According to a study conducted on pregnancy-related deaths, a large number of women die during transit to a health facility or returning home after a delivery. ‘Maternal Death Reviews — Implications for Quality of Care,’ (MDR) a review of maternal deaths done by the Federation of Obstetric and Gynaecological Societies of India (FOGSI) in Jhunjhunu and Sikar districts of Rajasthan between November 2010 and March 2012 has revealed that 90 per cent of these deaths had occurred during transit to a higher health centre.
The study, conducted on 819 deaths of a total of 1,065 probably maternal deaths reported in Madhya Pradesh between April 2011 and January 2012, suggests 132 women died on their way home or to a health facility. A similar analysis done in 69 health facilities in Karnataka has revealed that 20 per cent women die during transit.
Experts believe such deaths could possibly have increased because of an emphasis on institutional deliveries and a lack of corresponding clinical infrastructure — the Janani Suraksha Yojana gives women financial incentives for delivering at a health facility, but are often taken to the health facility as a mere formality and often asked to go home immediately after delivery because of lack of infrastructure to deal with the heavy patient load, which puts the life of the child and mother at huge risk.
This reality came across during a daylong conference to mark the Safe Motherhood Day last week, where participants from several States shared their experiences and progress on maternal death reviews.
The MDR was rolled out in 2010 under the Reproductive and Child Health programme as an important strategy to improve the quality of obstetric care and to reduce maternal mortality and morbidity.
It provides detailed information on various factors at the facility, district, community, regional and national levels that need to be addressed to reduce maternal deaths. Analysis of these deaths can identify the delays that contribute to maternal deaths at various levels and the information can be used to adopt measures to fill the gaps in service.
While haemorrhage, sepsis, abortion, obstructed labour and hypertensive disorders are the major medical causes of maternal deaths in the country, delay in initiating treatment, substandard care in hospital, lack of blood, equipment and drugs in hospitals coupled with lack of staff at health facility are other factors that often lead to the death of a young woman.
At the community level, absence of ante-natal check ups, delay in seeking care, referral, getting transport, mobilising funds and not reaching the appropriate facility in time are some other factors of maternal deaths, besides prevailing beliefs and customs that prevent women from going to a health facility at the appropriate time.
In a presentation on maternal death reviews in Madhya Pradesh, Apurva Chaturvedi, State Consultant, National Rural Health Mission, and Archana Mishra, Deputy Director (NRHM), explained that 32 per cent of the reviewed deaths had occurred in district hospitals, 25 per cent in maternity centres, 13 per cent in sub-centres and 6 per cent in private facilities. “Only 17.7 per cent of the expected maternal deaths are being reported and analysed while the remaining go unreported. Worse, in 37 per cent of the cases the cause of maternal deaths is registered as ‘other’,” they said.
“Maternal death review is a good thing and not some kind of a blame game. It aims to look into where and how maternal deaths are happening and how these cane be prevented,” says Aparajita Gogoi of the White Ribbon Alliance, working in the field of maternal health and rights.
“The government has given cash incentives to promote institutional deliveries but the communities should also be able to identify signs of emergency and understand the importance of regular ante-natal and post-natal check-ups for safe delivery. The focus should also be on the quality of care,” she said.
According to T.P. Jayanthi, Department of Community Medicine at Kilpauk Medical College (Chennai), in addition to medical causes, maternal death reviews also help us to identify the various contributory factors leading to maternal deaths. It is an important quality indicator to identify our system gaps and community barriers, including some problems that are area specific.
In her analysis of maternal death review process in 10 States between April and December 2011, Himachal Pradesh had reviewed 92 per cent of the reported maternal deaths, Uttar Pradesh 90 per cent, Orissa (79 per cent), Rajasthan (69 per cent), Assam (56 per cent), Uttarakhand (53 per cent), Bihar (38 per cent), Madhya Pradesh (39 per cent) and Chhattisgarh only 18 per cent.
In Tamil Nadu, all the 18 government medical college hospitals are being reviewed under the facility-based MDR programme. The review is being conducted by the Mission Director, State Health society through videoconferencing on the fourth Thursday of every month.
The MDR, even deaths occurring in other departments like Medicine, and Intensive Care Unit which would come under the criteria of maternal deaths are discussed along with the concerned specialist.
- Communities should identify signs of emergency to make use of State incentives: NRHM official
- MDR came out in 2010 to improve quality of obstetric care, reduce maternal mortality, morbidity