Reduction of Maternal and Infant Mortality Rates is one of the key goals of the Gujarat state population
policy and also the national population policy, Reproductive and Child Health Programme, National Rural
Health Mission and the Millennium Development Goals. The Department of Health and Family Welfare,
Government of Gujarat has initiated several efforts to reduce maternal and Infant Mortality Rates and
is among the states nearing achievement of Millenium Development Goal. The Maternal Mortality
Ratio in Gujarat is estimated at 148/100,000 live births.
While the overall access to health services is improving in the state, ensuring access to health services
in difficult and interior rural areas and for the disadvantaged sections is still a challenge.
CHETNA has been identified as a Regional Resource Centre(RRC) to provide capacity building support to
NGOs empanelled in the Mother NGO scheme, in partnership with support from the Ministry of Health
and Family Welfare, GOI and the Department of Health and family Welfare, GOG. This scheme was
initiated in 1998 to solicit NGO partnership in implementation of Reproductive and Child Health (RCH)
Programme. During 2006‐2013, the Mother NGO scheme was implemented in the state of Gujarat. A
total of 22 Mother NGOs, 91 Field NGOs implemented activities to reach a total of 7 lakh population
of 667 underserved villages in 22 Districts of Gujarat State.
Details about Maternal Deaths
A total of 212 villages of 20 blocks in 9 districts of the state were tracked during January‐December
2012. The total population of these villages is 391173. The number live births recorded from these
villages is 4559 .
Nine maternal deaths were reported from eight blocks of six districts‐ Ahmedabad, Banaskantha,
Kheda, Jamnagar, Tapi and Navsari. The total villages are 103 and the population is 226530 . The total
live births in these villages are 2502.
1. There is lack of system for tracking and reviewing deaths of women in the reproductive age
group and identify probable cause of death for all deaths. In some districts it was very difficult
to get accurate information about these deaths.
2. A significant number of deaths recorded were among the young and unmarried women.
3. More women in the reproductive age group died due to non maternal causes of death.
Tuberculosis, cancers (non‐reproductive) and suicide were found to be more prevalent cause
4. Care during pregnancy and after childbirth is grossly inadequate in terms of coverage and
quality. Ante natal care mostly limited to immunization and Iron‐Folic Acid Supplementation.
There is almost absence of focus on complications and referrals.
5. There is also a lack of continuity of care throughout the three phases‐pregnancy‐childbirthpostpartum.
There is lack of counseling and birth companionship
6. There is lack of system of continued linkages and communication between the various
levels of the public health system and also between the public and the private delivery service
7. Migrant women often fall out of the system and there is lack of tracking of women in their
place of work or at their natal homes.
8. Private practitioners are present in the remote areas and are providing service. However
there is a lack of training to enhance competencies, linkages with the private practitioners.
9. Anemia was found to be a common cause across all maternal deaths. Inadequate attention
to indirect causes particularly anemia with its universal prevalence during pregnancy poses a
greater threat to maternal deaths.
10. There are linkages between Still Births and Child Mortality, the number of births and
maternal mortality. Women are compelled to give birth to a number of children as the
pregnancy outcomes are not positive or there is no security of the child’s survival. For most
poor and vulnerable women, this increases the risk of complications and in absence of
adequate care, there are increased chances of death.
11. Social issues such as son preference, skewed sex ratio and bride buying practices add to
the multiple underlying factors that affect maternal mortality. Woman’s social value is linked
to giving birth to a son and her security lies in the fact that the son survives. Due to high infant
mortality, often there is a preference for two sons. Which again leads to a number of births till
there are two sons born and survive. The multiple births take toll on her body and increase the
chances of complications. Similarly in areas where the sex ratio is skewed, brides are bought
from other‐distant places and many times they are remarried a couple of times. In such
situation it is difficult to touch base . In absence of a system to focus on floating /moving
population, women often fall between the cracks and are exposed to risk of maternal death
The report was presented to the Additional Director(FW) ,Department of Health and Family Welfare,
Government of Gujarat on 14th May 2013. Based on the discussions with the MDR team and the state
NGO Coordinator, the following actions need to be taken:
Maternal Death Review Process
1. Strengthen the MDR process at the local, district and state level to focus on lessons learnt and take
2. Ensure percolation of lessons learnt to the local Primary Health Centres utilising staff sector meetings
to discuss the events that lead to maternal death and ways of saving mother’s lives.
3. Involve civil society members in the MDR process‐ to prepare an alternate report/to accompany the
MDR team/ to be a member of the MDR committees.
4. Publish accountability report on Maternal Deaths, annually and make it available in the public