Overwhelmed, understaffed delivery wards, 53 deaths in a year: MP district is Ground Zero for maternal mortality

But the district in question — Sidhi, which is part of the eastern tribal belt that also includes Singrauli, Shahdol, Dindori, Umaria and Anuppur — had a much higher MMR of 211, posing a challenge the state has struggled to address.

To understand what led to the 53 deaths that are now under the state’s scanner, The Indian Express accessed maternal death records, visited the largest district hospital, and spoke to the families of at least 20 women [see accompanying story].

The maternity ward at Sidhi District Hospital. (Express Photo)

Some things stood out:

• Sixteen of the 53 women died at the Shyam Shah Medical College, a tertiary referral centre about 70 km from Sidhi.
• Thirteen women died in transit — in ambulances, hired vehicles or private cars driven by loved ones who struggled to find transport.
• Thirteen died at home.
• Five died at the district hospital in Sidhi, and four at private facilities.
• One death each was recorded at Netaji Subhash Chandra Bose Medical College and SGMH, Rewa.
• The average age of the women was 26; most were first- or second-time mothers. The youngest was 19.
• Where causes were identified — in 40 of the 53 cases — they point to conditions that could have been addressed with timely care. Obstetric haemorrhage, both postpartum and antepartum, accounted for 12 deaths; hypertensive disorders, mainly eclampsia, for seven; and severe anaemia for five.
• Beyond the immediate causes, the review flags anaemia – specifically iron and folic acid deficiency – as a contributing factor in 16 deaths.
• Puerperal sepsis and other infections claimed four lives, and abortion-related complications three. The review also notes two deaths from thrombocytopenia, and single cases of cardiac failure, pulmonary aspiration and amniotic fluid embolism — conditions requiring intensive care beyond the district’s capacity.
• One woman died from a snakebite during pregnancy; another by suicide. These cases also figure in the district’s Maternal Death Review records because the audit reviews all deaths occurring during pregnancy or within the postpartum period, though not all may fall under direct obstetric causes used in official MMR calculations.
• Thirteen cases await post-mortem reports.

At a divisional review in Rewa in December last year, chaired by the Mission Director of the National Health Mission, officials highlighted that Sidhi had recorded the highest maternal mortality in the division: 38 in nine months between April and December 2025.

At the maternity ward of the community health centre in Rampur Naikin town of Sidhi district. (Express photo by Anand Mohan J)

The department was critical of Dr S B Khare, the chief civil surgeon and head of the district hospital, during the divisional review, and subsequently in a show-cause notice issued in February this year by the then Civil Surgeon and Chief Hospital Superintendent of Sidhi district hospital, which cited “poor decision-making during delivery,” “lack of preparedness of facilities,” and a “failure to ensure (that) benefits of government maternal schemes reach the public,” which it said had damaged the government’s image.

The notice added that Sidhi had “consistently ranked among the bottom three districts in CMHL (Community Maternal Health League grading, used by the state health department to assess maternal and child health performance),” with maternal and child health outcomes “among the worst in the state.”

Dr Khare, when contacted, said the district hospital was working to strengthen its screening process to identify high-risk pregnancies and severe anaemia, and to bolster its blood bank units. “We are yet to respond to the showcause notice. The data shows a high number of deaths, but this isn’t the correct picture. Many cases were from other districts,” he claimed.

The main hospital: Overwhelmed, understaffed, underequipped

Nowhere is the strain on the system more visible than at the maternity ward of Sidhi District Hospital, which is constantly handling pregnant women arriving with cramps, weakness and painful contractions. District Health Officer Dr Sunita Tiwari, who oversees the ward, told The Indian Express, “I am also the hospital’s sonographer, and I work in the OPD and handle administrative duties. I am doing the work of four people.”

Between April 2025 and March 2026, the hospital recorded 10,022 admissions in the maternity ward and 5,922 deliveries. Of these, 726 were C-sections – a rate the health department flagged as below average during reviews conducted between late 2025 and early 2026, largely because the hospital has only one anaesthesiologist, a critical gap in managing high-risk pregnancies.

“The anaesthesiologist works only for eight hours and then refuses to turn up for emergency night shifts. Many other staff keep taking leave, and we face that difficulty,” Dr Khare claimed.

The hospital received 1,109 referrals from peripheral centres and, in turn, referred 492 patients to higher facilities — 486 of them to Rewa. An internal review by the district health authorities of 383 referral cases between April and December 2025 found that many were made for “avoidable reasons.”

“One of the main reasons for high referrals is the lack of additional anaesthesiologist,” said Dr Babita Khare, Chief Medical and Health Officer of Sidhi.

“I’ve written repeatedly for an additional anaesthesiologist,” said Dr Tiwari. “There is none on the night shift, which is when most cases arrive. We cannot handle caesarean deliveries and have no option but to refer patients.”

District records also show four sanctioned posts for gynaecologists in Sidhi, but staffing remains thin. “One specialist visits Sihawal twice a week for sonography, and there is only one anaesthesiologist at the district hospital,” an official said.

The burden is substantial. Between April 2025 and March 2026, the district hospital and referral network handled 1,706 high-risk pregnancies. The maternity ward managing this load has 22 staff members, including supervisors, while around 40 are required.

“We need a dedicated OT, a blood storage unit, a paediatrician, an anaesthesiologist, and even a ventilation unit in the maternity ward,” an official said.

Blood supply is another reason for referral to other districts. Officials at the maternity ward said patients are sometimes referred to other hospitals due to lack of platelets at the blood bank, which isn’t equipped with a blood component separation unit.

The hospital’s blood bank had just seven units in stock, according to its in-charge, Dr Sunidhi Singh, when The Indian Express visited the facility in April. “We managed to finally get 53 units of blood after organising blood donation camps this month. We hope to have at least five to six units per day with this new supply,” Dr Singh said on Thursday.

Responding to questions on maternal deaths, Dr Babita Khare said an inquiry had been initiated, pointing in part to the district’s terrain. “I have been trying to bring down maternal mortality in Sidhi, but it isn’t declining,” she said. “Many villages are hard to reach, and most women, largely from tribal communities, have poor diets and are anaemic.”

Smaller healthcare centres show a similar strain

The district hospital that The Indian Express visited sits at the top of a referral chain that also comprises community and primary health centres, where antenatal check-ups are conducted, low-risk deliveries are handled, and complications are caught early. Except, the situation is just as stark there.

At the Rampur Naikin primary health centre, about 50 kilometres away, staff nurse Manju Singh describes a cramped labour room with no isolation for infectious cases. There are three health workers against a sanctioned strength of five, and six staff nurses in the labour room instead of eight.

The facility has a blood storage unit but no transfusion capability. “If a pregnant woman needs blood, we refer her to Rewa,” Singh said. “We face a heavy load and cannot treat everyone. Rewa is an hour and a half away. If two emergencies come at once and both need blood, there is no contingency.”

Between April 2025 and March 2026, the PHC recorded 2,387 admissions, of which 21 were stillbirths.

The facility runs three MMU (mobile medical unit) ambulances, including a Janani vehicle for pregnant women, staffed with a driver but no medical personnel.

Praveen Kumar Mishra, a Janani vehicle driver, said, “Many villages don’t have roads. Most cases come during the monsoon, when roads are washed away. Women are carried on cots for two to three kilometres to reach the ambulance.” At least four more vehicles are needed to cover the tehsil, he said.

At the Sihawal primary health centre, more than 60 kilometres from Sidhi, nursing officer Pushpa Dwivedi points to registers listing stockouts. Crucial drugs such as labetalol and methyldopa for hypertension in pregnancy are running low; emergency medicines like injectable hydralazine are out of stock, as are uterotonics such as carboprost, used to control postpartum haemorrhage. The centre also lacks basic supplies such as sanitary pads and has not stocked some antibiotics, including ampicillin tablets, she said. The staff said supplies are irregular, and replenishment requests often take time to be approved and delivered through district procurement channels.

Of its three delivery tables, two are defunct, leaving a single functional table for all births. Five nurses are in place against a requirement of eight to nine. There are no permanent doctors, and no gynaecologist, forcing staff to stretch across roles — even pulling personnel from the operating theatre to cover shifts in the labour room during staff shortages and high patient load.

Between April 1, 2025, and March 21, 2026, the PHC conducted 875 deliveries but referred more than 120 cases, largely because it lacked the staff to manage them.

State Health Minister Rajendra Shukla’s office refused to comment on queries from The Indian Express. The health department refused to comment on the allegations specifically pertaining to the deaths in Sidhi. A health department official noted that as per the latest figures of the Government of India’s Sample Registration System, Madhya Pradesh’s maternal mortality ratio has declined from 173 in 2018–20 to 135 in 2022–24. The department has said this was “achieved through the promotion of institutional deliveries, the availability of trained doctors and staff, and the expansion of emergency obstetric services.”