Maternal Mortality: India’s silent tragedy
In a remote village in Madhya Pradesh, Banku and his family are mourning the death of Sushma, his 25 year-old wife, who passed away during child birth.
Sushma, who was at the mercy of a local quack died before being taken to the nearest hospital about 15 kms away from her house.
"I don't know what he did to my daughter-in-law. The quack kept me outside the room and later, after almost two hours, he said she had to be taken to a hospital," said Banku’s mother Pushpa Devi.
The stories of women like Sushma who die during pregnancy, delivery or from post-partum complications largely remain untold. It would be startling to know every fifth women in the world dies of poor medical care available during childbirth. Though the situation is changing and India is trying to pull itself out of the bottom-of-barrel a lot needs to be done in this area.
The Indian Government estimates that 301 women die annually for every 100,000 live births. In some states the maternal mortality ratio is even higher - 358 in Orissa, 371 in Bihar and 379 in MP. Many deaths happen in the anonymity of women’s homes or on the way to seek help at a medical facility, they often go unrecorded.
An estimated 80,000 pregnant women or new mothers die each year in India often from preventable causes including hemorrhage, eclampsia, sepsis and anemia, a study conducted by UNICEF said.
“The tragic reality is that too often maternal deaths are not visible. They don’t leave any trace behind, and their deaths are not accounted for,” said UNICEF India’s Deputy Director of Programmes, Chris Hirabayashi said.
The figures illustrate how poor women in rural India have largely been left behind by India's economic boom which has lifted millions of people out of poverty.
India's maternal mortality rate currently stands at 450 per 100,000 live births, against 540 in 1998-1999. The figures are way behind India's Millennium Development Goals which call for a reduction to 109 by 2015, according to UNICEF.
According to UNICEF's 2009 State of the World's Children report, “India's fight to lower maternal mortality rates is failing due to growing social inequalities and shortages in primary healthcare facilities. Millions of births are not attended by doctors, nurses or trained midwives, despite India's booming economy which grew at nearly 9 percent in each of the past three years.
Around two-thirds of Indian women still deliver babies at home. Women from the lower castes suffer the most as they are often denied basic healthcare facilities. Medical records only capture part of the story, documenting the biological causes of death. In rural India traditional midwives are often the only help available for women in labour in remote areas. With little or no training these midwives only know how to cut the cord with a blade and this accounts as a major factor behind maternal deaths. With the help of skilled health personnel, adequate nutrition, better medical facilities and family planning such incidents can be drastically reduced.
But poor women, especially in rural India where fertility rates are higher and teenage marriages are common, it is an uphill battle to overcome lack of access to medical care.
Women get pregnant very early with no preparedness to cope with childbirth, at times failing to recognise the signs when they should go to a hospital , the report said.
"Nutrition and anaemia are other major factors in the MMR (maternal mortality rate)," the report said adding,"Inside the homes, women are the last to get food. They are much more vulnerable and that is why they are dying."
But with the advent of a powerful new tool called Maternal and Prenatal Death Inquiry and Response (MAPEDIR ) the situation could improve. The tool plays an important role in analysing medical and social reasons behind maternal death.
MAPEDIR empowers communities by demystifying maternal mortality. The accumulated evidence can help communities understand the root causes behind these deaths so they can take effective, local action and advocate for improved services to prevent future deaths. In addition, MAPEDIR informs health officials about the challenges local women face in accessing reproductive health care, the report said.
The MAPEDIR innovation is currently in use across select districts in Rajasthan, Madhya Pradesh (MP), West Bengal, Jharkhand, Orissa and Bihar and is providing an ongoing, systematic collection of data to reconstruct and analyze the cases of 1,600 women -- the highest number of audited maternal deaths in the world.
Unless we know the main reasons for maternal deaths we cannot take effective measures to tackle them. The traditional system did not deal with the issues adequately,” said Director of Medical and Health Services in Rajasthan, Dr S.P. Yadav. “Now using MAPEDIR, we can know if the deaths are due to delays in decision making at household level or lack of transport or delay at the facility or a cumulative of all three.”
MAPEDIR follows a six step process:
1. Sensitizing communities on maternal and prenatal health issues, including birth preparedness and complication readiness; 2. Reporting and investigating maternal deaths; 3. Interviewing all families with a maternal death to determine the biological and social causes; 4. Analyzing and interpreting the data (embed data sheet); 5. Sharing the finding with communities to develop appropriate, high-impact, local interventions; 6. Monitoring the interventions with ongoing maternal death inquires and developing new evidence-based interventions as needed.
Meanwhile, National Rural Health Mission (NRHM) and states have begun work at war footing and are offering incentive to health workers and expectant mothers to register and deliver at the nearest Government clinic. Under NRHM, the health worker trained in the community is offered financial incentive to encourage the family of expectant mother to visit health clinic at least thrice during the pregnancy. Money is also given to the health workers to meet incidental expenses like transportation costs in case any complication arises. Progressive States are offering additional incentive to encourage institutional deliveries.
