Maternal mortality in hospitals continues to haunt several States in the absence of skilled attention and staff scarcity
A young woman, Anita, who was admitted to a hospital in Jodhpur for her first delivery on February 14 last year, died two days later. Her family had already spent Rs. 60,000 for medicine and blood.
Almost a month later, on March 17, 21-year-old Tasneem was also admitted to Umaid Hospital in Jodhpur for delivery. She died the very next day; her family, too, had spent thousands of rupees on IV fluids and several units of plasma, each costing Rs. 6,500.
In Uttar Pradesh, money was demanded from 23 families even after the patients died during delivery. In fact, a Dalit man had to cycle 17 km through forest path at night to borrow money for his wife’s delivery. When he returned, he found her lying dead.
These are some of the cases that came to light during a study on Maternal Death Reviews conducted in a few States. Maternal Death Review has been made mandatory by the Centre and is used to prevent maternal mortality by ascertaining the cause of each death.
While maternal mortality in India has decreased over the last decade, yet it remains a significant problem of women’s health and rights. However, the rate of decline is uneven across the States. The Janani Suraksha Yojana (JSY) — conditional cash transfer scheme to encourage women for institutional deliveries — appears to have led to a huge increase in the proportion of women choosing institutional delivery; however, it has substantially deflected attention from what happens to women who do not or cannot reach hospitals. There is also inadequate assessment of the capacity of hospitals to handle this large volume of cases, and whether providers actually manage to provide skilled attention to women who need emergency obstetric care. The issues were raised by participants of a seminar ‘Chronicles of Deaths Foretold — Using Maternal Death Reviews to prevent Maternal Mortality and Morbidity in India’ in the Capital recently.
Discussing the Maternal Death Reviews from Rajasthan, U.P., Jharkhand and Gujarat, Jashodhara Dasgupta of National Alliance for Maternal Health and Human Rights (NAMHHR) said a common factor in all the reports above is that most of the women approached institutions during labour (as encouraged by the government through JSY) and most of these deaths could have been prevented if adequate skilled medical attention had been provided.
It was also pointed out that while JSY was popular, there was lack of awareness about the Janani Shishu Suraksha Karyakram that entitled pregnant women to free delivery and the mother and new born babies to free treatment and food in public health institutions up to a month in addition to free pick up and drop from home to the health facility and back or to a referral hospital as the case may be. Even the staff was unaware of the scheme in the hospitals, thereby depriving the women of this entitlement.
Shobha Shah of Gujarat’s Bharuch district said her review of 70 maternal deaths among poor tribal women showed that many had died of malaria or hepatitis or severe anaemia that could not be prevented only by hospital care during childbirth. In Madhya Pradesh, tribal women face neglect and social discrimination in health facilities while in Uttar Pradesh, the health centres do not have staff capacity, equipment and essential drugs to handle a large volume of cases, and often harass women for additional payments. Haemorrhage is one of the main causes of maternal death followed by unsafe abortion, severe anaemia, sickle cell disease, hypertension, sepsis, hepatitis and malaria. Lack of transport or delay in arranging for transport has also resulted in women dying en route to a health facility.
Dr. Shah said a special strategy is required for addressing maternal deaths during antenatal and late post partum period. Her study also shows that there has been a paradigm shift in epidemiology of maternal mortality as increasing proportion of deaths now occurred due to medical causes and in hospitals.