TN's mission 2026: Reduce maternal mortality rate to single digit

CHENNAI: If having a baby is many women’s dream, the risk of medical complications during and after delivery, which could lead to the death of the mother, also known as maternal mortality, is a sobering thought. However, Tamil Nadu’s performance in lowering maternal mortality rate (MMR) has been significant.

Recently, Health Minister Ma Subramanian stated that MMR had dropped to 39.4 per 1 lakh births in Tamil Nadu, and that the health department was working towards bringing it down further – to single digits in the next 2 years.

In 2020, the global MMR was 223 per 100,000 live births, according to the World Health Organization (WHO). The Sustainable Development Goal (SDG) 3 aims to reduce the global MMR to fewer than 70 per 100,000 live births by 2030.

To identify the cause of MMR in the State, the health department is conducting a comprehensive audit of maternal deaths. The audit will also help to determine the solutions to these challenges.

Causes

“Several causes have been identified for maternal mortality, and those include post-partum haemorrhage in around 20% of cases, hypertensive disorders in more than 19% of cases, sepsis is around 10%, as many as 9% have heart disease, 4% are abortion cases and the remaining are other factors. The data also revealed that around 74% of maternal deaths happened during the postnatal period,” said a senior official from the National Health Mission.

The State Health Department recently set up a special task force to lower MMR in the State. The task force has introduced a new and robust pre-birth planning mechanism (PBPM) to seal the gaps in providing critical care for pregnant women both in the government and private sectors.

The report on MMR that analysed data from 2014-2024 revealed that 72% deaths happened in rural areas, while the remaining was in urban areas. “Accessibility and awareness are challenging factors in rural areas. So, efforts are being made through medical officers to prevent mortality, and also enable safe delivery at a tertiary care centre,” said the official.

Referrals, strategies

Several districts including Thanjavur, Chengalpattu, Dindigul, Mayiladuthurai, Pudukkottai, Theni, Namakkal, and Tiruvarur report a high MMR, which has caught the attention of the task force. “Rural areas need to have access to tertiary care institutions for high risk cases. Cases at risk of maternal mortality are reported often in tertiary care hospitals because these arrive (with complications) as referrals from primary care institutions or even Primary Health Centres if there are any complications,” says health secretary Supriya Sahu.

To prevent this, the department’s strategy is to focus on pre-birth planning. “There are about 130-140 deliveries done in PHC, and over 600 in a government hospital; all deliveries are being monitored by the department,” she added. “In this manner, we ensure that high-risk pregnancies are given priority at tertiary care centres.”

The department is identifying the type of high-risk pregnancies and ensuring resources are available at the hospital. “We’re monitoring each case so that there is no complication during the delivery,” stated Sahu.

Expert training is also being provided to nurses and doctors at CEmONC centres (Comprehensive Emergency Obstetric and Newborn Care) to handle any emergency condition. “The critical strategy now is to track all the mothers, identify high-risk pregnancies at the earliest and plan for their delivery at the appropriate place,” said Dr TS Selvavinayagam, Director of Public Health and Preventive Medicine. “The State Health Department is also working along with private sector healthcare facilities in this regard.”

Identifying high-risk cases

There are approximately 9 lakh pregnant women in Tamil Nadu every year, and around 9 lakh children are born. The 102 call centre service has identified 3 lakh pregnant women who are more than 6 months pregnant. They will be monitored and provided with necessary medical assistance.

Pregnant women with identified risk factors such as diabetes, hypertension, anaemia and other health issues are scheduled for delivery only in CEmONC centres. The war room is also monitoring the birth planning through the 102 call centres.

“Each healthcare facility will be mapped with the appropriate higher institution. Whenever there is a challenge during delivery, the expectant mother will be transported to that facility. We’re ensuring that the standard operating protocol is followed at all levels and monitoring is done through 102 call centres,” pointed out Dr Selvavinayagam.

IN A NUTSHELL

What is MMR?

The maternal mortality rate (MMR) is calculated by dividing the number of maternal deaths by the number of live births in a given time period and then multiplying by 100,000

· Global MMR in 2020 was 223 deaths per 100,000 live births, a significant improvement from 1985 when MMR was 441 deaths per 100,000 live births

· WHO’s goal: Reduce global MMR to less than 70 deaths per 100,000 live births by 2030

Causes in TN

· Post-partum haemorrhage (severe bleeding) – 20%

· Hypertensive disorders (including pre-eclampsia and eclampsia) – more than 19%

· Sepsis (body’s improper response to infection) – around 10%

· Heart disease – 9%

· Abortion – 4%

Around 74% of maternal deaths happen during postnatal period

Identifying pregnant women

· Around 9 lakh pregnant women in TN every year

· 102 call centre service has identified 3 lakh pregnant women who are more than 6 months pregnant