Hostname: page-component-cd9895bd7-8ctnn Total loading time: 0 Render date: 2024-12-23T09:27:13.512Z Has data issue: false hasContentIssue false
  • English
  • Français

WHAT IS THE CAUSE OF THE DECLINE IN MATERNAL MORTALITY IN INDIA? EVIDENCE FROM TIME SERIES AND CROSS-SECTIONAL ANALYSES

Published online by Cambridge University Press:  22 October 2013

SRINIVAS GOLI  and
ABDUL C. P. JALEEL
SRINIVAS GOLI*
Affiliation:
Department of Development Studies, Giri Institute of Development Studies, Lucknow, India
ABDUL C. P. JALEEL
Affiliation:
International Institute for Population Sciences, Mumbai, Maharashtra, India
*
1Corresponding author. Email: [email protected]
Get access Rights & Permissions [Opens in a new window]

Summary

Studies on the causes of maternal mortality in India have focused on institutional deliveries, and the association of socioeconomic and demographic factors with the decline in maternal mortality has not been sufficiently investigated. By using both time series and cross-sectional data, this paper examines the factors associated with the decline in maternal mortality in India. Relative effects estimated by OLS regression analysis reveal that per capita state net domestic product (−1.49611, p<0.05), poverty ratio (0.02426, p<0.05), female literacy rate (−0.05905, p<0.10), infant mortality rate and total fertility rate (0.11755, p<0.05) show statistically significant association with the decline in the maternal mortality ratio in India. The Barro-regression estimate reveals that improvements in economic and demographic conditions such as growth in state income (β=0.35020, p<0.05) and reduction in poverty (β=0.01867, p<0.01) and fertility (β=0.02598, p<0.05) have a greater association with the decline in the maternal mortality ratio in India than institutional deliveries (β=0.00305). The negative β-coefficient (β=−0.69578, p<0.05), showing the effect of the initial maternal mortality ratio on change in maternal mortality ratio in the Barro-regression model, indicates a greater decline in maternal mortality ratio in laggard states compared with advanced states. Overall, comparing the estimates of relative effects, the socioeconomic and demographic factors have a stronger statistically significant association with the maternal mortality ratio than institutional deliveries. Interestingly, the weak association between ‘increase in institutional deliveries' and ‘decline in maternal mortality ratio’ suggests that merely increasing deliveries alone will not help in ensuring maternal survival in India. Quality of services provided by the health facility, birth preparedness and avoiding delay in reaching health facility are also important. Deliveries in health facilities will not necessarily translate into increased survival chances of mothers unless women receive full antenatal care services and delays in reaching health facility are avoided.

Type
Articles
Information
Journal of Biosocial Science , Volume 46 , Issue 3 , May 2014 , pp. 351 - 365
Copyright
Copyright © Cambridge University Press 2013 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Ahmed, S., Li, Q., Liu, L. & Tsui, A. (2012) Maternal deaths averted by contraceptive use: results from a global analysis of 172 countries. Lancet 380(9837), 111–125.Google Scholar
Bang, A. T., Bang, R. A., Baitule, S. B., Reddy, M. H. & Deshmukh, M. D. (1999) Effect of home-based neonatal care and management of sepsis on neonatal mortality: field trial in rural India. Lancet 354, 1955–1961.Google Scholar
Barro, R. J. & Sala-i-Martin, X. (1995) Economic Growth. McGraw-Hill, New York.Google Scholar
Bhat, P. N. M., Navaneetham, K. & Rajan, S. I. (1995) Maternal mortality in India: estimates from a regression model. Studies in Family Planning 26, 217–232.Google Scholar
Campbell, M. R. O., Graham, J. W. & Lancet Maternal Survival Series Steering Group (2006) Strategies for reducing maternal mortality: getting on with what works Lancet 368, 1284–1299.Google Scholar
Filippi, V., Ronsmans, C., Campbell, O. M., Graham, W. J., Mills, A. & Borghi, J. (2006) Maternal health in poor countries: broader context and call for action. Lancet 386, 1542–1545.Google Scholar
Goldie, S. J., Sweet, S., Carvalho, N., Natchu, U. C. M & Hu, D. (2010) Alternative strategies to reduce maternal mortality in India: a cost-effectiveness analysis. PLoS Medicine 7(4), e1000264.Google Scholar
Gopichandran, V. & Chetlapalli, S. K. (2012) Conditional cash transfer to promote institutional deliveries in India: toward a sustainable ethical model to achieve MDG 5A. Public Health Ethics doi: 10.1093/phe/phs021.Google Scholar
Government of India (1973–2010) Poverty Estimates Reports. Planning Commission, Government of India, New Delhi.Google Scholar
Government of India (1981–2009) Family Welfare Statistics Years Books. Ministry of Health and Family Welfare (MoHFW), Government of India, New Delhi.Google Scholar
Government of India (2005) National Rural Health Mission (2005–2012): Mission Document. Ministry of Health and Family Welfare, Government of India, New Delhi, p. 28.Google Scholar
Hogan, M. C., Foreman, K. J., Naghavi, M., Ahn, S. Y., Wang, M., Makela, S. M.et al. (2010) Maternal mortality for 181 countries, 1980–2008: a systematic analysis of progress towards Millennium Development Goal 5. Lancet 375(9726), 1609–1623.CrossRefGoogle ScholarPubMed
IIPS & Macro International (2007) National Family Health Survey (NFHS-3). International Institute for Population Sciences, Mumbai, India.Google Scholar
Iyengar, K., Iyengar, S. D., Suhalka, V. & Dashora, K. (2009) Pregnancy-related deaths in rural Rajasthan, India: exploring causes, context, and care-seeking through verbal autopsy. Journal of Health Population and Nutrition 27(2), 293–302.Google Scholar
Jain, A. K. (2010) Janani Suraksha Yojana and the maternal mortality ratio. Economic and Political Weekly 45(11), 15–16.Google Scholar
Jain, A. K. (2011) Measuring the effect of fertility decline on the maternal mortality ratio. Studies in Family Planning 42(4), 247–260.Google Scholar
Kesterton, A. J., Cleland, J., Sloggett, A. & Ronsmans, C. (2010) Institutional delivery in rural India: the relative importance of accessibility and economic status. BMC Pregnancy and Childbirth 10(30).CrossRefGoogle ScholarPubMed
Koblinsky, M., Matthews, Z., Hussein, J., Mavalankar, D., Mridha, M. K. & Anwar, I.et al. (2006) Going to scale with professional skilled care. Lancet 368, 1377–1386.Google Scholar
Lahariya, C. (2011) Additional cash incentive within a conditional cash transfer scheme: a ‘controlled before and during’ design evaluation study from India. Indian Journal Public Health 55, 115–120.Google Scholar
Lim, S. S., Lalit, D., Hoisington, J. A., James, S. L., Hogan, M. C. & Gakidou, E. (2010) India's Janani Suraksha Yojana, a conditional cash transfer programme to increase births in health facilities: an impact evaluation. Lancet 375(9730).CrossRefGoogle ScholarPubMed
Motashaw, N. D. (1997) Root causes of maternal mortality: infancy to motherhood. Journal of Family Welfare 43(2).Google Scholar
Mukhopadhyay, B. K. (2012) Is maternal mortality in India expecting the “revised” Millennium Development Goal? International Journal of Developing Societies 1(1), 31–42.Google Scholar
Preston, S. H. (1980) Causes and consequences of mortality change in less developed countries in the twentieth century. In Easterlin, R. (ed.) Population and Economic Change in Developing Countries. National Bureau of Economic Research, University of Chicago Press, Chicago.Google Scholar
Radkar, A. & Parasuraman, S. (2007) Maternal deaths in India: an exploration. Economic and Political Weekly 31.Google Scholar
RBI (1955–2011) Handbook of Statistics. Reverse Bank of India, Government of India, New Delhi.Google Scholar
RGI (1997–2003) Maternal & Child Mortality and Total Fertility Rate, Sample Registration System (SRS). Office of the Registrar General, New Delhi, India.Google Scholar
RGI (2007) Compendium of India's Fertility and Mortality Indicators 1971–2007. Office of the Registrar General, New Delhi, India.Google Scholar
RGI (2010) Sample Registration System (SRS). Office of the Registrar General, New Delhi, India.Google Scholar
RGI (2011) Maternal & Child Mortality and Total Fertility Rate, Sample Registration System (SRS). Office of the Registrar General, New Delhi, India.Google Scholar
RGI & Census Commissioner (1981–2011) Census of India 1981–2011. Office of the Registrar General, New Delhi, India.Google Scholar
Ronsmans, C., Graham, W. J. & Lancet Maternal Survival Series Steering Group (2006) Maternal mortality: who, when, where and why? Lancet 368, 1189–2000.Google Scholar
Srinivasan, K., Chander, S. & Arokiasamy, P. (2007) Reviewing reproductive and child health programmes in India. Economic & Political Weekly 42(27), 2931–2939.Google Scholar
Stover, J. & Ross, J. (2008) How Contraceptive Use Affects Maternal Mortality. Health Policy Initiative. Task Order 1, Washington, DC, USA.Google Scholar
Trussell, J. & Pebley, A. R. (1984) The potential impact of changes in fertility on infant, child, and maternal mortality. Studies in Family Planning 15, 267–280.Google Scholar
United Nations (2008) UN MDG Indicators Database. United Nations, New York.Google Scholar
United Nations (2010) Goal 5 Maternal Health Fact Sheet. United Nations Summit High-Level Plenary Meeting of the General Assembly, New York.Google Scholar
WHO, UNICEF, UNFPA & World Bank (2012) The World Trends in Maternal Mortality: 1990 to 2010. World Health Organization, Geneva.Google Scholar
World Bank (2009) Reducing Maternal Mortality: Strengthening the World Bank Response. World Bank. Google Scholar