Risks to mother's life

THE CHALLENGE

Every eight minutes a mother dies in childbirth in India. For every maternal death in India, 20 more women suffer from lifelong health impairments that result from complications during their pregnancies. The majority of these deaths are among women in the 15-29 age group, at the prime of their reproductive lives.

The most tragic aspect of these deaths is that about 90 percent of them are avoidable, if women receive the right kind of intervention. The chart below shows the top five causes of maternal death. Each of these medical conditions has received extensive research and has methods of treatment and prevention. The key to avoiding the onset of these conditions is providing continual medical care and education to pregnant women throughout the entirety of their pregnancy.

      
Causes of Maternal Death in India
Haemorrhage 38
Sepsis 11
Hypertensive Disorders 5
Obstructed Labour 5
Abortion 8
Other Conditions 34

    


 

Three Delays:
Pregnancy and child birth is a journey, not just of one woman or her family, but where all of us as a nation have a role to play. Each mis-step or delay could mean a difference between life and death.

The ‘three delays model’ explains the complex political, socio-economic and medical factors that prevent women from getting the care they need, at the right time and result in the high maternal, neo-natal and child mortality rates in India.


The First Delay

The first delay relates to the earliest mis-steps made during pregnancy that, if altered, could change the outcome of the pregnancy. Women and their families are often unable to recognize warning signs and seek medical help during pregnancy because they do not have accurate education on proper prenatal care.

  • Inadequate Nutrition: Almost 90% of women in Maharashtra and Gujarat, the most prosperous states in India, are anemic according to World Health Organization standards.
  • Only 23.1 percent of mothers, just one in five pregnant women, received iron and folic acid for at least 90 days during their last pregnancy.
  • More than half the women in the child bearing age group in India (56.2 percent) are anemic.
  • Only 4% of expectant mothers took a de-worming drug during pregnancy. 

Many women are also unable to attend prenatal visits throughout pregnancy where they could receive this information from a doctor or health worker. These early mis-steps factor into the First Delay.


The Second Delay

Many mothers die at home or on their way to the hospital because they were unprepared for any complication, lacked transportation, or were referred from one hospital to another. The incidents of mothers dying because they cannot get to the right hospital at the right time is high because more than half of the child births in India still happen at home, and in most cases a skilled attendant or midwife is not available. 

  • 70 percent of patients, who face an emergency situation, do not have a means of transportation readily available. They had not planned for it earlier.
  • 40 percent of deaths occur at home, mainly from severe infection (sepsis) and bleeding. Delays occur while trying to find money or while transporting the patient.

The Third delay

Even if a mother gets to a hospital in time, there is no guarantee that her life is safe. The third delay happens when the right medical facilities, trained professionals, medicines and other critical inputs like blood are not available. The facilities available, the expertise level of health care workers and quality of care differs widely depending on the hospital that a woman travels to. For example, according to the National Family Health Survey II, less than 30 % community health centers had an obstetrician available; less than 10 % had an anesthetist. All these factors lead to critical delays when transferring a patient to another hospital to get the right treatment.


THE SOLUTION

Reduction of the first and second delays involves increasing “Birth Preparedness and Complication Readiness” by planning interventions at the community level including raising awareness of danger signs and improving access to information, communication and transportation. The best and most cost-effective strategy for reducing third delay and also maternal mortality is to provide Emergency Obstetric Care (EmOC) services within the reach of all pregnant women. This is the goal of ARMMAN.