Magnitude and trend of maternal mortality in Rajasthan from 2014 to 2021 - spatio-temporal analysis supported by...

The higher maternal mortality in Rajasthan (one of the Empowered Action Group states in India) is attributed to various determinants in health systems, geographical context, and socio-cultural customs. This study aimed to assess the magnitude and trend of maternal deaths in Rajasthan and the associated medical, social and health system factors by comparing their distribution across two selected districts.

Spatiotemporal analysis of maternal mortality in the state was done using the secondary data. Household surveys and healthcare facility visits were conducted (systems approach study) to assess and compare maternal deaths in two selected districts of Rajasthan (Jodhpur and Udaipur). Verbal autopsies were conducted to ascertain the causes of maternal mortality and the contributing factors. Quantitative data analysis (SPSS and Jamovi) and spatiotemporal analysis (Python) were done.

A total of 8784 maternal deaths have been reported in Rajasthan in the past seven years (2014-21). Among the reported maternal deaths in Jodhpur and Udaipur, majority were facility based (81% and 64%, respectively), mostly between the ages 21 and 25 years. There was an overall increasing trend of Maternal Mortality Ratio (MMR) for Rajasthan (2014-2021 HMIS data). From the verbal autopsy of 248 deaths (173 in Jodhpur and 75 in Udaipur), it was observed that obstetric hemorrhages accounted for about 40% of deaths in both the districts. Comparison of the two districts revealed significant differences in characteristics of the deceased women, including socioeconomic status, rural residence, access to ambulance services, place of delivery, and treatment-seeking behavior.

The low MMR from secondary data do not reflect the status in the field, but merely a result of poor reporting and lack of strong surveillance. Beyond medical causes, maternal mortality was associated with significant differences in social and health-system factors. Strengthening of surveillance and response systems to address the observed spatiotemporal clustering of maternal deaths in the State is highly recommended.