Averting maternal deaths in spite of resource constraints: an Indian rural experience over two decades.

The present study was conducted to analyse the changing trends in maternal deaths and the factors affecting them in a rural institution in India. Analysis of case records of maternal deaths over a period of 20 years, between April 1982 and March 2002 was performed in relation to the age, parity and disorders leading to death. It was revealed that the maternal mortality ratio has declined significantly, from 890.7 between April 1982 and March 1987 to 259.4 between April 1997 and March 2002. Most of the deaths were in young women (20-29 years) and primigravidae. Hypertensive disorders (27.4%) and haemorrhage (12.9%) were the leading direct causes, while anaemia (13.9%) was the main indirect cause. It was shown that from 1982-1987 to 1997-2002 there was a fall in the percentage of deaths due to hypertensive disorders, from 27.5% to 14.6%, peripartum sepsis from 13.7% to 7.3% and ruptured uterus from 3.9% to nil, but there was a rise in deaths due to septic abortions from 9.8% to 14.0% and haemorrhage from 7.8% to 17.1%. Deaths within 24 hours of admission decreased from 60.8% between 1982 and 1987 to 46.3% between 1997 and 2002. It appears that even with resource constraints, maternal mortality can be reduced by improving peripheral services and individualised evidence- based appropriate interventions at referrals. However, the problems of anaemia and septic abortions need to be examined further.