Kerala’s maternal mortality ratio (MMR) as per the latest Sample Registration System (SRS) special bulletin of 2022-24 stands at 24 (per one lakh live births) and it continues to be the State with the lowest MMR in the country. At the national level, the MMR stands at 87.

This is a drop by six points as the SRS bulletin of 2021-23 had shown Kerala’s MMR at 30.

Tamil Nadu is at the number two spot with an MMR of 25, and seems to have made significant strides in reducing maternal deaths as this is a drop by 10 points from 2021-23.

Wide variance

The SRS data on MMR, while quoted in official documents, has always been at wide variance with the MMR reported by the Health department, calculated using actual line list figures. According to the Health department’s data, in 2022-23, the MMR was 28, and in 2023-24, it was 32.

With 70.8% of child births in the State taking place in the private health sector (NSSO data, 80th round), the contribution of private hospitals in ensuring that the State maintains its record of lowest MMR should be acknowledged, even though most serious cases of delivery-related complications get pushed to the tertiary care maternity hospitals in the public sector.

From 2017-18, maternal deaths have been on a steady decline in the State, except in 2021-22, when Covid-19 claimed 220 maternal lives. Over the last few years at least, the average number of maternal deaths in the State annually has stood at 120-140.

Child births have been declining sharply in the State over the last decade but the proportion of maternal deaths recorded in the State has not shown as drastic a decline.

High-risk pregnancies

Health officials pointed out that the State was grappling with a situation wherein, alongside the common causes of maternal deaths, postpartum haemorrhage, sepsis and amniotic fluid embolism, there was an increase in the number of high-risk pregnancies in the State.

The number of women choosing to have children at older ages, pregnant women with multimorbidities like diabetes or hypertension and those with heart diseases has gone up in the State, many gynaecologists have reported.

Kerala Federation of Obstetricians and Gynaecologists said that some of the causes of maternal deaths that they identified recently, during their maternal death auditing process, included serious conditions like Moyamoya disease, ICSOL (intracranial space occupying lesion), bacterial meningoencephalitis and massive hemoptysis due to pulmonary TB.

“This change in maternal profile means that Ob-Gyns will be encountering more of hidden or unexpected/ unexplainable maternal complications and the health system will need to focus on improving the infrastructure and human resources for better management of obstetric complications,” a senior Health official said.

“Kerala had set a target for itself at least a decade or more ago, based on the UN Sustainable Development Goals, that it would achieve an MMR of 20 by 2030. Given the changing realities, there is no room for complacency,” he said.