Monday, March 17, 2008

Maternal Health in India

I feel that it is necessary to paint a picture of the global maternal situation before delving into India's maternal health statistics. All the cited statistics can be found on the website of White Ribbon Alliance, an informal coalition that seeks to weave together the maternal health related efforts of various NGOs, INGOs, bilaterals and individuals.
Please visit:
http://www.whiteribbonalliance-india.org/introduction.htm

WRA Global Fact Sheet: - Every pregnancy, anywhere in the world, faces risk. An estimated 15 per cent of all pregnant women develop life-threatening complications.
- Globally, for every two people who die in traffic accidents, one mother and 20 children die from preventable and treatable causes (WHO, 2004).
- Every minute, 20 children under five die. That means nearly 30, 000 children die every day. 10.6 million children die each year (Black, Morris & Bryce, 2003). Of these 3.1 million are from South East Asia.
- Up to a third of maternal mortality and morbidity could be avoided if women had access to information and a full range of modern, safe and effective fertility control methods.
-For every three deaths of women in their reproductive years in developing countries, one is the result of complications from pregnancy and childbirth. In India, 15 per cent of deaths of women in the reproductive age are maternal deaths.
- Worldwide, unsafe abortions contribute to nearly 15 per cent of all maternal deaths. In India, nearly seven million abortions take place annually. Post abortion care is essential to safe motherhood. (Information kit, World Health Day ’98, WHO).
- Not enough mothers and children receive existing and affordable life-saving care. Globally, just 61 per cent of births are assisted by a skilled attendant, while in some low income countries the average is as low as 34 per cent (WHO, 2004).
- HIV/AIDS presents an ever-increasing threat to both mothers and their children. Women currently account for nearly half of all adults living with HIV/AIDS (UNAIDS, 2004). This not only compromises the health of women, but it also increases the risk of mother-to-child transmission of HIV.

The Birth Realities for a Majority of Indian Women:
In India, a woman loses her life to pregnancy related causes every five minutes! This adds up to 130,000 maternal deaths per year - almost all of which are preventable!
India’s mortality ration (MMR) has reached 407 deaths per 100,000 live births, approximately 4 x higher than India’s 2010 goal of 100 per 100,000 births. A grave disparity exists between maternal health other areas of development: there has been no sign of reduction in maternal deaths for the past 10 years!
This tragedy is confirmed by the MMRs of three states (Assam Madhya Pradesh and Utter Pradesh), which equal 700 deaths per 100,000 live births. Out of those women who do manage to survive, an estimated 30 out of 1,000 will develop chronic pregnancy-related conditions.
Medical Causes of Maternal Mortality in India:

24% = anaemia
23% = Haemorrhage
12% = Abortion
10% = Toxemia
10% = Puerpal Sepsis
7% = malposition
24% = eclampsia, malaria etc.
Additional Causes:
1. Early marriages and births – 50% of women marry before 18 years-old and half of those women conceive their first child by 19 years-old. A large number of maternal deaths occur in women with ages ranging from 15-19 years-old.
Note: There is significant social pressure in India to have a child within the first year of marriage; otherwise family members will question the mother’s fertility and condition of the husband/wife relationship!
2. Lack of access to Emergency Obstetric Care (EmOC)
3. Inadequate Nutrition – average weight gain of Indian women is only 7 kg.
Note: Many of the women I support in government hospitals have stomachs as flat as mine within minutes of their delivery!
4. Other medical causes include hemorrhage, eclampsia, obstructed labor, sepsis, unsafe abortion, anaemia and malaria.
5. Absence of skilled professional – only 42% of births attended by skilled (drops to 5-6% in some rural areas)
Note: Asha NGO has made huge progress in retraining their dais and outfitting them with government certified dai kits outfitted with basic sanitation amenities and clean razors for cord cutting. This has significantly reduced the need to cut cords with rocks and other unsanitary utensils.
6. Short intervals between births – 3 out of 10 births follow a recent birth that occurred less than 24 months prior.
7. High Parity, meaning 4 or more deliveries
8. No blood transfusion
9. Lack of support from family members, especially men
Repercussions of Maternal Death:
Scars of maternal deaths extend beyond just the family, disrupting the well being of society at large! When a woman dies, a good portion of a family’s income is also lost, and the ensuing financial burden often exacerbates the poverty of her relatives and partner. Studies have estimated that the risk of childhood death, for children under five, doubles or even triples when a matriarch is lost. Other studies have calculated that, across the board, children are ten times more likely to die during the two years following their mother’s death.
In India, girl children are especially affected, as they are usually forced to relinquish their education to care for abandoned siblings.

The bite of suffering and inequality that reality holds for the majority of women around the world proves that maternal health concerns should qualify firstly as human right issues! The discrimination and lack of care found in spheres of both poverty and plenty testifies to the need for reform and empowerment of women, families, and caregivers! The way we give birth matters!

As a famous French physician named Michel Odent said:
"To change humankind, it is necessary to change the way we are born."

1 comment:

Aditi said...

with this state i am skeptical about India reaching the Millennium Development goals??
What do you say..??