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Cited by 213Global Maternal and Child HealthMaternal and fetal healthcareReproductive Health and Contraception

Maternal Mortality in India: Causes and Healthcare Service Use Based on a Nationally Representative Survey

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Montgomery, Ann L., Ram, Usha, Kumar, Rajesh, Jha, Prabhat, for The Million Death Study Collaborators·2014·PLoS ONE
DOI 10.1371/journal.pone.0083331PMC PMC3893075
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Abstract

BACKGROUND: Data on cause-specific mortality, skilled birth attendance, and emergency obstetric care access are essential to plan maternity services. We present the distribution of India's 2001-2003 maternal mortality by cause and uptake of emergency obstetric care, in poorer and richer states. METHODS AND FINDINGS: The Registrar General of India surveyed all deaths occurring in 2001-2003 in 1.1 million nationally representative homes. Field staff interviewed household members about events that preceded the death. Two physicians independently assigned a cause of death. Narratives for all maternal deaths were coded for variables on healthcare uptake. Distribution of number of maternal deaths, cause-specific mortality and uptake of healthcare indicators were compared for poorer and richer states. There were 10,041 all-cause deaths in women age 15-49 years, of which 1096 (11.1%) were maternal deaths. Based on 2004-2006 SRS national MMR estimates of 254 deaths per 100,000 live births, we estimated rural areas of poorer states had the highest MMR (397, 95%CI 385-410) compared to the lowest MMR in urban areas of richer states (115, 95%CI 85-146). We estimated 69,400 maternal deaths in India in 2005. Three-quarters of maternal deaths were clustered in rural areas of poorer states, although these regions have only half the estimated live births in India. Most maternal deaths were attributed to direct obstetric causes (82%). There was no difference in the major causes of maternal deaths between poorer and richer states. Two-thirds of women died seeking some form of healthcare, most seeking care in a critical medical condition. Rural areas of poorer states had proportionately lower access and utilization to healthcare services than the urban areas; however this rural-urban difference was not seen in richer states. CONCLUSIONS: Maternal mortality and poor access to healthcare is disproportionately higher in rural populations of the poorer states of India.

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  • Whereas maternal and perinatal conditions are not a major cause of death in Madurai, poorer and rural regions of the country experience markedly higher maternal and infant mortality.

    “For example, whereas maternal and perinatal conditions are not a major cause of death in Madurai, poorer and rural regions of the country experience markedly higher maternal and infant mortality62.”

    From Attributed causes of excess mortality during the COVID-19 pandemic in a south Indian city (2023) · cites this paper as [62]

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Research works printed but not linked: 3

  1. [16]RGI (2011) Special bulletin on maternal mortality in India 2007–09. New Delhi: Office of the Registrar General.
  2. [18]RGI (2009) Special bulletin on maternal mortality in India 2004–2006. New Delhi: Office of the Registrar General.
  3. [37]Cunningham FG, Williams JW (2009) William's obstetrics. New York: McGraw-Hill Education, 23 edition.

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Authors
Montgomery, A. L., Ram, U., Kumar, R., Jha, P., & Collaborators, F. T. M. D. S.
Affiliations
  • St. Michael's Hospital (CA)
  • Post Graduate Institute of Medical Education and Research (IN)
Corresponding author
Montgomery, Ann L.
ORCID
Venue
PLoS ONE
Publisher
Public Library of Science (PLoS)
Published
2014-01-15
Volume
9
Issue
1
Pages
e83331
ISSN
1932-6203 (ISSN-L)
DOI
10.1371/journal.pone.0083331
PMC
PMC3893075
OpenAlex
W2035109025
Cited by
213
References
30
Citations by year
2026: 7 · 2025: 13 · 2024: 12 · 2023: 16 · 2022: 18 · 2021: 20 · 2020: 37 · 2019: 19 · 2018: 22 · 2017: 15 · 2016: 19 · 2015: 12 · 2014: 3
FWCI
14.38
Type
journal article
Language
en
Open access
Licence
Locations
  • PLoS ONE (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Greater South Information System
Topics
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Maternal and fetal healthcare
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Reproductive Health and Contraception
Keywords
maternal mortality, cause-specific mortality, emergency obstetric care, skilled birth attendance, health care utilization, urban-rural differences, state-level poverty, direct obstetric causes, India
MeSH terms
Female, Humans, India, Maternal Mortality, Pregnancy

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