A systematic review of risk factors for maternal mortality in India

Abstract

Background: India as one of the rapidly developing economies where health challenges are myriad at the population level has the highest number of maternal death in the world. Understanding risk factors for maternal mortality is paramount because maternal health is the basic indicator for the overall adequacy of healthcare of a country. This study was conducted to review on the various risk factors of maternal mortality and the multifarious challenges for maternal health in India.

Methods: A literature search was conducted with PubMed and Google scholar using the key words of (“risk factors” AND (“maternal mortality” OR “maternal death”) AND India) for articles published from 1970 to May 2014. PubMed was primarily used for the systematic search.

Findings: Twelve studies were identified for the final review of which six were case series studies, three were case studies and three were case control studies. Most of the studies were conducted in institutional settings from the five regions (North, South, West, Central and East) of India with different range of Maternal Mortality Rate (MMR) estimates. Previous literature had highlighted socio economic disadvantages as important determinants for maternal mortality. The current review shows a complex interplay of four factors in general in India: social, obstetrical, behavioural and medical factors. Variables of both social demographic and economic factors such as median age of the women at childbirth, literacy rate of the female population and area of residences are put together in the social factors of this study. Compared to the causes, descriptions on behavioural risk factors were rather limited and so the requisite to examine the risk factors affecting maternal mortality is justified. Intervention strategies include conditional cash transfer scheme, voucher scheme, training of village health volunteers and training of auxiliary mid wives’.

Conclusions: India has a unique social system of diversity and stratification. The pattern of maternal mortality in India is different and varied widely in zones or regions. The variations of challenges should be highlighted so as to give a clear grasp of the inequalities of maternal health as well as also help in reducing the MMR substantially.