkar, D; Singh, K; Dehingia, N; Raj, A; Silverman, JG (2018). "Understanding intersections of social determinants of maternal healthcare utilization in Uttar Pradesh, India". PLOS ONE. 13 (10): e0204810. Bibcode:2018PLoSO..1304810D. doi:10.1371/journal.pone.0204810. PMC 6171889. PMID 30286134.
  46. ↑ "Maternal mortality". www.who.int. Retrieved 2020-04-01.
  47. 1 2 World Health Organization (10 June 2018). "India has achieved groundbreaking success in reducing maternal mortality". www.who.int. World Health Organization.
  48. 1 2 Kansal, A; Garg, S; Sharma, M (2018). "Moving from maternal death review to surveillance and response: A paradigm shift". Indian Journal of Public Health. 62 (4): 299–301. doi:10.4103/ijph.IJPH_37_18. PMID 30539893.
  49. 1 2 3 Rai, Rajesh Kumar; Singh, Prashant Kumar; Kumar, Chandan (September 2016). "Is the use of maternal healthcare among prospective mothers higher in households that have experienced maternal death? Evidence from India". Health Policy and Planning. 31 (7): 844–852. doi:10.1093/heapol/czv140. PMID 26864163.
  50. 1 2 Jungari, Suresh; Sharma, Baby; Wagh, Dhananjay (20 October 2019). "Beyond Maternal Mortality: A Systematic Review of Evidences on Mistreatment and Disrespect During Childbirth in Health Facilities in India". Trauma, Violence, & Abuse. 22 (4): 739–751. doi:10.1177/1524838019881719. PMID 31630667. S2CID 204815017.
  51. ↑ "Janani Suraksha Yojana (JSY)". National Health Portal of India.
  52. ↑ "Pradhan Mantri Matru Vandana Yojana". Ministry of Women and Child Development, Government of India.
  53. ↑ "PRADHAN MANTRI SURAKSHIT MATRITVA ABHIYAN". Ministry of Health & Family Welfare, Government of India.
  54. ↑ "पोषण अभियान (राष्ट्रीय पोषण मिशन)". Ministry of Women Welfare.
  55. ↑ "Ambulance Services at Rural Hospitals" (PDF). WB Department of Health.
  56. ↑ Prakash, A; Swain, S; Seth, A (December 1991). "Maternal mortality in India: current status and strategies for reduction". Indian Pediatrics. 28 (12): 1395–400. PMID 1819558.
  57. ↑ Dhar, Sujoy (26 January 2009). "India grapples with high maternal death rate". Reuters.
  58. ↑ GBD 2015 Maternal Mortality Collaborators (8 October 2016). "Global, regional, and national levels of maternal mortality, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015". The Lancet. 388 (10053): 1775–1812. doi:10.1016/S0140-6736(16)31470-2. PMC 5224694. PMID 27733286. {{cite journal}}: |author1= has generic name (help)CS1 maint: numeric names: authors list (link)
  59. ↑ Global Burden of Disease Collaborative Network (2016), Global Burden of Disease Study 2015 (GBD 2015) Life Expectancy, All-Cause and Cause-Specific Mortality 1980-2015 (dataset), Seattle: Institute for Health Metrics and Evaluation
  60. ↑ Alkema, L; Chou, D; Hogan, D; Zhang, S; Moller, AB; Gemmill, A; Fat, DM; Boerma, T; Temmerman, M; Mathers, C; Say, L; United Nations Maternal Mortality Estimation Inter-Agency Group collaborators and technical advisory group (30 January 2016). "Global, regional, and national levels and trends in maternal mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN Maternal Mortality Estimation Inter-Agency Group". The Lancet. 387 (10017): 462–74. doi:10.1016/S0140-6736(15)00838-7. PMC 5515236. PMID 26584737. {{cite journal}}: |author12= has generic name (help)
  61. ↑ Kassebaum, Nicholas J; Lopez, Alan D; Murray, Christopher J L; Lozano, Rafael (December 2014). "A comparison of maternal mortality estimates from GBD 2013 and WHO". The Lancet. 384 (9961): 2209–2210. doi:10.1016/S0140-6736(14)62421-1. PMID 25625393. S2CID 205975571.
  62. ↑ Semrau, Katherine E. A.; Hirschhorn, Lisa R.; Marx Delaney, Megan; Singh, Vinay P.; Saurastri, Rajiv; Sharma, Narender; Tuller, Danielle E.; Firestone, Rebecca; Lipsitz, Stuart; Dhingra-Kumar, Neelam; Kodkany, Bhalachandra S.; Kumar, Vishwajeet; Gawande, Atul A. (14 December 2017). "Outcomes of a Coaching-Based WHO Safe Childbirth Checklist Program in India". New England Journal of Medicine. 377 (24): 2313–2324. doi:10.1056/NEJMoa1701075. PMC 5672590. PMID 29236628.

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