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  • Title: Levels and causes of maternal mortality in southern India.
    Author: Bhatia JC.
    Journal: Stud Fam Plann; 1993; 24(5):310-8. PubMed ID: 8296332.
    Abstract:
    Most studies of maternal mortality are hospital based. However, in developing countries, where many such deaths take place in the home, hospital statistics do not reflect the true extent of maternal mortality. Furthermore, the socioeconomic and demographic factors and health behavior affecting maternal mortality are rarely known. A study conducted in 1986 in South India demonstrates a new approach to investigating maternal mortality that combines the collection of information from hospital and health-facility records, field surveys, and case-control studies. The findings from this study indicate that there were 7.98 maternal deaths per 1,000 live births. Approximately one-half of the deaths occurred in the home or on the way to the hospital. Maternal deaths accounted for 36 percent of mortality for women of reproductive age. Analysis reveals that many of these deaths were preventable and that significant differentials existed with regard to demographic, social, and behavioral factors between the cases of maternal deaths and the controls. The maternal mortality ratio is considered a sensitive index of the prevailing health conditions and general socioeconomic development of a community. In this study, maternal mortality was estimated for Anantapur district in Andra Pradesh state from July 1984 through June 1985; causes of death were examined as well as case control comparisons. Data were collected from the 15 district hospitals, death certificates files with civil registration authorities, 22 Primary Health Centers (PHCs) and 50% of subcenters (181 villages), and a variety of people who knew women who were known to have died and were reported to PHCs and subcenters. The population served by these facilities was 47.3% of the total district rural population. Detailed interviews in the second phase were conducted in 10 PHC villages, 66 subcenter villages, and 135 other control villages. Controls were selected from urban and rural areas from birth records. The findings indicated 867 maternal deaths in rural areas and 206 in urban areas. 52.5% of these deaths occurred to women aged 29 years or younger. Followup of 391 deaths revealed that 333 in rural areas and 58 in urban areas were due to pregnancy complications, childbirth, and the puerperium. 70% of this population were aged 30 years or younger and 31.7% were aged 20=24 years. Maternal mortality for women aged 15-49 years accounted for 36.4% of total female mortality; 28.2% in urban areas and 38.4% in rural areas. About 50% of the maternal deaths for women aged 15-29 years in rural areas were due to pregnancy complications and childbirth. Rural subcenter records were recording only 44.6% of maternal deaths. An index was constructed on levels of rural development and compared with maternal mortality; the results were that poorly developed villages had 4 times the maternal mortality rates as highly developed villages. Maternal survival was found to be reacted to higher socioeconomic status, literacy, better contacts with the outside world, and prenatal care. The number of prior stillbirths was higher among deceased women. 40.8% of deaths were determined by the obstetrician=gynecologist to be preventable 37.0% may have been preventable, and 22.2% were unpreventable.
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