Situational analysis of maternal death review in India: Evidence from health management information system

Abstract

Maternal Death Review (MDR) is a continuous effort of identification, notification, and review of maternal deaths for possible causes followed by actions to improve quality of care for preventing future deaths. The present study has used three consecutive years’ data of MDR and assessed the causes of maternal death which are available in the Health Management Information System (HMIS) for years 2017–18, 2018–19 and 2019–20. A total 61,472 maternal deaths occurred in India during the past three years. A higher proportion of these deaths occurred particularly in Uttar Pradesh (22.9%) followed by Madhya Pradesh (9.8%), Rajasthan (6.3%), Maharashtra (6.2%), Bihar (5.8%), West Bengal (5.3%) and Assam (5.1%). The Community Based Maternal Death Reviews (CBMDR) revealed that only one-third (32.6%) of maternal deaths are reviewed at the national level out of total deaths. The Empowered Action Group (EAG) states such as Bihar has the lowest MDR followed by Madhya Pradesh, Rajasthan, Jharkhand and Uttar Pradesh. Likewise, the chief medical officer (CMO) at the district level reviewed 39.4% of deaths during the past three years in India. Haemorrhage causes 15 percent of maternal deaths followed by severe hypertension/fits (10%), high fever (3%) in India. Bihar has the highest maternal deaths due to postpartum hemorrhage followed by Meghalaya, Manipur, Uttar Pradesh, Jharkhand and Mizoram. The study concludes that the implementation of MDR at both the level (CBMDR and reviews by CMO) are found to be poor in India. Strategic interventions based on the identified causes at both levels may help to reduce the maternal deaths in India, particularly in EAG states.