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  • SRINIVAS GOLI (a1) and ABDUL C. P. JALEEL (a2)


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.


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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), 111125.
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, 19551961.
Barro, R. J. & Sala-i-Martin, X. (1995) Economic Growth. McGraw-Hill, New York.
Bhat, P. N. M., Navaneetham, K. & Rajan, S. I. (1995) Maternal mortality in India: estimates from a regression model. Studies in Family Planning 26, 217232.
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, 12841299.
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, 15421545.
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.
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.
Government of India (1973–2010) Poverty Estimates Reports. Planning Commission, Government of India, New Delhi.
Government of India (1981–2009) Family Welfare Statistics Years Books. Ministry of Health and Family Welfare (MoHFW), Government of India, New Delhi.
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.
Hogan, M. C., Foreman, K. J., Naghavi, M., Ahn, S. Y., Wang, M., Makela, S. al. (2010) Maternal mortality for 181 countries, 1980–2008: a systematic analysis of progress towards Millennium Development Goal 5. Lancet 375(9726), 16091623.
IIPS & Macro International (2007) National Family Health Survey (NFHS-3). International Institute for Population Sciences, Mumbai, India.
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), 293302.
Jain, A. K. (2010) Janani Suraksha Yojana and the maternal mortality ratio. Economic and Political Weekly 45(11), 1516.
Jain, A. K. (2011) Measuring the effect of fertility decline on the maternal mortality ratio. Studies in Family Planning 42(4), 247260.
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).
Koblinsky, M., Matthews, Z., Hussein, J., Mavalankar, D., Mridha, M. K. & Anwar, al. (2006) Going to scale with professional skilled care. Lancet 368, 13771386.
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, 115120.
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).
Motashaw, N. D. (1997) Root causes of maternal mortality: infancy to motherhood. Journal of Family Welfare 43(2).
Mukhopadhyay, B. K. (2012) Is maternal mortality in India expecting the “revised” Millennium Development Goal? International Journal of Developing Societies 1(1), 3142.
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.
Radkar, A. & Parasuraman, S. (2007) Maternal deaths in India: an exploration. Economic and Political Weekly 31.
RBI (1955–2011) Handbook of Statistics. Reverse Bank of India, Government of India, New Delhi.
RGI (1997–2003) Maternal & Child Mortality and Total Fertility Rate, Sample Registration System (SRS). Office of the Registrar General, New Delhi, India.
RGI (2007) Compendium of India's Fertility and Mortality Indicators 1971–2007. Office of the Registrar General, New Delhi, India.
RGI (2010) Sample Registration System (SRS). Office of the Registrar General, New Delhi, India.
RGI (2011) Maternal & Child Mortality and Total Fertility Rate, Sample Registration System (SRS). Office of the Registrar General, New Delhi, India.
RGI & Census Commissioner (1981–2011) Census of India 1981–2011. Office of the Registrar General, New Delhi, India.
Ronsmans, C., Graham, W. J. & Lancet Maternal Survival Series Steering Group (2006) Maternal mortality: who, when, where and why? Lancet 368, 11892000.
Srinivasan, K., Chander, S. & Arokiasamy, P. (2007) Reviewing reproductive and child health programmes in India. Economic & Political Weekly 42(27), 29312939.
Stover, J. & Ross, J. (2008) How Contraceptive Use Affects Maternal Mortality. Health Policy Initiative. Task Order 1, Washington, DC, USA.
Trussell, J. & Pebley, A. R. (1984) The potential impact of changes in fertility on infant, child, and maternal mortality. Studies in Family Planning 15, 267280.
United Nations (2008) UN MDG Indicators Database. United Nations, New York.
United Nations (2010) Goal 5 Maternal Health Fact Sheet. United Nations Summit High-Level Plenary Meeting of the General Assembly, New York.
WHO, UNICEF, UNFPA & World Bank (2012) The World Trends in Maternal Mortality: 1990 to 2010. World Health Organization, Geneva.
World Bank (2009) Reducing Maternal Mortality: Strengthening the World Bank Response. World Bank.
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