Page 101 - GHES-3-1

Global Health Economics and
Sustainability
Maternal health-care service utilization

declined by 34% between 2000 and 2020 (Khalil et al., 100,000 live births in 1990 to 145 in 2017 (WHO, UNICEF,
2023). However, a divide exists between rich and poor WORLD BANK GROUP, 2020).
countries regarding maternal mortalities due to differences Countries such as Finland, Greece, and Poland have the
in economic conditions, geographical locations, and lowest MMR, MMR for these countries were reported 8,
educational levels (Yadav & Jena, 2021). The Sustainable 8, and 2/1,00,000 live births, respectively, in 2020 (WHO,
Development Goals (SDG) emphasize the goal of 2021), whereas India’s MMR was reported as 97/100,000
expediting the decline of MMR by 2030 (Ogu et al., 2016). live births as per sample registration system (SRS, 2020)
The ambitious goal of SDG 3.1 is to reduce the global < 60% of pregnant women globally receive at least four
MMR to fewer than 70/100,000 births by 2030, with no antenatal services (ANC4+). Even fewer women access
country having a maternal death rate higher than twice ANC4+ services in regions with the highest maternal
the world average (Bhowmik et al., 2020; the World Health mortality rates, such as 53% in Western and Central Africa
Organization [WHO], 2023). To meet this target, an annual and 49% in South Asia (Chauhan et al., 2021). Several
rate of decline of up to 11.6% is required, a rate that has
rarely been achieved at the national level (WHO, 2023). factors contribute to this, including direct obstetric causes
This also underscores the connections between maternal such as hemorrhage, infection, embolism, hypertensive
health and development. An increase in MMR leads to an disorders, uterine ruptures, hepatitis, and anemia, which
unfavorable environment for child development, ultimately are responsible for approximately 50 – 98% of maternal
hindering national development (Bhatta & Aryal, 2015). deaths (Totade et al., 2023). About 50% of deaths due to
To meet these goals, it is essential to understand the degree sepsis are linked to illegal abortions, and these factors are
of inequality affecting maternal outcomes, and this study common among women globally (Totade et al., 2023).
is an effort in that direction. Empowered Action Group There are also indirect causes, such as under-reporting
(EAG) states in India have the highest rates of MMR and and misclassification of maternal deaths due to HIV/
the greatest health disparities compared to non-EAG states AIDS (Say et al., 2014). Literacy levels, awareness, and
(Kumar & Paswan, 2021). EAG states, which comprise 48% regional backwardness also influence maternal health-
of India’s population, are more vulnerable due to severe care service (MHCS) utilization, thereby impacting
health inequalities (Yadav & Jena, 2020). With only 6 years MMR (Yadav et al., 2021). As mothers’ education levels
remaining to achieve the SDGs, coordinated efforts must increase, so does PNC utilization (Yadav et al., 2021). One
be intensified and commitments renewed to eliminate of the major challenges facing public health systems is the
preventable maternal mortality at the global, regional, disparity in maternal health among medical professionals
national, and local levels. Tracking maternal mortality in (Yadav & Jena, 2022). The correlation between maternal
developing countries remains challenging due to a lack death, child health, and maternal health inequality raises
of reliable health data and inadequate vital registration significant concerns (Yadav & Jena, 2020). Economic
systems. growth and inequality are often negatively impacted
when urbanization outpaces infrastructural development
The WHO estimates that approximately 287,000 (Liddle & Messinis, 2015). Rapid urbanization is likely
women died in 2020 due to complications during linked to suboptimal access to basic health-care services
pregnancy and childbirth (WHO, 2023). It is further (Blumenberg et al., 2023). According to the Central
estimated that over 95% of all maternal deaths in 2020 Bureau of Health Intelligence, India’s overall literacy rate
occurred in low- and lower-middle-income countries. was 73% in 2011, with urban areas reporting a 16% higher
Most of these deaths could have been prevented with rate (84%) than rural areas (68%).
optimal use of prenatal care, skilled birth attendance
(SBA), and postnatal care (PNC) (Kumar, 2010). In 2020, In the past few decades, several scientific studies and
approximately 87% (253,000) of global maternal deaths intervention programs have identified that prior planning,
occurred in sub-Saharan Africa and Southern Asia (Do SBA for all deliveries, and access to emergency care for
et al., 2018). Sub-Saharan Africa alone accounted for women with life-threatening complications are the three
around 70% (202,000) of these deaths, and Southern Asia essential components to reducing maternal mortality
accounted for approximately 16% (47,000) (Alam et al., and improving neonatal health (Donnay, 2000). Pre-
2015). In 2005, India’s MMR was 16 times higher than independence India’s earliest initiatives to improve maternal
Russia’s, 10 times higher than China’s, and 4 times higher health focused primarily on developing safe midwifery
than Brazil’s (Lozano et al., 2011). In 2017, Pakistan’s practices and providing support during childbirth. The
MMR was 186/100,000 live births (WHO, 2023) and founding of a “Dai’s” (midwifery) school in Amritsar in
Afghanistan’s was the highest at 638/100,000 live births 1880 (Kumar, 2010) indicates that with an emphasis on
(UNICEF, 2024). India’s MMR dropped from 556 per slowing population growth, India became the first country

Volume 3 Issue 1 (2025) 93 https://doi.org/10.36922/ghes.3324