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Maternal Health in India
‘God could not be everywhere and therefore he made mothers’ – a Jewish proverb sums up the importance of a mother. That should put mothers in a very privileged position. But the irony is that every minute a woman dies in childbirth. 536,000 women continue to die needlessly every year at a time that should be joyful – just when they are bringing life into the world. Another 300 million suffer from preventable disease and disability.
About 14 years have passed since the International Conference on Population and Development (ICPD) formulated a reproductive health agenda for the world, and about seven years remain to achieve the Millennium Development Goals (MDGs).
The fifth Millennium Development Goal (MDG) (Table 1) which aims to “improve maternal health” – is hopelessly off track.
Table 1 MDG 5-Improve maternal health
Goal 5A: reduce by two-thirds, between 1990 and 2015, the maternal mortality ratio
1. Maternal mortality ratio
2. Proportion of birth attended by skilled Health personnel
Target5B: To achieve, by 2015, universal access to reproductive health
1. Contraceptive prevalence rate
2. Teenage birthrate
3. Prenatal care
4. Unmet need for family Planning
Maternal mortality is an important indicator of the status of women in society – maternal death often represents the end point of a life of gender discrimination and deprivation “inside” the household, and failure of the “outside” (eg, health system) to. provide timely and effective care. Chronic conditions such as malnutrition, anemia, diabetes and hypertension make women more susceptible to maternal death, but even healthy women can succumb to an unexpected complication during pregnancy or childbirth.
Only the use of good health care can make maternal death rare, as it has done in the developed world. Indeed, a striking feature of maternal health in the world today is the vast difference in maternal mortality in developed and developing countries, the latter still alarmingly high. In 2000, 13 developing countries accounted for 70 percent of maternal deaths worldwide and South Asia for one third. The country with the single largest number of deaths was India, where an estimated 136,000 women died.
A number of individual and household factors place women at high risk of death during pregnancy and childbirth. These include age (too young or too old), high inequality, poor nutritional status, low access to health services, low social status, illiteracy and poverty. As with other indicators of reproductive health, maternal mortality is higher in rural areas, among the economically poorer, and those with little or no education. Women who received no prenatal care appear to be at greater risk of death (cause or correlate), and those with an unmet need for contraception are clearly at higher risk than they would be if they could avoid pregnancy.
Maternal death is a death like no other. The impact of maternal death on families and communities is devastating – but especially for surviving children. A newborn baby is three to ten times more likely to die in its first two years without its mother. Women’s health is critical to the social, economic and political development of a country. The survival of women in childbirth reflects the general development of a country and whether or not the health services are working. In reality, the survival of women reflects whether women matter or not.
According to NFHS-3 and SRS 2001-2003, various health indicators reflecting the current situation of Women’s health in India are
o Women in the reproductive age group constitute almost 19% of the total population with 16% of women in the age group of 15-19 years. already giving birth. The average age of giving birth in India is 19.8 years. (Urban area -20.9 years, Rural area – 19.3 years).
o 77% of the total pregnant mother received some form of Prenatal Care. (Urban area 91%, rural area 72%)
o Among women who received ANC, less than two-thirds had weight, blood or urine taken or blood pressure measured, Three-quarters had their abdomen examined and 36% were told about pregnancy complications. 56% of married and 59% of pregnant women are anemic. 65% of the pregnant mother received or purchased Iron and folic acid but only 23% consumed IFA for 90 days. In urban Area the 76% pregnant women received or bought IFA and only 35% consumed IFA for 90 days and in the rural area 61% received or bought IFA and 19% consumed the same for 90 days.
o 49% of all deliveries are institutional. Only about 1 in 7 home deliveries are assisted by an experienced provider. (urban-68%, rural-29%)
o 13% of the lowest indexed women delivered in an institution in contrast to 84% of women in the highest indexed group. 33% of pregnancies belonging to SC caste delivered in the institution against 18% among Scheduled tribe.
o Only 42% of postpartum mothers receive any form of postpartum care. Maternal Mortality Rate gradually improved from 437 in 1992-1993 to 301/100000 live births. Maternal Mortality in India is not uniform. High maternal mortality is clustered among the EAG states of Bihar, Jharkhand, Madhya Pradesh, Chhattisgarh, Rajasthan, UP, Uttaranchal, Assam & Orissa.
The overall average rate of MMR decline during the period 1997-2003 was, of 16 points per year. At this rate of decline, an MDG of 109 by 2015 may be difficult to achieve Under the prevailing conditions, the MMR would be approximately 231 by 2012.
They give us the impression that although we are moving in the right direction, progress is slow and to prevent mothers from dying and living with problems related to childbirth, a lot still needs to be done and much faster.
The main causes of maternal mortality are excessive bleeding during childbirth (generally among home deliveries), (38%) obstructed and prolonged labor, (5%) infection/sepsis (11%), unsafe abortion, (8%) disorders related to high . blood pressure (5%) and other condition including anemia. (34%). Forty-seven percent of maternal deaths in rural India are attributed to excessive bleeding and anemia resulting from poor feeding practices. Intermediate causes, which are the first and second delays in care, include the low social status of women, lack of awareness and knowledge at the household level, inadequate resources to seek care, and poor access to quality health care. Causes of third-party delay are inappropriate diagnosis and treatment, poor skills and training of caregivers, and prolonged waiting time at the facility due to lack of trained staff, equipment, and blood. There are insufficient facilities for antenatal care and more than half of all deliveries are still carried out at home, very often by untrained assistants. The link between pregnancy-related care and maternal mortality is well established.
National programs and plans have emphasized the need for universal screening of pregnant women and the operation of essential and emergency obstetric care. Focused prenatal care, birth preparedness and complication preparedness, skilled attendance at birth, care within the first seven days, and access to emergency obstetric care are factors that can help reduce maternal mortality. One of the most important objectives of the Department of Health and Family Welfare of Government of India is to reduce maternal mortality and morbidity. The focus has shifted from individualized interventions to attention to reproductive health care, which includes skilled attendance at birth, operating Referral Units and 24-hour delivery services at Primary Health Centers. and initiation of Janani Suraksha Yojna (National Maternity Benefit Scheme). The program to attend the same is Rural Health Mission in EAG states and RCH II in the other states.
If India is to achieve the Millennium Development Goal 5 (MDG 5) by 2015, in addition to providing universal emergency obstetric care to every pregnant mother in need, it will have to address critical social and economic factors, such as the low status of women, the poor understanding of many families about health care, the cost of such care, and also the low standard
Strategies that must be adopted are
o Improve inclusion. Two important groups—poor women and adolescents—need to be brought directly into the fold of reproductive health services through geographic and household targeting and clearly directed outreach. Social and gender sensitivity among providers, managers and policy makers is essential to achieve this inclusion, as well as the supply and demand improvements noted below.
o Improve supply. Strengthen the provision of services for all stages of the reproductive life cycle, for which integrating the essential package and providing a client-centered continuum of care are good approaches. Four services have been particularly neglected and require additional attention in this context: combating unsafe abortion, nutrition counseling and care, postpartum care, and RTI/STI diagnosis and treatment. Improving the availability and quality of frontline female health workers through recruitment and/or contracting in, training, field support and performance-based incentives would help meet many needs, while contracting out of services and other client/provider payment systems could increase availability. on care for poor women.
o Increase demand. Increase demand for several services that are provided but underutilized, such as ANC, IFA, institutional deliveries and family planning (although supply may be a constraint in some areas). In addition to “behavior change communication”, demand funding is important to achieve this.
o Reform the health sector for reproductive health. As reforms take place in the health sector, the delivery and financing of reproductive health services deserve special attention. Reforms are particularly needed in three areas to support the above approaches to improving reproductive health. Decentralized planning and resource allocations, human resource development and financial improvements are important to implement targeting, service integration, supply improvements, customer focus, demand creation and effective outreach.
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