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Maternal Health in India
‘God could not be everywhere, so he created mothers’ – A Jewish proverb sums up the importance of a mother. This should put mothers in a very privileged position. But the irony is that every minute one woman dies in childbirth. 536,000 women still die needlessly every year at what should be a joyous time – precisely when they are bringing life into the world. An additional 300 million suffer from avoidable diseases and disabilities.
It has been about 14 years since the International Conference on Population and Development (ICPD) formulated the reproductive health agenda for the world, and about seven years remain to achieve the Millennium Development Goals (MDGs).
The fifth Millennium Development Goal (MDG) (Table 1) which aims to ‘improve maternal health’ – has fallen desperately off track.
Table 1 MDG 5-Improving maternal health
Goal 5A: reduce by two-thirds, between 1990 and 2015, the maternal mortality rate
1. Maternal mortality ratio
2. Share of births attended by qualified health personnel
Goal 5B: Achieve universal access to reproductive health by 2015
1. Contraception prevalence rate
2. Birth rate of adolescents
3. Coverage of prenatal care
4. Unsatisfied need for family planning
Maternal mortality is an important indicator of the status of women in society – the death of a mother often represents the end point of a life of gender discrimination and deprivation ‘inside’ the household, and failure ‘outside’ (eg the health system) to provide timely and effective care. Chronic conditions such as malnutrition, anemia, diabetes and hypertension make women more vulnerable to maternal death, but even healthy women can succumb to unexpected complications during pregnancy or childbirth.
Only the use of good health care can make maternal death as rare as it is in the developed world. Indeed, a striking feature of maternal health in today’s world is the vast difference in maternal mortality in developed and developing countries, the latter still alarmingly high. In 2000, 13 developing countries accounted for 70 percent of the world’s maternal deaths, with South Asia accounting for one third. The country with the highest number of deaths was India, where about 136,000 women died.
A number of individual and household factors place women at high risk of death during pregnancy and childbirth. These include age (too young or too old), high parity, poor nutritional status, poor access to health services, low social status, illiteracy and poverty. As with other indicators of reproductive health, maternal mortality is higher in rural areas, among economically disadvantaged populations and those with little or no education. Women who received no antenatal care appear to be at greater risk of death (cause or correlate), and those with unmet need for contraception are clearly at greater risk than they would have been if they had been able to avoid pregnancy.
The death of a mother is a death like no other. The impact of maternal death on families and communities is devastating – but especially for surviving children. A newborn is three to ten times more likely to die within the first two years without a mother. Women’s health is crucial for the social, economic and political development of the country. Maternal survival reflects the overall development of the country and whether the health services are functioning or not. In reality, the survival of women reflects whether women matter or not.
According to NFHS-3 and SRS 2001-2003, various health indicators that reflect the current situation of women’s health in India are
o Women of reproductive age make up almost 19% of the total population with 16% of women in the age group of 15-19 years. they are already giving birth. The median age of childbearing in India is 19.8 years. (urban area -20.9 years, rural area – 19.3 years).
o 77% of the total number of pregnant women received some form of prenatal care. (urban area 91%, rural area 72%)
o Among women who received ANC, less than two-thirds had weight, blood or urine taken, or blood pressure measured, three-quarters had an abdominal exam, and 36% were notified of pregnancy complications. 56% of married women and 59% of pregnant women are anemic. 65% of pregnant women received or purchased iron and folic acid, but only 23% consumed IFA during 90 days. In the urban area, 76% of pregnant women received or purchased IFA, and only 35% of them consumed IFA during 90 days, and in the rural area, 61% of pregnant women received or purchased IFA, and 19% of them consumed the same during 90 days.
o 49% of all births are institutional. Only about 1 in 7 home births are assisted by a qualified provider. (urban-68%, rural-29%)
o 13% of women with the lowest index were born in an institution, in contrast to 84% of women in the group with the highest index. 33% of pregnancies belonging to the SC caste were delivered in a facility against 18% among the Scheduled Tribes.
o Only 42% of mothers receive any form of postnatal care after giving birth. The maternal mortality rate gradually improved from 437 in 1992-1993. on 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 overall average rate of decline in the MMR in the period from 1997 to 2003 was 16 points per year. At this rate of decline, the MRC of 109 by 2015 may be difficult to achieve Under prevailing conditions, the MMR would be around 231 by 2012.
They leave us with 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 more needs to be done and at a much faster pace
The main causes of maternal mortality are excessive bleeding during childbirth (generally in home births), (38%) obstruction and prolonged labor, (5%) infection/sepsis (11%), unsafe abortion, (8%) disorders related to high blood pressure. 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 nutrition. Intermediate causes, namely the first and second delay 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 causes of the third delay are untimely diagnosis and treatment, poor skill and training of care providers, and prolonged waiting time in the institution 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 performed at home, very often by untrained assistants. The link between pregnancy-related care and maternal mortality is well established.
National programs and plans emphasize the need for universal screening of pregnant women and the operationalization of basic and emergency obstetric care. Focused antenatal care, preparedness for childbirth and preparedness for complications, professional care during childbirth, 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 shifted from individualized interventions to reproductive health care, which includes professional assistance during childbirth, operationalization of referral units and 24-hour delivery in primary care homes. and the initiation of the Janani Suraksha Yojna (National Maternity Benefit Scheme). The program for attending the same is Rural Health Mission in EAG states and RCH II in other states.
If India is to achieve Millennium Development Goal 5 (MDG 5) by 2015, apart from providing universal emergency obstetric care to every pregnant woman who needs it, it will have to address key social and economic factors such as the low status of women, poor understanding by many families about health care, the costs of that care, but also a low standard
The strategies that need to be adopted are
o Improve involvement. Two important groups – poor women and adolescents – need to be directly involved in reproductive health services through geographic and household targeting and clearly targeted outreach. Social and gender sensitivity among service providers, managers and policy makers is essential to achieving this inclusion, as well as the supply and demand improvements outlined below.
o Improve supply. Improving the service offering for all stages of the reproductive life cycle, for which the integration of the core package and the provision of a client-centred continuum of care are good approaches. Four services are particularly neglected and require additional attention in this context: combating unsafe abortion, nutrition counseling and care, postnatal care, and STI/STI diagnosis and treatment. Improving the availability and quality of frontline health workers through recruitment and/or contracting, training, field support, and performance-based incentives would help meet many needs, while contracting out services and other client/provider payment systems could increase the availability of care for poor women.
o Increase demand. Increase demand for several services that are provided but underutilized, such as ANC, IFA, institutional births and family planning (although supply may be a constraint in some areas). Along with ‘behaviour change communication’, demand-side funding is important to achieve this.
o Reform the health sector for reproductive health. As reforms take place in the health sector, the provision and financing of reproductive health services deserves special attention. Reforms are particularly needed in three areas to support these approaches to improving reproductive health. Decentralized planning and resource allocation, human resource development and funding improvements are important to implement targeting, service integration, supply enhancement, client focus, demand generation and effective outreach.
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