Fresh initiative to bring down MMR

The Health Department will look at new and improved strategies and augment antenatal and delivery care facilities at public sector hospitals in an effort to bring down infant and maternal mortalities in the State.

A 10-point quality standards manual developed by the State Health Department in 2013, in partnership with the NICE International, U.K., and the Kerala Federation of Obstetricians and Gynaecologists (KFOG), as part of a major initiative to reduce the State’s maternal mortality ratio (MMR), is being further expanded by adding on two more components which the KFOG feels is imperative in the changing times

“So far the programme’s target has been MMR reduction and our focus has only been on the mother. But we feel that as obstetricians, we need to do more to reduce perinatal mortality, which is a major contributor for infant mortality rate (IMR). About 50 per cent of infant deaths occur within the first week of birth. In fact, almost 60 per cent of the initiatives required to bring down IMR have to do with better obstetric management,” said V. P. Paily, a senior obstetrician and State coordinator of the Confidential Review of Maternal Deaths.

Also, this time, we are giving more attention to delivery care and follow-up management of mothers who are detected with gestational diabetes and hypertension. Another focus area is improving the safety of C-section deliveries and reducing unnecessary C-sections, he said.

The manual, which had earlier been piloted in 13 selected public and private sector hospitals, had brought significant improvements in delivery care practices and reduced the proportion of maternal deaths due to post-partum haemorrhage. But the initiative had lost momentum in between because of administrative apathy.

The initiative is now being given a fresh lease of life as reduction of MMR and IMR are two of the major targets to be achieved by the State under Sustainable Development Goals (SDGs) in the next five years.

The latest official statistics, as per the Sample Registration System (SRS), 2013, put Kerala’s MMR at 61 (100,000 live births). However, the KFOG and the Health Department insist that realistically the MMR cannot be more than 35.

Shortage of funds and staff was a major hurdle in implementing the initiative. Many government hospitals do not even have sterile linens or towels to provide for the mother and baby.

The National Health Mission is planning to provide delivery kits and additional personnel.