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Maternal Health in India
“God could not be everywhere, so he created mothers” – A Jewish proverb sums up the meaning of a mother. This should put mothers in a highly privileged position. But the irony is that every minute a woman dies in childbirth. 536,000 women continue to die needlessly every year at what should be a joyous time – just as they are giving birth. Another 300 million suffer from preventable diseases and disabilities.
About 14 years have passed since the International Conference on Population and Development (ICPD) formulated the reproductive health agenda for the world, and about seven years remain until the Millennium Development Goals (MDGs) are achieved.
The fifth Millennium Development Goal (MDG) (Table 1), which aims to “improve maternal health” – is woefully off track.
Table 1 MDG 5 – Improve maternal health
Goal 5A: reduce the maternal mortality ratio by two-thirds between 1990 and 2015
1. Maternal mortality ratio
2. Proportion of births attended by qualified medical personnel
Goal 5B: Achieve universal access to reproductive health by 2015
1. Contraception prevalence rate
2. Teenage fertility
3. Coverage of prenatal care
4. Unmet need for family planning
Maternal mortality is an important indicator of women’s status in society – maternal death often represents the endpoint of a lifetime of gender discrimination and deprivation ‘inside’ the household and failure ‘outside’ (eg the health system). provide timely and effective care. Chronic conditions such as malnutrition, anemia, diabetes and hypertension make women more susceptible to maternal death, but even healthy women can succumb to an unexpected complication during pregnancy or childbirth.
Only the use of good health care can make maternal death as rare as it is in the developed world. Indeed, a striking feature of maternal health in the world today is the huge difference in maternal mortality in developed and developing countries, which remains alarmingly high. In 2000, 13 developing countries accounted for 70 percent of maternal deaths worldwide, with South Asia accounting for one third. The country with the highest number of deaths was India, where an estimated 136,000 women died.
A number of individual and household factors put women at high risk of death during pregnancy and childbirth. These include age (too young or too old), high parity, poor nutritional status, low access to health services, low social status, illiteracy and poverty. As with other indicators of reproductive health, maternal mortality is higher in rural areas, among the economically disadvantaged and those with little or no education. Women who received no prenatal care appear to be at greater risk of death (cause or association), and women with unmet need for contraception are clearly at greater risk than if they could have avoided pregnancy.
Maternal death is a death like no other. The impact of maternal deaths on families and communities is devastating – but especially so for surviving children. A newborn baby is three to ten times more likely to die in the first two years without a mother. Women’s health is essential for the social, economic and political development of a country. The survival of women in childbirth reflects the overall development of the country and whether the health services are working or not. In fact, women’s survival reflects whether women matter or not.
According to NFHS-3 and SRS 2001-2003, various health indicators reflecting the current health situation of women in India
o Women of reproductive age make up almost 19% of the total population, with 16% of women in the 15-19 age group. already giving birth to children. The median age of childbirth in India is 19.8 years. (urban area -20.9 years, rural area – 19.3 years).
o 77% of the total number of pregnant mothers received some form of antenatal care. (urban area 91%, rural 72%)
o Among women who received ANC, less than two-thirds had a weight, blood or urine sample or blood pressure taken, three-quarters had an abdominal examination, and 36% were informed of pregnancy complications. 56% of married and 59% of pregnant women are anemic. 65% of pregnant mothers received or purchased iron and folic acid, but only 23% consumed IFA for 90 days. In the urban area, 76% of pregnant women received or purchased IFA and only 35% consumed IFA for 90 days, and in the rural area, 61% received or purchased IFA and 19% consumed the same for 90 days.
o 49% of all supplies are institutional. Only about 1 in 7 home deliveries are assisted by a qualified provider. (urban-68%, rural-29%)
o 13% of women with the lowest index gave birth in an institution, in contrast to 84% of women in the group with the highest index. 33% of pregnancies belonging to SC caste delivered in an institution as against 18% in Scheduled Tribe.
o Only 42% of mothers use any form of postnatal care after giving birth. Maternal mortality is gradually improving from 437 in 1992-1993 to 301/100,000 live births. Maternal mortality in India is not uniform. High maternal mortality is concentrated among the EAG states of Bihar, Jharkhand, Madhya Pradesh, Chhattisgarh, Rajasthan, UP, Uttaranchal, Assam and Orissa.
The overall average rate of decline in the MMR in the period 1997-2003 was 16 points per year. At this rate of decline, it may be difficult to achieve the MDG of 109 by 2015. Under prevailing conditions, the MDG by 2012 would be around 231.
They give us the impression that while we are moving in the right direction, progress is slow, and much more needs to be done, and at a much faster pace, to prevent mothers from dying and living with childbirth-related problems.
The main causes of maternal mortality are excessive bleeding during childbirth (generally among home births), (38%) obstructive and prolonged labor, (5%) infection/sepsis (11%), unsafe abortion, (8%) disorders related to high blood pressure (5%) and other conditions including anemia. (34%). Forty-seven percent of maternal deaths in rural India are attributed to excessive bleeding and anemia due to poor nutritional practices. Intermediate causes of the first and second delays in seeking care include women’s low social status, lack of awareness and knowledge at the household level, insufficient resources for seeking care, and poor access to quality health care. The causes of the third delay are premature diagnosis and treatment, poor skills and training of care providers, and prolonged waiting time in facilities due to lack of trained staff, equipment and blood. There are insufficient facilities for antenatal care and more than half of all births are still conducted at home, very often by untrained assistants. The association between pregnancy-related care and maternal mortality is well established.
National programs and plans have emphasized the need for universal screening of pregnant women and the implementation of basic and emergency obstetric care. Focused prenatal care, birth preparedness and preparedness for complications, skilled birth attendance, care during the first seven days and access to emergency obstetric care are factors that can help reduce maternal mortality. One of the main objectives of the Indian Ministry of Health and Family Welfare is to reduce maternal mortality and morbidity. The focus has shifted from individualized interventions to attention to reproductive health care, which includes skilled delivery care, operationalization of referral units, and 24-hour delivery services in primary health centers. and inauguration of Janani Suraksha Yojna (National Maternity Benefit Scheme). The program to participate in the same program is Rural Health Mission in EAG states and RCH II in other states.
If India is to achieve Millennium Development Goal 5 (MDG 5) by 2015, in addition to providing universal emergency obstetric care to every pregnant mother in need, it will have to tackle critical social and economic factors such as the low status of women, poor understanding by many families about health care, the cost of such care and also the low standard
The strategies to be adopted are
o Strengthen inclusion. Two important groups—poor women and adolescents—need to be directly involved in reproductive health services through geographic and household targeting and clearly focused outreach. Social and gender sensitivity among providers, managers and policy makers is necessary to achieve this inclusion, as well as the supply and demand improvements outlined below.
o Improve supply. Improving service offerings for all stages of the reproductive life cycle, for which integrating a core package and providing a client-centred continuum of care is a good approach. Four services have been particularly neglected and require further attention in this context: combating unsafe abortion, nutritional counseling and care, postnatal care and diagnosis and treatment of RTI/STI. Improving the availability and quality of female frontline health workers through recruitment and/or contracting, training, field support, and performance-based incentives would help meet many needs, while contracting for services and other client/provider payment systems could increase availability. care for poor women.
o Increase demand. Increase demand for several services that are provided but underutilized such as ANC, IFA, institutional delivery and family planning (although supply may be limited in some areas). In addition to ‘behaviour change communication’, demand-side financing is important to achieve this goal.
o Healthcare reform for reproductive health. As reforms are underway in the health sector, the provision and financing of reproductive health services deserves special attention. Reforms are needed in three areas in particular to support the above-mentioned approaches to improving reproductive health. Decentralized planning and resource allocation, human resource development, and improved financing are important for implementing targeting, integrating services, improving supply, client focus, demand generation, and effective outreach.
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