Maternal mortality in India: a 20-year study from a large referral medical college hospital, West Bengal

Aim:  The present study was carried out to analyze the maternal death rate and its changing trends over a 20-year period in a large referral/teaching institution in Eastern India.
Methods:  A retrospective analysis of maternal deaths was carried out from January 1986 to December 2005 at the Department of Obstetrics and Gynaecology, R. G. Kar Medical College and Hospital, Kolkata, India. Records were divided into four 5-yearly periods: 1986–1990; 1991–1995; 1996–2000; and 2001–2005, for comparison of the trends. The initial interval from 1986 to 1990 was chosen as the reference period.
Results:  The cumulative maternal mortality ratio (MMR) was 599.3 per 100 000 live births. Comparison between the first 5-year period (1986–1991) and the last (2001–2005) showed a statistical significant downward trend in MMR (683.6 vs 474.3; P  < 0.001). Deaths due to direct causes are still the leading cause, accounting for 82.09% of total deaths. Hypertensive disorders (36.14%), hemorrhage (21.91%) and sepsis (19.54%) were still the major causes of direct obstetric deaths throughout the study period. Hypertensive disorders alone showed a substantial decline after the introduction of magnesium sulphate.
Conclusion:  The fall in maternal mortality has been very slow.