Monday, May 17, 2010

Experts project 350 maternal deaths per lakh live births against government claims of 254

On 13th April, Tribune published a special report regarding Maternal mortality ratio estimate for India between 325 and 350. The estimate is mainly taken from International Institute of Population Sciences (IIPS).  The government agency, Office of Registrar General of India estimate for the year 2004-06 as 254 per one lakh live births during the period. Their estimate is based on SRS.  The report also asks the Government not to rejoice the situation as there is very poor progress under NRHM.  Criticism is also on the use of RGI estimates for measuring the progress under NRHM as it is also the Government's body.  But the Tribune respondent should know that IIPS is mainly MOHFW's funded organisation, whereas ORGI is part of Ministry of Home Affairs. It may be noted that NRHM was initiated in the year 2005, but it actually effectively functioning in the year 2007. Thus the RGI estimate is no reflection on progress under NRHM. The special report has not mentioned any period specifically. Probably they mean the year 2005.


    The experts claim is also that the MMR of 254 is not consistent with other programme indicators under the NRHM like the immunization progress, institutional deliveries, antenatal and post natal care for mothers. IIPS expert involved in NRHM evaluation reported to state that their estimate of 325 – 350 MMR per one lakh live births is based on actual maternal health indicators revealed by survey data (probably NFHS – 2005).     ORGI utilize SRS and had a sample of 5348441 Females having 436648 live births. Whereas NFHS data is from less than one lakh households. Thus reporting of IIPS expert that SRS data is too small comparatively, to provide correct estimate of maternal deaths in India for the period is not of much substance.     

For India, the National Family Health Survey of 1992-93 was the first to provide a national-level estimate of 437 maternal deaths per 100,000 births for the two-year period preceding the survey (International Institute for Population Sciences, 1995). Even at the national level, the sample inadequacies of the NFHS came into sharp focus when the second round of the survey in 1998-99 produced a maternal mortality estimate of 520, but failed to confirm statistically the possible rise in the level of maternal mortality (International Institute for Population Sciences and ORC-Macro, 2000). To fill the data gap, in recent times, the potential of the Sample Registration System – a duel record system for collecting data on births and deaths - for estimating maternal mortality has also been explored. The source has recorded a maternal mortality rate of 408 and 407 for 1997 and 1998, respectively (India, Registrar General, 1999 and 2000).

It is seen that although SRS estimates of MMR have not been very acceptable at the State Level because of low sample size, but at all India level, many experts had agreed and compared their alternative estimates with the same. Thus the official figure at all India is quite firmed up and the forthcoming Annual Health Survey may also yield more acceptable estimates at the regional level.