Reproductive morbidities basically include gynaecological and obstetric morbidities. An obstetric morbid complication has been defined as the acute condition arising from maternal deaths such as antepartum or postpartum haemorrhage, obstructed labour, postpartum sepsis, complications of abortion, pre-eclampsia or eclampsia, ectopic pregnancy, and ruptured uterus, or indirect causes such as anaemia, malaria, and tuberculosis (Maine, 1997). Obstetric morbidity is an important marker for obstetric care (Paruk, 2001).
Three decades back World Health Organization, (WHO) at the International Conference in Kenya in order to improve the quality of maternal health worldwide declared the Safe Motherhood Initiative in 1987. The initiative focused mainly on the low and middle-income countries as 98% of the maternal deaths occurred in low-income countries (Santora, 2020). The low-income countries even today have a high maternal mortality ratio of 462 per thousand live births (WHO, World Health Organization, 2019). Maternal mortality is unacceptably still high, the Sustainable Development Goals given by the United Nations have been set to achieve a maternal mortality ratio of less than 70 per 100,000 live births by 2030 (Assembly, 2015).
Daily 800 women die worldwide due to complications from childbirth, the main cause of deaths in developing nations have been severe bleeding, hypertension, sepsis, unsafe abortion, and obstructed labour (Spiegel, 2013). The World Health Organisation (WHO, 2012) stated that about 15% of pregnant women develop a life-threatening complication out of which few require major intervention all of which require a great medical skill. In developing countries, 6.25% of pregnant women may die of pregnancy-related complications (WHO, 2004). Studies have shown that women in developing countries face a high risk of developing life-threatening complications for them as well as their new-borns (Filippi, 2010). There is still very little understood about the impact of socio-economic and demographic factors on pregnancy-related complications. Education, religion, ANC care and other socio-economic characteristics, although poorly explained, were found to have an impact on various complications (Gogoi M. U., 2014). There is a little and unexplored interrelationship of different pregnancy-related complications understanding about the impact of one complication on another.
India has improved in the last few decades, the maternal mortality ratio has reduced from 212 in 2007-08 to 113 in 2016-18 (SRS, 2020). In India still today, obstetric morbidities have not been given much importance. The women even after being aware of the darker side of pregnancy complications resulting in deaths many times ignore it. In India, maternity-related complications are the leading cause of death and disability among women of reproductive age (Biswas, 2016). The complications are a result of inadequate facilities for identifying and managing complications, as most of them are preventable (World Bank, 1996). The frequency of obstetric morbidity depends on the area and available health care services (Prual, 2000). In developing countries like India, where pregnant women are at high risk of morbidity and mortality resulting from different psychological stress, which remains as high as 10 to 20 percent in developing countries like India (Quraishi, 2017). A study conducted in rural Gambia reported that obstetric morbidities such as anaemia, obstructed labour, haemorrhage and eclampsia were the main reasons for maternal mortality (Cham, 2007). A prospective study conducted in India’s small village resulted in 16.5 pregnancy-related morbidities for every maternal death in the village (Datta KK, 1980). Another study from Kerala stated that 34.33 women per 1000 births suffer from severe obstetric complications (Reena, 2015). Study conducted based on NFHS-2 indicated that obstetric complication was high in case of Madhya Pradesh and Bihar, almost a large proportion are suffering from all kinds of morbidities. The main reason behind this was early marriages, birth orders and low standard of living (Jain R. P., 2002). Lack of education and poor economic standards resulted in one-third of the women reporting maternal morbidities in Karnataka (Bhatia, 1995). Different studies conducted at Jharkhand (Kumar, 2004), Maharashtra(Bansod, 2002) and Tamil Nadu(Santhya, 1996) concluded that obstetric morbidity including contraceptive morbidity was high among scheduled caste, scheduled tribes and poor women resident of rural areas. Even today, a large section of Indian women suffers from obstetric complications but still, the severity of the problem remains unknown.
Many studies have been done in India related to obstetric complications (Mukhopadhyay, 2010) (Jungari, 2019) (Gogoi M. &., 2013) (Gajbhiye, 2021) (Lionel, 2008) (Ahmad, 2021), but there is a scarce of studies focused on the spatial aspect. Geographical information system (GIS), in recent decades, have been popular and helps to know the pattern and trait at a regional level so that interventions can take place accordingly. The potential to relate the social and environmental risks to health outcomes is consistent to reduce adverse maternal health outcomes, by action on social determinants (M. Marmot, 2008). In the case of India, which is considered to be a diverse country with different socio-demographic characteristics in different regions. The regional differences in case of the maternal morbidity conditions are vast in different geographical areas of India (Vora, 2009). The present study assesses the socio-demographic characteristics of women with obstetric complications in India and examines the spatial heterogeneity at the district level for different obstetric complications for the year 2015-16 based on National Family Health Survey (NFHS).