Understanding Maternal Mortality Ratio and State Ranking

The question asks us to arrange four specific Indian states based on their Maternal Mortality Ratio (MMR) according to the Special Bulletin of SRS (Sample Registration System) released in May 2018. The arrangement needs to be in descending order, meaning from the state with the highest MMR to the state with the lowest MMR.

Maternal Mortality Ratio (MMR) is a key indicator of maternal health. It is defined as the number of maternal deaths during a given time period per 100,000 live births during the same time period. Mathematically, it is represented as:

\(\text{MMR} = \frac{\text{Number of maternal deaths}}{\text{Number of live births}} \times 100,000\)

Maternal death is the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes.

Analyzing MMR Data from SRS Special Bulletin

The SRS Special Bulletin on Maternal Mortality in India, released around May-June 2018, provided data for the period 2014-2016. Let's look at the MMR values for the states mentioned in the question based on this bulletin:

We need to arrange these states in descending order of MMR, which means starting with the highest value and ending with the lowest value:

1. Assam: 237 (Highest)
2. Uttar Pradesh: 201
3. Madhya Pradesh: 188
4. Bihar: 165 (Lowest)

Arranging States in Descending Order of MMR

Based on the MMR values from the SRS Special Bulletin (2014-2016), the states arranged in descending order of Maternal Mortality Ratio are:

• Assam (i) - MMR 237
• Uttar Pradesh (iv) - MMR 201
• Madhya Pradesh (iii) - MMR 188
• Bihar (ii) - MMR 165

The order is therefore (i), (iv), (iii), (ii).

Comparing with Options

Let's compare our derived order with the given options:

• Option 1: (i), (iv), (iii), (ii)
• Option 2: (ii), (iv), (iii), (i)
• Option 3: (iv), (i), (ii), (iii)
• Option 4: (iii), (ii), (i), (iv)

Our derived order (i), (iv), (iii), (ii) matches Option 1.

Conclusion on MMR Ranking

The correct arrangement of the given states in descending order according to Maternal Mortality Ratio (MMR) as per the Special Bulletin of SRS, May 2018 (covering 2014-2016) is Assam, Uttar Pradesh, Madhya Pradesh, and Bihar. This corresponds to the sequence (i), (iv), (iii), (ii).

Revision Table: Key MMR Data Points

Additional Information on Maternal Mortality and SRS

The Sample Registration System (SRS) is a large-scale demographic survey conducted in India to provide reliable annual estimates of birth rate, death rate, and other fertility and mortality indicators at the state and national levels. The SRS periodically releases special bulletins specifically on Maternal Mortality.

MMR is a critical health statistic because it reflects the quality of healthcare services available to pregnant women, access to skilled birth attendants, emergency obstetric care, and the overall health status of women in a population. High MMR indicates significant challenges in accessing and utilizing maternal healthcare.

Factors contributing to high MMR can include:

• Lack of access to antenatal care (ANC).
• Lack of skilled assistance during childbirth.
• Lack of access to emergency obstetric and neonatal care (EmONC).
• Poor nutritional status of women.
• Early marriages and pregnancies.
• Socio-economic factors like poverty and education levels.
• Geographical barriers to health facilities.

Government initiatives like the Janani Shishu Suraksha Karyakram (JSSK) and the Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA) aim to reduce MMR by providing free services to pregnant women and infants, including free diagnostics, drugs, and blood, as well as fixed-day ANC services.

Tracking MMR over time through reports like the SRS Special Bulletins helps policymakers identify areas needing improvement and evaluate the effectiveness of maternal health programs.