PUNE: Almost 50% of maternal deaths go unreported; as much as 61% of maternal deaths occur just after delivery, mostly due to excessive loss of blood; abortion constitutes 16% of maternal deaths; death during transit and deliveries at home occur in 8% of cases; in 54% of maternal deaths, the surviving newborns would be at risk of dying owing to loss of their mother; and one per cent of death occur in mothers less than 18 years.This is the situation in Pune and Solapur districts, reveals the latest analytical report of the state health services. The analysis is based on the 'health management information system' (HMIS) data on maternal mortality for during the period April 2010 to March 2011."Maternal mortality continues to be a major public health concern. Despite considerable efforts and huge inputs through the National Rural Health Mission (NRHM), reduction in mortality is not substantial," admits the report.Maternal mortality rate (MMR) is defined as the number of deaths of pregnant women per one lakh live births, where the cause of death is directly attributed to pregnancy or a pregnancy-related complication. It is a direct parameter of the healthcare services available.From April 2010 to March 2011, 1.96 lakh live births were registered from Pune and Solapur districts. The estimated maternal deaths from these districts during the period were 256. Maternal deaths in rural population, at 66% of total maternal deaths, were almost double of that of urban population (34%)."The actually reported maternal mortality rate during the period under study is 134. Considering that the prevailing maternal mortality rate in Maharashtra is 130, there is a difference in reporting of 122 deaths. That means maternal deaths are underreported by 48%. This registers the MMR at 68/per one lakh live births during the period," the report states."Majority of maternal deaths are taking place in hospitals (84%). However, a substantial number of maternal deaths are taking place at home (8%) and during transit," the report says."In Solapur, the situation is worse - about 23% of maternal deaths are taking place during transport which underlines the concern about the quality of primary care and delay in receiving medical treatmentâ€¦ The actual reasons and conditions related to delays could not be explored because of non-availability of information. This information needs to be explored to undertake specific remedial measures," the report says."Teenage maternal death of around 1% is a cause of concern," the report states, adding that about 16% of maternal deaths are among abortions, which could be unsafe.Commenting on the findings, Uddhao Gawande , deputy director of state health services, Pune division, said: "The inferences will be useful for planning the strategic actions for faster reduction of maternal mortality."In Maharashtra, large number of first referral units, skilled birth attendants, emergency obstetric care, and institutionalism of maternal death review are some of the inputs for reduction of maternal mortality through the National Rural Health Mission, he added.Charuchandra Joshi, gynaecologist and president of the Pune branch of the Obstetrics and Gynaecological Society of India, said: "In developed countries, the MMR has been brought down to single-digit level. In Maharashtra, it is estimated to be 130, which is unacceptably high. In rural areas, it is double that of the urban areas.""The main causes of maternal mortality are unsafe abortions, ante- and post-partum haemorrhage, anaemia, obstructed labour, hypertensive disorders and post-partum sepsis. There has been no major change in the causes of deaths over years. Deaths due to anaemia, obstructed labour, hypertensive disorders and sepsis are preventable with adequate ante-natal care, referral and timely treatment of complications of pregnancy, promotion of institutional delivery and post-natal care," Joshi said.Elaborating on government efforts, Gawande said, "We are making available large number of first referral units, training skilled birth attendants and providing emergency obstetric care training to doctors, nurses, etc. We have and a designed system of reporting and analysing maternal deaths. Local, facility-based and regional committees are formed to analyse the information, plan strategies and give recommendations."Although, India has acknowledged the 5th Millennium Development Goal of reducing maternal mortality by 75% between 1990 and 2015, substantial reduction is not witnessed, the report admits.