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  • Title: Maternal mortality in India: estimates from a regression model.
    Author: Bhat PN, Navaneetham K, Rajan SI.
    Journal: Stud Fam Plann; 1995; 26(4):217-32. PubMed ID: 7482679.
    Abstract:
    This report outlines a new technique for the estimation of maternal mortality by relating the sex differentials in mortality for people of reproductive age to the age schedule of fertility. The application of this method to the data from the Sample Registration System for 1982-86 indicates a level of maternal mortality of 580 deaths per 100,000 live births for India as a whole, 638 deaths in rural areas, and 389 deaths in urban areas. Estimates derived for the major states suggest relatively high maternal mortality in the eastern and northern parts of the country. They also indicate a substantial decline in maternal mortality since the 1960s. The decline in the birth rate is estimated to have accounted for nearly one-fourth of the decrease in the maternal death rate and 5 percent of the fall in the maternal mortality ratio in the 10-year period between 1972-76 and 1982-86. The method of estimation described here is well-suited to the data circumstances in India. This report uses a new method for estimation of the level of maternal mortality using the relationship between sex differences in mortality among reproductive age groups and age-specific fertility. This parametric method assumes a standard age pattern of maternal mortality among women 15-49 years old. Data requirements are identified as age-specific death rates from all causes by sex, age-specific fertility rates, the ratio of maternal mortality at different ages to ages 20-24 years (country specific or a similar country's data), and the age pattern of sex ratios of death rates excluding maternal mortality. This new method is applied to data obtained from the Sample Registration System and the National Sample Surveys of India. Data obtained from Matlab, Bangladesh, are used to express the ratio of the age pattern of maternal mortality to women 20-24 years old. Age-specific fertility and mortality rates are averaged during 1982-86 for 15 major states, excluding Kerala, Punjab, Orissa, and Rajasthan states. Regressions are constructed for estimating the level of rural maternal mortality for women 20-24 years old. When the model uses the dependent variable, the sex ratio of mortality, maternal mortality at age 20-24 years is estimated at 465 deaths per 100,000 live births. When the model is fitted to female death rates, maternal mortality at age 20-24 years is 480 deaths per 100,000 live births. Further adjustments are made to conform to state patterns. Final estimation of maternal mortality under two specifications reveals a maternal mortality ratio of 568 or 591 deaths per 100,000 live births during 1982-86. An average maternal mortality ratio of 580 for India is given as the equivalent of a maternal mortality rate of 82 per 100,000 women 15-49 years old, or 21% of deaths of females 15-49 years old. State variations range widely from 20 deaths per 100,000 women in Kerala to 160 in Uttar Pradesh. This estimation is comparable to adjustment of Survey of Cause of Death estimation, suggesting the reliability of this method.
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