maternal mortality ratio in india and world.pptx

powerpoint on maternal mortality in india and the world

1. PRE-FINAL MBBS GMC-JAMMU ROLL NO: 55-58 MATERNAL MORTALITY RATIO

2. WHAT IS MATERNAL MORTALITY RATIO? According to WHO, a maternal death is defined as "the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from unintentional or incidental causes. This definition allows identification of a maternal death, based on the cause of the death being identified as either a direct or indirect maternal cause. It is calculated as: Total no. Of female deaths due to complications of pregnancy,childbirth or within 42 days of delivery from "puerperal causes" in an area during a given year X 1000 Total no. of live births in the same area and year

3. Direct obstetric deaths (or direct maternal deaths): those resulting from obstetric complications of the pregnant state (pregnancy, labour and puerperium), from interventions. Omissions or incorrect treatment. Deaths due to obstetric haemorrhage or hypertensive disorders in pregnancy, for example, or those due to complications of anaesthesia or caesarean section are classified as direct maternal deaths .  Indirect obstetric deaths (or indirect maternal deaths): those resulting from previous existing disease or disease that developed during pregnancy and which was not due to direct obstetric causes, but was aggravated by physiological effects of pregnancy. For example, deaths due to aggravation of an existing cardiac or renal disease are considered indirect maternal deaths. .

4. Late maternal death: It is "the death of a woman from direct or indirect obstetric causes, after more than 42 days but less than one year after termination of pregnancy". Like maternal deaths, late maternal deaths also include both direct and indirect maternal/obstetric deaths. Complications of pregnancy or childbirth can lead to death beyond the six-week (42 day) postpartum period, and the increased availability of modern life-sustaining procedures and technologies enables more women to survive adverse outcomes of pregnancy and delivery Maternal deaths and late maternal deaths are combined in the 11th revision of the ICD under the new grouping of "comprehensive maternal deaths".

5. Pregnancy-related death (also known as death occurring during pregnancy, childbirth and puerperium): is defined as "The death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the cause of death (obstetric and non-obstetric)"; this definition includes unintentional/accidental and incidental causes. This definition allows measurement of deaths that occur during pregnancy, childbirth and puerperium while acknowledging that such measurements do not strictly conform to the standard "maternal death" concept in settings where accurate information about causes of death based on medical certification is unavailable. The number of maternal deaths in a population (during a specified time period, usually one calendar year) reflects two factors: (i) the risk of mortality associated with a single pregnancy or a single birth (whether live birth or stillbirth); and (ii) the fertility level (i.e. the number of pregnancies or births that are experienced by women of reproductive age. i.e. age 15-49 years).

6. Maternal mortality ratio (MMR): is defined as the number of maternal deaths during a given time period per 100,000 live births during the same time period; thus, it quantifies the risk of maternal death relative to the number of live births. Maternal mortality rate (MMRate): is defined and calculated as the number of maternal deaths divided by person-years lived by women of reproductive age in a population. The MMRate captures both the risk of maternal death per pregnancy or per birth (whether live birth or stillbirth), and the level of fertility in the population .  Adult lifetime risk of maternal death: for women in the population, is defined as the probability that a 15 year-old girl (in the year of the estimate) will eventually die from a maternal cause. This indicator takes into account competing causes of death.

7. The proportion of maternal deaths of women of reproductive age (PM): The number of maternal deaths in a given time period divided by the total deaths, among women aged 15-49 years. The 43rd World Assembly in 1990 adopted the recommendation that countries consider the inclusion on death certificates of questions regarding current pregnancy and pregnancy within one year preceding death in order to improve the quality of maternal mortality data and provide alternative methods of collecting data on deaths during pregnancy or related to it, as well as to encourage the recording of deaths from obstetric causes occurring more than 42 days following termination of pregnancy.

8. Approaches for measuring maternal mortality In the absence of complete and accurate civil registration systems, MMR estimates are based upon a variety of methods: (1) Civil registration systems: This approach involves routine registration of births and deaths. Ideally, maternal mortality statistics should be obtained through civil registration data.   (2) Household survey: Where civil registration data are not available, household survey provides an alternative.   (3) Sisterhood methods: Sisterhood methods obtain information by interviewing a representative sample of respondents about the survival of all their adult sisters (to determine the number of ever married sisters, how many are alive, how many are dead, and how many died during pregnancy, delivery, or within six weeks of pregnancy.

9. (4) Reproductive-age mortality studies (RAMOS): This approach involves identifying and investigating the causes of all deaths of women of reproductive age in a defined area/population by using multiple sources of data.   (5) Verbal autopsy: This approach is used to assign cause of death through interview with family or community members, where medical certification of cause of death is not available. Records of births and deaths are collected periodically among small populations, under demographic surveillance systems. (6) Census: A national census, with the addition of a limited number of questions, could produce estimates of maternal mortality; this approach eliminates sampling errors and hence allows a more detailed breakdown of the results, including time trends, geographic subdivisions and social strata.

10. CAUSES OF MATERNAL MORTALITY Maternal deaths mostly occur from third trimester to the first week after birth . Studies show that mortality risks for mothers are particularly elevated within the first two days after birth . Most maternal deaths are related to obstetric complications , like postpartum hemorrhage , infections , pre eclampsia and prolonged or obstructed labor. About 80% of maternal deaths are due to direct causes like obstetric complications of pregnancy, labor and puerperium Puerperal infections, often the consequence of poor hygiene during delivery account fort 15% of total maternal mortality Hypertensive disorders constitute about 13% of the total deaths

11. Of the estimated 210 million pregnancies that occur every year , about 42 million end in induced abortion , of which only 60 % are carried out under safe conditions . A greater proportion of abortions are conducted by unskilled people or in an environment lacking the minimal medical standards or both . Around 85% of deaths occur due to prolonged or obstructed labor . Other direct causes are : ectopic pregnancies , embolism, deaths related to interventions About 20% deaths are due to indirect causes i.e. due to pre –existing diseases or diseases that developed during pregnancy and are aggravated by the physiological effects of pregnancy , most significant being anemia .

12. Social factors A number of social factors influence maternal mortality The important ones being: WOMEN’S AGE – The optimal child bearing age is between 20 to 30 years . The further away from this range , greater the risks of a woman dying of pregnancy and childbirth . BIRTH INTERVAL – Short birth intervals are associated with increased risk of maternal mortality . PARITY - Mortality is directly linked to high parity Other factors are economic circumstances , cultural practices and beliefs , nutritional status, environmental conditions ,

13. Global Strategy for Women's, Children's and Adolescent's Health 2016-2030 The Global Strategy for Women's, Children's and Adolescent's Health, 2016-2030 was launched in the year 2015 with a vision to have by 2030, a " world in which every woman, child and adolescent in every setting realize their rights to physical and mental health and well-being, has social and economic opportunities. and is able to participate fully in shaping prosperous and sustainable society ". The strategy seeks to end ,all preventable deaths of women, children and adolescents and create an environment in which these groups not only survive, but thrive, and see their health and wellbeing transformed. The global strategy goals of SURVIVE, THRIVE and TRANSFORM and the targets to be achieved by 2030 are as follows : SURVIVE : End preventable deaths Reduce global maternal mortality to less than 70 per 100,000 live births Reduce newborn mortality to at least as low as 12 per 1000 live births in every country

14. Reduce under 5 mortality to at least as low as 25 per 1000 live births in every country End epidemics of HIV, tuberculosis, malaria, neglected tropical diseases and other communicable diseases . Reduce by one third premature mortality from non communicable diseases and promote mental health and well-being . THRIVE Ensure health and well-being Ensure universal access to sexual and reproductive healthcare services (including for family planning) and rights Ensure that all girls and boys have access to good quality early childhood development Substantially reduce pollution-related deaths and illnesses

15. Achieve universal health coverage including financial risk protection and access to quality essential services, medicines and vaccines TRANSFORM Expand enabling environments Eradicate extreme poverty Ensure that all girls and boys complete free, equitable and good quality primary and secondary education . Eliminate all harmful practices and all discrimination and violence against women and girls Achieve universal and equitable access to safe and affordable drinking water, and to adequate sanitation and hygiene Enhance scientific research, upgrade technological capabilities and encourage innovation Provide legal identity for all, including birth registration -Enhance the global partnership for sustainable development.

16. INDIA Despite significant improvements in maternal health over the last decade or so, which is evident in the reductions in maternal mortality in the country, an estimated 44,000 mothers continue to die every year due to causes related to pregnancy, childbirth and the post-partum period. The major medical causes of these deaths are haemorrhage , sepsis, abortion. hypertensive disorders, obstructed labor and other causes including anaemia . A host of socio economic-cultural determinants like illiteracy, low socio economic status, early age of marriage, low level of women's empowerment, traditional preference for home deliveries contribute to these deaths. From year 2000 onwards, (Central registration system) included a new method called the "RHIME" or Representative, Re-sampled, Routine Household Interview of Mortality with Medical Evaluation . RHIME include random re-sampling of field-work by an independent team for maintaining quality of data. .

17. For comparability with WHO estimates for India and for other countries, the WHO's "Global Burden of Disease " categorizaton of maternal deaths have been used, which includes various categories such as: haemorrhage , sepsis, hypertensive disorder, obstructed labour , abortion The SRS report has been grouped into three categories; EAG states of Bihar and Jharkhand, Madhya Pradesh and Chhattisgarh, Odisha, Rajasthan, Uttar Pradesh and Uttaranchal and Assam States of Kerala, Maharashtra, Andhra Pradesh, Gujarat and Tamil Nadu have already achieved the goal of a MMR of 100 per lakh live births. In EAG and Assam category of states, MMR is about 237 per lakh live births. with Assam on top (237) and Uttar Pradesh (201), Rajasthan (199). Odisha (180). Madhya Pradesh (173) closely following.

18. The age distribution of maternal and non-maternal deaths from the 2014-2016 Special Survey of Deaths are given in the table. It shows that more than two-thirds of the maternal deaths are of women in age group 20-34 years. In contrast, non-maternal deaths are more evenly distributed.

19. Causes The major causes of maternal mortality in india according to the 2001-2003 SRS survey are haemorrhage (38 per cent) sepsis (11 per cent) hypertension (5 per cent) obstructed Labour (5 per cent) abortion (8 per cent) other conditions (34 per cent). Anaemia ( 19 per cent) is not only the leading cause of death but also an aggravating factor in haemorrhage , sepsis and toxaemia . Illegal abortions are also one of the leading causes of maternal death. That this should continue despite MTP facilities points to the need for wider dissemination of information about these facilities. Induced abortions also point to a large unmet need for contraceptives, as with each pregnancy the woman faces increased risk of death.

20. National maternal health care indicators . The estimates of maternal mortality can only be used as a rough indicator of maternal health situation in any given country. Hence indicators such as antenatal check-up, institutional delivery and delivery by trained personnel etc. are used to assess the maternal health status. These indicators also reflect the status of the ongoing programme interventions and the situation of maternal health .

21. Preventive and social measures High maternal mortality reflects not only about the inadequacy of health care services for mothers , but also low standards of living and socio-economic status of the community . Any attempt to lower the maternal mortality must take into consideration the following measures ; early registration of pregnancy At least four antenatal check-ups Dietary supplementation , including anemia correction by administration of iron and folic acid tablets. Prevention of infection and hemorrhage during puerperium Prevention of complications i.e. eclampsia , malpresentations , ruptured uterus Clean delivery practices Treatment of medical conditions like hypertension , diabetes , tuberculosis etc

22. Proper utilization of maternal health care services Anti malaria and tetanus prophylaxis In India ,a large proportion of maternal deaths could be prevented with the help of trained village level health workers Institutional deliveries for women with bad obstetric history and risk factors Promotion of family planning – to control the number of children to not more than two and spacing of births Identification of every maternal death , and searching for its cause Safe abortion services Improvement in the health care infrastructure which includes – providing MCH services to rural areas and urban slums , facilities for essential or emergency obstetric care , training traditional birth attendants , management of eclampsia or third stage complications at the PHC level

23. Thank You