Despite a government guarantee of free maternal health care, tens of thousands of pregnant women in India die from mostly “preventable causes,” according to a Human Rights Watch (HRW) report, released on Wednesday, the BBC reports.

“The 150-page report – No Tally of the Anguish: Accountability in Maternal Health Care in India – documents repeated failures both in providing health care to pregnant women in Uttar Pradesh [the most populous northern state in India] and in taking steps to identify and address gaps in care, HRW said in a press release,” the BBC writes (10/7). The report says the situation is the result of a poorly planned medical system, “caste discrimination, a lack of accountability and limited access to emergency care,” the Associated Press reports.

According to the report, India’s maternal mortality rate is 16 times higher than the rate in Russia and 10 times higher than in China. “That means one out of every 70 Indian women who reach reproductive age will die because of pregnancy, childbirth or during unsafe abortions,” the AP writes. Although the country’s overall maternal mortality rate has dropped in the past few years, those numbers obscure problems in other regions, which are getting worse in some cases, according to HRW. About 117,000 women died in 2005 – the last year for which comprehensive data is available – from complications related to pregnancy, according to Aruna Kashyap, an author of the report (Sullivan, 10/8).

“Unless India actually counts all the women who die because of childbirth, it won’t be able to prevent those thousands of unnecessary deaths,” Kashyap said, Agence France-Presse reports. “Accountability might seem like an abstract concept, but for Indian women it’s a matter of life and death,” Kashyap added (10/7).

To improve maternal medical care, HRW recommends “requiring that all pregnancy-related deaths be formally reported to authorities, institutionalizing a system of investigating those deaths and establishing an early response system, including a telephone hot line, for obstetric emergencies,” the AP writes (10/8).