While institutional deliveries have increased in rural India, maternal morbidity is still an issue
For every one woman who dies due to pregnancy-related complications, there are 20 others who suffer from acute and chronic morbidity which could even be life-threatening.
But these morbidities go unnoticed and unaccounted for since there is no formal documentation. While maternal mortality audit has been made mandatory by the government, there is no such provision for auditing maternal morbidities.
Making a strong pitch for auditing pregnancy-related morbidities for a better roll-out of healthcare for reproductive and child care, Dr Srinath Reddy, president of the Public Health Foundation of India said while institutional deliveries in the last five years had increased over the years, there was not adequate availability of trained manpower in rural India that had resulted in high incidence of “maternal morbidity.”
The maternal morbidities can be obstetric fistula, uterine prolapse — a condition followed by a traumatic childbirth -- high diabetes, damage of the reproductive tract, loss of child-bearing ability.
In addition to a high burden of diabetes, mental ailments during and after pregnancy are also serious issues. Incidence of violence against women, too, is a major concern.
According to Dr Reddy, the women are suffering because of inability of people attending the primary health care centres to recognise the clinical symptoms, failure in referring to a bigger hospital in time, poor quality medical intervention and absence of even basic facilities in the labour room.
Speaking at a national consultation on “Maternal Health: Emerging Patterns” organised by the Population Foundation of India, Gita Sen, professor at the Indian Institute of Management, Bangalore said earlier pregnant women died at home or in between home and a health care centre. Now they die between a primary health care centre and referral institution because the persons attending a PHC – many of them are Indian system of medicine doctors – have little training to recognise clinical symptoms.
“Without quality manpower, hurried roll out of the policy has backfired. Children are being delivered in PHC labour rooms without electricity connection,” said Abhijit Das, assistant professor at the University of Washington.
Globally 20 per cent women suffer from mental health issues during and after pregnancies while this percentage goes up to 30 per cent in the developing countries. The mental health issue can range from baby blues, depression and psychotic illnesses.
Two million women suffer from fistula across the world and one in every 1,000 woman suffers uterine prolapse. Then there is high incidence of TB, HIV infection and other non-communicable diseases. Women who have diabetes during pregnancy have 50 per cent higher chance of getting diabetes within 5 to 10 years of delivery.
While cities have an average of 9-13 doctors per 10,000 population, the number is just about 2-3 doctors in the rural area. The number of nurses comes down by one-third in villages compared to cities, according to the statistic of the Union Health and Family Welfare Ministry released in December 2012.
While the maternal mortality ratio improved from 254 in 2004-06 to 212 in 2007-09 per 100,000 live births, it is still a long way from the Millennium Development Goal of 150 for India.
Institutional delivery and improved family planning have helped reduce an annual estimated 8 lakh maternal deaths in the last three years. Out of the estimated 24 lakh death averted in the last three years, more than 10 lakh deaths were in the age group of 15-19 years while the remaining were mothers above 35 years.