Contributing factors for reduction in maternal mortality ratio in India

Area of Science:

• Public Health
• Demography
• Health Systems Research

Background:

• Maternal mortality ratio (MMR) variations across India require analysis of space, time, and system-level factors.
• Understanding these multifactorial influences is crucial for effective public health interventions.

Purpose of the Study:

• To estimate and quantify the impact of maternal health and system-level indicators on MMR in India.
• To analyze spatio-temporal patterns and identify high-risk areas for maternal mortality.

Main Methods:

• Utilized National Family Health Survey (NFHS: 2019-21) and government reports for maternal and system-level indicators.
• Employed heatmap visualizations, facet plots, and Bayesian spatio-temporal random effects models.
• Analyzed MMR data from Sample Registration System (SRS) reports (2014-2020).

Main Results:

• India has observed a general linear decline in MMR, with cyclical increases in states like Haryana and West Bengal.
• A significant transition period in MMR levels occurred between 2009-2013 for most states.
• Bihar and Assam were identified as 'hot spots' with higher estimated spatial risks.
• Health system factors, particularly institutional delivery and skilled birth attendance, showed a greater impact on MMR reduction.

Conclusions:

• Health system strengthening is paramount for reducing maternal mortality in India.
• Targeted interventions in high-risk areas like Bihar and Assam are necessary.
• Future research should focus on district-level data for more robust MMR estimations.