Maternal Mortality In India

Major causes of maternal mortality in India are:

1. Haemorrhage(29%)
2. Anaemia(19%)
3. Sepsis(16%)
4. Obstructed labour(10%)
5. Abortion(9%)
6. Toxaemia(8%)
7. Others(9%)

Maternal mortality in India is very high. Health action can reduce maternal mortality to about half in a 5 to 10 year-period. Other factors such as income, nutrition, education, women’s status and equity are important, but improvements can be seen in the long term.

The three Es to reduce maternal mortality are:

• E1: Essential obstetric care for all
• E2: Early detection of complications
• E3: Emergency services for those who need it

Essential Obstetric Care for All:

All pregnant women are at risk of complications. One or more risk factors are observed in 50% of the maternal deaths. therefore, all pregnancies should be treated as potentially at risk and essential obstetric care is provided to all pregnancies. This includes:

• Early registration of pregnancy
• 3 or more ante-natal check-ups during pregnancy
• Anaemia prophylaxis and treatment: For prophylaxis, 1 tablet containing 100 mg elemental iron and 500 ug Folic acid daily and in case of anaemia, 2 such tablets daily for at least 100 days. Mebendazole(2nd/3rd trimester) for those with history of passing worms.
• 2 doses of Tetanus toxoid or a booster
• Skilled care at birth: Institutional deliveries and deliveries by skilled birth attendants observing five cleans during delivery- clean hands, clean surface, clean razor blade, clean cord tie and clean cord stump. Provision for disposable safe delivery kits for the same, in addition to IEC and reorientation training efforts.
• Birth spacing and birth timing: To avoid pregnancies before 20 years and after 30 years. Birth interval to be at least 3 years.
• Home-based postnatal care alongwith the care of the newborn. This will be provided through TBAs, AWWs and link workers. These workers will visit on days 1,2,7,14 and 28.

Early Detection of Complications:

This will be through regular check-ups, self-reporting based on danger signals or timely referral by TBAs and health workers. Common complications are: Bleeding(APH,PPH), anaemia, toxaemia, sepsis, abortion and obstructed labour. Deliveries will be promoted at institutions to not only ensure five cleans but also for reducing the time gap between onset of complications and reaching an institution for emergency care.

Emergency Care:

The complications like haemorrhage, severe anaemia, severe toxaemia, obstructed labour, ruptured uterus or abortions are obstetric emergencies and will be managed at First Referral Unit(FRU), details of which are given on a previous post on FRU.