KOLLAM: A confidential review of maternal mortality in Kerala from 2020 to 2024 has flagged a disturbing trend: Suicide has become one of the leading causes of such deaths in the state.
The study -- carried out by the Kerala Federation of Obstetrics and Gynaecology (KFOG) -- recorded 609 early maternal deaths, of which 62 were suicides, during the four-year period. Among the victims, 37 were aged between 20 and 29. In 2023-24 alone, suicide accounted for 14 of the 120 maternal deaths reported.
Of the 54 suicide cases reviewed by the report, most occurred during pregnancy. Thirty-seven were antenatal cases -- suicides committed during pregnancy -- while five were postnatal. In 12 cases, it could not be determined whether the women were pregnant or postpartum due to incomplete records.
The stage of pregnancy appears to be a factor. Eight suicides occurred within the first 12 weeks, 13 between 12-24 weeks -- indicating mid-pregnancy as a high-risk period -- and six at 25 weeks or later.
Experts warn that this trend points to growing psychological distress among pregnant women in the state. Unlike in western countries, where mental illness is often the primary cause, specialists say family-related pressures play a larger role here. They urge stronger counselling services for expectant mothers and advocate “psychological autopsies” -- detailed inquiry into the mental state of deceased individuals -- to better understand the challenges faced during pregnancy.
The report warns that maternal suicides are ‘poorly investigated’, thereby hampering identification of causes. Most incidents occurred outside hospital settings, where documentation is rare.
“Most of the cases occurred in communities where documentation of early maternal suicide is rare. Preliminary reports by health workers often lack necessary details, as grieving families often refuse to share details due to fear of legal prosecution; besides, social stigma hinders family members from cooperating with health officials,” it noted.
The study stresses early detection of suicide-warning signs as critical, recommends trained personnel for psychological autopsies, their integration into suicide-prevention services, and strict confidentiality. A “biopsychosocial” approach, which addresses pregnancy complications, psychiatric issues and social factors such as domestic abuse, is deemed essential, it said.
Dr Pandu R, a Kannur-based gynaecologist, said evolving family structures and lack of knowledge contribute to mental stress and depression after delivery.
“We now have a nuclear-family system. Earlier, parents were on hand for guidance after delivery. That is now missing. Women are also under pressure due to their jobs... in fact, in some cases, patients are discharged immediately after delivery. That shows lack of knowledge. We need proper guidance and facilities for maternal care. Most importantly, it is key that we identify the early signs of depression. Otherwise, things will not improve,” said Dr Pandu.
Dr Sashi Kumar, former gynaecologist at the Thiruvananthapuram Women and Children Hospital, said postpartum depression and social stressors such as domestic violence, financial strain and marital disputes are among the key triggers. “Maternal suicides point to the deterioration of society. The fact is that the issue has not been properly addressed. There could be many reasons for such societal pressures, including financial status and others. We require detailed studies and intervention to reach to the root of the issue,” Dr Sashi said.
Key Findings
54 No. of maternal suicide cases* reviewed in KFOG report
37 were antenatal -- suicides during pregnancy and 5 were postnatal
12 were cases where it could not be determined whether the women were pregnant or postpartum due to incomplete records
8 suicides were within
the first 12 weeks of pregnancy
13were between 12-24 weeks
6 occurred at 25 weeks or later
* Between 2020 and 2024