Maternal and Newborn Health
Almost 90 percent of maternal deaths in India are avoidable if women receive the right kind of intervention.
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.
Three Delays Model
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, neonatal 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 recognise 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% 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 childbearing age group in India (56.2 percent) are anemic.
- Only 4% of expectant mothers took a deworming 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 missteps factor into the First Delay.
The Second Delay
Many mothers die at home or on their way to the hospital because they are unprepared for any complication, lacked transportation, or 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% of patients, who face an emergency situation, do not have a means of transportation readily available. They had not planned for it earlier. 40% 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.
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. Providing critical healthcare information creates awareness regarding the need for regular care, risk factors and complications, and develops agency to demand healthcare. 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.