(a): The percentage of institutional deliveries in the country as per the UNICEF Coverage Evaluation Survey, 2009 (CES 2009) is 72.9%. State wise data is placed at Annexure I.
(b): The percentage of deliveries conducted by Caesarean section between 2006-2012 was 8% for India as per the World Heath Statistics report 2014, State wise details are not shared in the report. State wise percentage of deliveries conducted by caesarean section for the 21 States reported in District Level Household Survey 4 (2012-13), and for the 8 EAG States and Assam reported in the Annual Health Survey -2012-13 are placed at Annexure-II.
(c): The Government of India has enacted the Clinical Establishments (Registration and Regulation) Act, 2010 with the objective of registration and regulation of health care institutions including those in the private sector.
Under the National Health Mission (NHM), in order to maintain C- section rates within the acceptable standards, the Government of India has taken a number of steps to provide quality maternal care which are:
1. Early identification and timely management of complications to prevent unnecessary caesarean section.
2. Safe motherhood booklet being given during ANC to the mothers contains information on signs and symptoms of complications and place of referral so that the pregnant women are informed where to go in case of emergency.
3. Under JSSK (Janani Shishu Suraksha Karyakram), every pregnant woman is entitled for free referral transport during complications of pregnancy and child birth so that services are accessed timely.
4. Similarly, the service providers particularly Auxiliary Nurse Midwives (ANMs) & Staff Nurses (SNs) have been trained for maintaining Partographs which helps timely detection for delayed progress of labour.
5. Medical Officers have been trained in Basic Emergency Obstetric Care (BEmOC) training where assisted vaginal delivery is also part of the training.
6. The ANMs & SNs have also been empowered and oriented on identification and basic management of various types of complication during pregnancy and child birth.
7. As a part of Ante-natal care, pregnant women and their families are educated and counselled through ANMs/ ASHAs / other health functionaries on various aspects of safe motherhood, including early identification of danger signs and referral to appropriate health facilities. All the above steps help in early identification and timely management of complications and avoiding unnecessary caesarean sections.
(d): 575 number of hospitals have Special New-born Care Unit (SNCUs), 2020 facilities have Newborn Stabilization Units (NBSUs) while 14,441 have Newborn Care Corners (NBCCs) in place. State-wise details are placed at Annexure-III.
(e): As per the Health Management Information System (HMIS) 2014-15, the data on stillbirths State-wise is placed at Annexure-IV. The five most common causes of Still birth as per Lancet Series 2011 are as under:
1. Child-birth Complications
2. Maternal Infections In Pregnancy (Malaria, Syphilis, HIV, Chorioamnionitis)
3. Maternal Conditions, especially Hypertension, Diabetes, Pre-existing disorders like cardiac ailments, maternal under-nutrition, smoking, obesity, abnormal labor, uterine rupture etc.
4. Fetal Growth Restriction
5. Congenital Abnormalities in the fetus.
Survey data released does not capture data on deaths of the mother during delivery. However, the Registrar General of India through its Sample Registration System (RGI-SRS) gives data on Maternal Mortality Ratio (MMR) of India which as per its latest data is 167 per 100,000 live births in the period 2011-13. State-wise details are placed at Annexure-V. As per the Report of Registrar General of India titled “Maternal Mortality in India: 1997-2003 trends, causes and risk factors”, major medical causes of maternal deaths in the country are Haemorrhage (38%), Sepsis (11%), Hypertensive Disorders (5%), Abortion (8%), Obstructed Labour (5%) and Other Conditions (34%) . Besides this, socio-economic determinants like low level of education, poverty, cultural misconceptions and lack of access to services also contribute to Maternal Mortality.