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Maternal Health in India
‘God could not be everywhere and therefore he made mothers’ – A Jewish proverb sums up the relevance of a mother. This 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 each year at a time that should be joyful, just when they are giving life to the world. About 300 million more suffer from preventable diseases 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 some seven years remain until the Millennium Development Goals (MDGs) are achieved.
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 the maternal mortality ratio by two-thirds between 1990 and 2015
1. Maternal mortality ratio
2. Proportion of birth assisted by qualified health personnel
Target5B: Achieve, by 2015, universal access to reproductive health
1. Contraceptive prevalence rate
2. Birth rate in teenagers
3. Coverage of prenatal care
4. Unmet need for family planning
Maternal mortality is an important indicator of a woman’s status in a society: a maternal death often represents the end point of a lifetime of discrimination and gender deprivation ‘inside’ the home, and lack of ‘outside’ (eg 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 health 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 large difference in maternal mortality in developed and developing countries, the latter still alarmingly high. In 2000, 13 developing countries accounted for 70% of maternal deaths worldwide and South Asia for one third. The country with the highest number of deaths was India, where an estimated 136,000 women died.
A number of 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 higher in rural areas, among the most disadvantaged and those with little or no education. Women who have not received prenatal care appear to have a greater risk of death (either a cause or a correlate), and those who do not need contraception are clearly at greater risk than 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 surviving children. A baby is three to ten times more likely to die in the first two years without its mother. Women’s health is fundamental to the social, economic and political development of a country. The survival of women in childbirth reflects the overall development of a country and whether health services are working or not. In reality, women’s survival reflects whether women matter or not.
According to NFHS-3 and SRS 2001-2003, there are several health indicators that reflect the current status of women’s health in India.
o Women of reproductive age make up about 19% of the total population with 16% of women in the age group of 15 to 19 years. they already have children The average age of having children 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 ANC, less than two-thirds had their weight, blood or urine taken, or blood pressure measured, three-quarters had their abdomen examined, and 36% had She informed them of pregnancy complications. 56% of married women and 59% of pregnant women are anemic. 65% of expectant mothers received or purchased iron and folic acid, but only 23% consumed IFA within 90 days. In the urban area 76% of pregnant women received or purchased IFA and only 35% consumed IFA during 90 days and in the rural area 61% received or purchased IFA and 19% consumed the same during 90 days
o 49% of all deliveries are institutional. Only 1 in 7 home deliveries are assisted by a qualified provider. (urban-68%, rural-29%)
o 13% of the lowest indexed women gave birth in an institution, in contrast to 84% of women in the highest indexed group. 33% of pregnancies belonging to the SC caste gave birth in the institution as against 18% among the Scheduled Tribes.
o Only 42% of postnatal mothers are receiving some type of postnatal care. The maternal mortality rate has gradually improved 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 global average rate of decline in the TMM during the period 1997-2003 has been 16 points per year. At this rate of decline, the MDG of 109 in 2015 may be difficult to achieve. Under current conditions, the MMR would be around 231 in 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, much remains to be done and at a much faster pace.
The main causes of maternal mortality are excessive bleeding during childbirth (usually among home births), (38%) obstructed and prolonged labor, (5%) infection/sepsis (11%), unsafe abortion, (8%) blood pressure-related disorders (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 delays in seeking care, include women’s low social status, lack of awareness and knowledge at the household level, inadequate resources for seeking care and poor access to quality health care. The third causes of delay are untimely diagnosis and treatment, lack of skills and training of care providers, 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 births are still carried out at home, 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 essential and emergency obstetric care. Focused prenatal care, preparation for childbirth and preparation for complications, skilled birth attendance, care during the first seven days, and access to emergency obstetric care are factors that can help to reduce maternal mortality. One of the main objectives of the Department of Health and Family Welfare, Government of India is to reduce maternal mortality and morbidity. The focus has shifted from individualized care interventions to reproductive health care, which includes skilled birth attendance, the operation of referral units and 24-hour delivery services in primary health centers . and the launch of Janani Suraksha Yojna (National Maternity Benefit Scheme). The program to attend is the Rural Health Mission in the EAG states and RCH II in the rest of the states.
If India is 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 need to address factors critical social and economic factors, such as the low status of women, the poor understanding of health care by many families, the cost of such care, and also the low
The strategies to be adopted are
o Improve inclusion. Two important groups, poor women and adolescents, need to be brought directly into reproductive health services through geographic and household targeting and clearly targeted outreach. Social and gender sensitivity among providers, managers and policy makers is essential to achieving this inclusion, as well as the supply and demand improvements outlined below.
o Improve the offer. Improving the service offering for all stages of the reproductive life cycle, for which integrating the essential package and offering a continuum of customer-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 STI/STI diagnosis and treatment. Improving the availability and quality of frontline health workers through recruitment and/or hiring, training, field support, and performance-based incentives would help meet many needs, while contracting for services and other payment systems for customers/suppliers could increase availability. of care for poor women.
o Increase demand. Increase demand for various services that are provided but underutilized, such as ANC, IFA, institutional deliveries and family planning (although supply may be constrained in some areas). In addition to ‘behaviour change communication’, demand funding is important to achieve this.
o Reform the healthcare sector for reproductive health. As health sector reforms take place, 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 allocation, human resource development and financing improvements are important to implement targeting, service integration, supply improvements, customer focus, demand creation and effective disclosure.
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