The latest Sample Registration System (SRS) data on the Maternal Mortality Ratio (MMR) has put Tamil Nadu at 63, indicating that the State’s continuing efforts to bring down the number of maternal deaths seem to be working. However, as the pace of the fall slows down, the next major drop in the State’s MMR would have to be fuelled by a quantum leap in maternal care activities.
Tamil Nadu remains in the third position in the country, only behind Kerala (42) and Maharashtra (55), as revealed by the SRS data for the 2015-2017 period. MMR is read as the number of maternal deaths per 1,00,000 live births. While at 63, Tamil Nadu’s MMR is way below the all-India figure of 122, the pace of the fall has slowed down when compared to the previous interval. Between 2011 and 2013 and 2014 and 2016, the State’s MMR had fallen from 79 to 66 — a drop of 16%. Just as in the case of Kerala, the rate of reduction is slowing down — something, experts point out, may be expected in States that have steadily falling MMRs. The last mile is proverbially, and literally, always hard to cross.
The good news, though, is that the health authorities are already on the ball when it comes to this issue. The target is to bring MMR down to 25 by 2023. Health Secretary Beela Rajesh says: “The aim is to be the number one State in MMR. So, we are determined to put in all efforts that could provide crucial interventions.” For instance, the State has launched an intensive three-month study of the health status of mothers immediately after the delivery, when the mother and baby are discharged. New protocols and systems would be put in place once this study identifies the key issues. “There are about 2,000 deliveries per day in Tamil Nadu. We are planning to set up a core committee that would monitor the top 10 districts with high MMR. We have noticed that the maximum number of deaths occur during the first month after delivery, post-partum, so that is when we will be paying attention,” she explains.
The government is planning to have its automated registration system for all mothers in the State – Pregnancy Infant Cohort Monitoring and Evaluation (PICME) – throw up the ‘high risk’ cases, which can then be followed up on at home.
Besides, all gynaecologists — right through the government healthcare set-up — from primary through secondary to tertiary levels, will be linked together so that quick solutions can be found in crisis situations. “If the doctor in the PHC (Primary Health Centre) has some doubts about how to best handle a particular case, she or he can establish contact with another doctor at the secondary or tertiary levels,” Dr. Rajesh says.
Technology has made it easy. Video calls and VoIP calls between doctors will help resolve issues, the State believes. This is also one way to monitor all deliveries in the State and ensure that experts, who may not be physically present, can chime in as and when necessary. This is expected to lead to gains in reducing MMR.