Maternal Health in India
‘God couldn’t be everywhere and that’s why he made mothers’ – A Jewish proverb sums up the relevance of a mother. That should put mothers in a very privileged position. But the irony is that every minute a woman dies at work. 536,000 women continue to die unnecessarily each year at what should be a happy time, just as they are bringing life into the world. Another 300 million suffer from preventable illnesses and disabilities.
Some 14 years have passed since the International Conference on Population and Development (ICPD) formulated a reproductive health agenda for the world, and there are about seven years to go before the Millennium Development Goals (MDGs) are achieved.
The fifth Millennium Development Goal (MDG) (Box 1), which aims to ‘improve maternal health’, is hopelessly off the mark.
Box 1 MDG 5-Improve maternal health
OBJECTIVES INDICATORS
Target 5A: Reduce by two thirds, between 1990 and 2015, the maternal mortality rate
1. Maternal mortality rate
2. Proportion of births attended by trained health personnel
Target 5B: Achieve, by 2015, universal access to reproductive health
1. Contraceptive prevalence rate
2. Teenage birth rate
3. Antenatal care coverage
4. Unmet need for family planning
Maternal mortality is an important indicator of the status of women in a society: a maternal death often represents the end point of a lifetime of gender discrimination and deprivation ‘inside’ the household, and failures from ‘outside’ (for example , the 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 medical care can make maternal death a rarity, as it has been in the developed world. Indeed, a striking feature of maternal health in the world today is the vast difference in maternal mortality between 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 a third. The country with the highest number of deaths was India, where some 136,000 women died.
Various individual and household factors put women at high risk of death during pregnancy and childbirth. These include age (too young or too old), high parity, poor nutritional status, low access to health services, low social status, illiteracy, and poverty. As with other reproductive health indicators, maternal mortality is highest in rural areas, among the most economically disadvantaged, and those with little or no education. Women who have not received prenatal care appear to be at increased risk of death (either a cause or a correlation), and those with an unmet need for contraception are at clearly greater risk than they would be if they could avoid pregnancy.
A maternal death is a death like no other. The impact of a maternal death on families and communities is devastating, but it is especially so for child survivors. A newborn baby is three to ten times more likely to die within her first two years without her mother. Women’s health is essential for the social, economic and political development of a country. The survival of women in labor reflects the general development of a country and whether health services are working or not. In reality, the survival of women reflects whether or not women matter.
According to NFHS-3 and SRS 2001-2003, several health indicators that reflect the current status of women’s health in India are
o Women in the reproductive age group make up almost 19% of the total population with 16% of women in the 15-19 age group. they are already having children. The median age of childbearing in India is 19.8 years. (Urban area -20.9 years, Rural area – 19.3 years).
o 77% of all pregnant mothers received some type of prenatal care. (Urban area 91%, rural area 72%)
o Among women who received prenatal care, less than two-thirds had their weight, blood, or urine or blood pressure measured, three-quarters had their abdomens examined, and 36% were told about of pregnancy complications. 56% of married women and 59% of pregnant women are anemic. 65% of pregnant women received or bought iron and folic acid, but only 23% consumed IFA for 90 days. In the urban area, 76% of 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 births are institutional. Only about 1 in 7 home births are attended by a skilled provider (urban: 68%, rural: 29%).
o 13% of women with the lowest rate gave birth in an institution compared to 84% of women in the group with the highest rate. 33% of pregnancies belonging to the SC caste gave birth in the institution against 18% among the registered tribe.
o Only 42% of postnatal mothers receive any type of postnatal care. The maternal mortality rate has been gradually improving from 437 in 1992-1993 to 301/100,000 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, and Orissa.
The general average rate of decline of the MMR during the period 1997-2003 has been 16 points per year. At this rate of decline, the MDG of 109 by 2015 may be difficult to achieve. Under current conditions, the MMR would be around 231 for 2012.
They give us the impression that, although we are heading in the right direction, progress is slow and in order to prevent mothers from dying and living with problems related to childbirth, much remains to be done and at a much faster pace.
The leading causes of maternal mortality are excessive bleeding during childbirth (usually between home births), (38%) prolonged obstructed labor, (5%) infection/sepsis (11%), unsafe abortion, (8%) related disorders with high blood pressure (5%) and other conditions, including anemia (34%). Forty-seven percent of maternal deaths in rural India are attributed to excessive bleeding and anemia resulting from poor nutritional practices. Intermediate causes, which are the first and second care-seeking delays, include women’s low social status, lack of awareness and knowledge at home, inadequate care-seeking resources, and poor access to quality health care. . The causes of the third delay are inappropriate diagnosis and treatment, poor skills and training of care providers, and long waiting times at the facility due to lack of trained staff, equipment, and blood. There are not enough facilities for antenatal care and more than half of all births still take place at home, very often by untrained attendants. 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 implementation of emergency and essential obstetric care. Focused antenatal care, preparation for childbirth and preparation for complications, skilled attendance at delivery, care within the first seven days, and access to emergency obstetric care are factors that can help reduce maternal mortality . One of the main objectives of the Department of Health and Family Welfare of the Government of India is to reduce maternal mortality and morbidity. The focus has changed from individualized interventions to reproductive health care, which includes skilled delivery care, the implementation of Reference Units, and 24-hour delivery services in Primary Health Care Centers. and the initiation of the Janani Suraksha Yojna (National Maternity Benefit Scheme). The program to attend to it is the Rural Health Mission in the EAG states and RCH II in the other states.
If India wants to achieve Millennium Development Goal 5 (MDG 5) by 2015, in addition to providing universal emergency obstetric care to every expectant mother in need, it will have to address critical social and economic factors, such as low status of women, the poor understanding of many families about health care, the cost of such care, and also the low level
The strategies to 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 targeted outreach. Social and gender sensitivity among providers, managers, and policymakers is essential to achieving this inclusion, as well as the supply and demand enhancements noted below.
o Improve the offer. Improving the supply of services for all stages of the reproductive life cycle, for which the integration of the essential package and the provision of continuous client-centred care are good approaches. Four services have been particularly neglected and require additional attention in this context: combating unsafe abortion, nutritional counseling and care, postnatal care, and diagnosis and treatment of RTIs/STIs. Improving the availability and quality of female frontline health workers through recruitment and/or hiring, training, field support, and performance-based incentives would help meet many needs, while outsourcing services and other customer/supplier payment systems could increase availability. care for poor women.
o Increase demand. Increase demand for various services that are provided but underutilized, such as ANC, API, institutional delivery, and family planning (although supply may be a constraint in some areas). In addition to ‘behaviour change communication’, demand-side funding is important to achieve this.
o Reform the health sector for reproductive health. As health sector reforms unfold, the provision and financing of reproductive health services deserve special attention. Reforms are especially needed in three areas to support past approaches to improving reproductive health. Decentralized planning and resource allocations, human resource development, and financial improvements are important to implement targeting, service integration, supply enhancements, customer focus, demand creation, and effective outreach. .