OneWorld.net (U.S.)

A pilot project by Unicef in West Bengal, which tracked maternal deaths and uncovered some unpleasant truths about the healthcare system and other socio-economic factors, could become a model for other states with high maternal mortality rates

Unicef will soon initiate a maternal audit project (a detailed maternal death inquiry system) in Guna and Shivpuri districts in Madhya Pradesh. The project, based on a pilot study in Purulia, West Bengal, could become the model for states like Uttar Pradesh, Bihar, Madhya Pradesh, Jharkhand and Rajasthan that have high maternal mortality rates.

India accounts for over 20% of global maternal and child deaths, and also records 20% of births worldwide. Approximately 30 million women in India experience pregnancy annually, and 27 million have live births. Of these, nearly 136,000 maternal deaths occur annually, most of which can be prevented. The maternal mortality ratio in India is 540 maternal deaths per 100,000 live births, rising to 619 in rural areas.

Dr Sudha Balakrishnan, an expert working with Unicef, elaborates: “Every five minutes, India suffers one maternal death, yet there is hardly any discussion on the subject or lessons learnt from the deaths.”

As one of its priority activities, Unicef is supporting the development and implementation of Maternal and Perinatal (the death of a child within seven days of birth) Death Inquiries (MAPEDI) as a tool to strengthen community participation in evidence-based district-level planning.

Death inquiries seek to identify the biological, social and health system factors that contribute to maternal and perinatal death. Thereby, they provide a comprehensive picture of the determinants of maternal and perinatal mortality. Identifying maternal deaths is a challenge as they are under-reported.

Maternal mortality is generally defined as the death of a woman during pregnancy or delivery, or within 42 days of the end of pregnancy, from pregnancy-related causes. Major causes of maternal death are excessive bleeding during childbirth (generally among deliveries at home), obstructed and prolonged labour, infection, unsafe abortions, disorders relating to high blood pressure and anaemia.

Forty seven per cent of maternal deaths in rural India are caused by excessive bleeding and anaemia resulting from poor nutritional practices. Intermediate causes, which are the first and second delays in care-seeking, 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 healthcare. Causes of third delay are untimely diagnosis and treatment, poor skills and training of care-providers, and prolonged waiting time at the facility due to lack of trained personnel, equipment and blood. There are insufficient facilities for antenatal care, and 65% of all deliveries are still conducted at home, very often by untrained helpers.

The Purulia pilot project entailed a maternal death inquiry system from June 2005 to June 2006. Pregnant women were tracked and when deaths occurred the medical and socio-economic causes were noted so that necessary action could be taken to end many preventable deaths.

During the course of the pilot project it was found that around 106 maternal deaths took place in Purulia. About 62% of women were found to have died during labour or delivery, 26% during pregnancy and around 12% during abortions. About 20% of women did not seek formal healthcare and died due to complications.

Faced with these results the government began reviewing every maternal death on its own. A facility-based review was initiated to improve the quality of healthcare in hospitals, clinics and health centres in the state. All maternity beds in public sector facilities were made non-paying.

The achievements of the MMR advocacy project implemented in the four focus states of Rajasthan, Madhya Pradesh, West Bengal and Orissa include the printing of maternal death notification forms, promoting safe motherhood through women’s programmes, increasing awareness on safe motherhood through anganwadis, engaging the media in highlighting issues, and sensitisation and awareness of the community.

Source: Info Change More