Wikipedia:SWASTHA/Maternal death in India

Maternal death in India

Maternal death or maternal mortality as defined by the World Health Organization (WHO) is "the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes."[1]

The CDC considers a period of up to 1 year regardless of the outcomes of pregnancy.[2] Around 99% of the deaths from pregnancy-related causes per year occur in developing nations.[3] Maternal mortality rate or maternal maternity ratio (MMR) are the interchangeably used measures of maternal mortality and indicate deaths per 100000 live births.

Prevalence
According to the recently published report from Sample Registration System Bulletin-2016, India has registered a 26.9 per cent reduction in MMR since 2013. The MMR has declined from 167 in 2011-2013 to 130 in 2014-2016 and to 122 in 2015-17, registering a 6.15 per cent reduction since the last survey figures of 2014-2016.[4] More details available in the table below[5]

Causes


Increased maternal deaths in India is an outcome of several socioeconomic as well as medical factors. Teenage marriage and pregnancies are still very high in rural and remote areas of the country and hence adolescent and illiterate mothers and those living in hard to reach areas still have a much greater chance of dying in childbirth. It is estimated that, in India, 44,000 women per year die due to preventable pregnancy-related causes[6] and 50-98% of maternal deaths occurs due to improper handling of obstetrics cases.

The main pregnancy related causes of death are postpartum hemorrhage (24%); indirect causes such as anemia, malaria, and heart disease (20%); infection (15%); unsafe abortion (13%); eclampsia (12%); obstructed labor (8%); and ectopic pregnancy, embolism, and anesthesia complications (8%)3

The "Three Delays" model proposes that pregnancy-related mortality is due to delays in:[7]

·  Deciding to seek care

·  Reaching care in time, and

·  Receiving adequate and appropriate treatment.

The first delay is on the part of the mother, family, or community in not recognizing the need for care or ignoring the signs of a life-threatening condition. Because most deaths occur during labor or in the first 24 hours postpartum, recognizing an emergency is crucial however, by the time the family realizes that the patient needs medical help, harm has already been done. The second delay is in reaching a healthcare facility in time may be due to lack of a well-equipped facility in the vicinity or lack of transportation, etc. The third delay occurs at the healthcare facility, inadequate care or inefficient treatment in emergency, an inadequate number of trained hospital staff, lack of appropriate supplies, and the lack of emergency medicine and delivery kit.

Prevention
MMR can be reduced by a joint effort of the patient, family, healthcare professionals and government. The first crucial step is raising social awareness against early marriages, teenage pregnancies, frequent pregnancies and stressing the importance of girl child education in general and regarding health and sex in particular. The Government should encourage implementation of family planning programs, provide maternal and child health (MCH) services at rural and low income areas. Quality of MCH care at the rural community level (proper history taking, palpation, blood pressure and fetal heart screening, risk factor screening, and referral) where it already exists should be improved. Obstetrics and gynecology training primarily on practical skills in management of labor and delivery should be provided to the “daais” or the local female who conducts deliveries at home, though deliveries at home should be routinely discouraged. There should be improvement in the quality of care at the primary health care (PHC) level with availability of emergency care and proper referral. The hospital should be well-equipped with delivery kits and emergency medicines. The hospital staff should be well-trained in care during labor and delivery, which is the most critical period for complications. There should be availability of blood in case of emergency and arrangement of community-based delivery huts which can provide a clean and safe delivery place close to home, and maternity waiting rooms in hospitals for high risk mothers. Moreover, compulsory 3 ANC and 3 PNC visits for all pregnant females should be encouraged.

Public health initiatives
The government has started various public health initiatives to provide a safe and secure environment. Some of these initiatives are - Janani Suraksha Yojana (JSY), Pradhan Mantri Matru Vandana Yojana (PMMVY), Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA) Poshan Abhiyan and Laqshya. Government have also taken initiatives on improving the infrastructure of the country by improving roads and providing free ambulance services at PHC.