CWOB: Maternal Health Care in India
“Forty seven percent of maternal deaths in rural India are attributed to anemia and hemorrhage, causes that are very much avoidable.” - WHO (2006)
If you are looking for information related to maternal health care in India, you have come to the right place. Below you will find information regarding:
- Behavioural Prevention
- Maternal Risks
- Identifying Maternal Health Problems
Due to existing negative social determinants of health and a failing public health system in Uttar Pradesh, behavioural prevention is paramount to keep oneself healthy. There are several basic hygienic principles that help prevent illness and disease. These behavioural tips can help keep a mother healthy and safe during pregnancy, as maternal mortality is a severe threat for women in India. Here are some tips for behavioural prevention and general cleanliness:
Assuming a woman has become pregnant wishfully, the following actions can help reduce maternal mortality:
Mothers must take every precaution during their pregnancy to ensure proper health for themselves and for their baby. If a woman has become pregnant unwillingly or wishes to terminate the pregnancy, a safe and clean abortion is the best option. Do not resort to inducing abortion by yourself, as it can lead to many infections, bleeding, and death.
Throughout a pregnancy your body will react and feel differently than normal. There are several things that occur, that are normal for women during pregnancy. However, you must be cautious and address these issues as such:
External Prevention Assistance
In addition to preventative care on behalf of the expecting mothers, it is also important to have partisan and non-partisan support behind the issue. As a result of high incidences of maternal mortality, both the government of India and non-governmental organizations have initiated programs focused on reducing maternal mortality.
In 2005, the program Janani Suraksha Yojana (JSY) was initiated by the government in order to reduce neonatal and maternal deaths. The program gives cash as an incentive for mothers to give birth in a facility. Money is given to health workers and families in order to encourage childbirth in clean, safe health facilities.
While results vary state to state, 7 per cent of pregnant women in Uttar Pradesh received JSY payments and up to 44 per cent in other states. Data also shows that the majority of deaths that were prevented were perinatal and neonatal and there was little affect on maternal mortality.
Another program initiated by UNICEF in 2004 was the "Womens Right for Life and Health" project which targets poor women and children, ensuring they receive health care. The goal of the project is to "provide early detection of health risks and immediate treatment of pregnancy-related complications by competent and qualified personnel" (UNICEF 2004). Results show an increase in the use of health facilities by women and an increase in the delivery of births attended by skills attendants.
A third program addressing maternal mortality is an NGO called Save a Mother. The organization works within Uttar Pradesh to educate women about pregnancy, nutrition, and immunization. Data from May 2009 to June 2011 shows a significant decrease in maternal mortality and neonatal deaths. Maternal mortality has been reduced by 91 per cent while neonatal saw a reduction of 57 per cent.
For a full, unabridged report on behavioural prevention for maternal health care, please help yourself to the following downloadable, printable PDF document:
If you would like a printable, downloadable PDF version of this section of the site (Risks of Maternal Health in India), please feel free to download the document provided below:
Risks of Maternal Health
The state of maternal health in India is dire. Globally, India contributes more than any country to the maternal death rate. In fact, one quarter of global maternal deaths occur in India. It is estimated that 68, 000 women die annually due to poor maternal health in India. Within the country, India’s highest reported mortality ratio is in Uttar Pradesh - the country’s most populated state.
However, it is important to note that the medical causes of maternal mortality are primarily preventable. Socio-economic risk determinants are the reason why so many Indian women die of "very much avoidable causes". Lack of access to quality antenatal care and emergency obstetric care are barriers to good maternal health.
In India the onus is on the patient to pay for health care, which ultimately proliferates maternal mortality. Many Indian women cannot afford to have a delivery in the hospital. Consequentially, most women have home deliveries. Delivery without skilled birth attendants place women at even more risk for mortality.
Unfortunately, even if women are in fact able to access health care centres, other factors (such as the quality of these centres) put women at risk for maternal mortality. For example, a lack of available resources that are necessary to perform basic prenatal tests. Moreover, there is a lack of skilled staff. On a national and state level, poor management of maternal health has created poor quality services for maternal health.
Illiteracy is another socio-economic determinant of maternal health. The literacy rate of women in the reproductive age group of 15-49 years old is only 55 per cent. This has profound effects on maternal health because illiteracy deters a woman's ability to seek help during maternal and neonatal emergencies. Though educated women are more apt to seek out maternal health care when needed, disempowerment of other Indian women is a fatal risk for maternal health. Illiteracy and poor social status give women little control over their health care during pregnancy.
Even if knowledge were perfectly symmetrical and rural women knew of the services available to them, a lack of physical access (especially during an emergency) and insufficient funding continue to plague rural areas of Uttar Pradesh to the detriment of maternal health outcomes.
Broader gender issues also impact maternal health in lasting and important ways. Though males are traditionally less involved in reproductive health issues, they have more say in the host of choices surrounding reproductive health than women. It is this pervasive unequal power dynamic that continues to exacerbate poor maternal health outcomes, in which men frequently display ignorance, ambivalence, and a lack of concern for women's health.
In what is a commonly male dominated society, moving towards gender equality and engaging men in the pregnancy process can hold positive outcomes for maternal health in rural Uttar Pradesh.
The principle medical causes of maternal death are attributed to the following factors:
The socio-economic determinants of maternal health in rural Uttar Pradesh are wide-ranging and the products of various institutions, norms, and geographies. Such diverse impediments to maternal health underscore the need for village health care workers as knowledgeable, engaged, and helpful members of their communities, able to help address maternal health complications as well as the broader socioeconomic and gender determinants at their root.
If you would like a full, unabridged version of this report on maternal health care in India, please help yourself to this downloadable, printable PDF document:
If you would like a printable, downloadable PDF version of this section of the website (Risks of Maternal Health in India), please feel free to download the document listed below.
Identifying Maternal Health Problems
Although most complications leading to maternal and infant death are detectable and preventable in a developed country setting, it is not the case in Uttar Pradesh. This is due to a large variety of socio-economic factors that limit the quality, accesses, and availability of both basic and emergency maternal and infant health care.
There are widespread and disproportionate shortages in the health care sector, with a concentration of health care workers in urban areas, often due to the refusal to work at a village level which is lacking in social and medical infrastructure at rural facilities. With a lack of government funding of public health care, the majority of the health care costs are a burden to society, causing an increased impoverishment of 2.2 per cent of the population annually.
But even when there have been increases in government funding and more doctors in rural areas, there continues to be a low utilization of women's health care services due to the social context in India where pregnancy is not considered to require any special medical attention. As well, reflecting the lack of power women have in the household, 41 per cent of women do not seek out antenatal care because their husband, or their mother in law, did not think it was important or did not allow the women to access the care that was available.
Traditional beliefs in India also limit the proper utilization of maternal and infant health care, where even in emergency situations, women will not leave their home during the early postpartum period to protect themselves form contamination. Due to cultural taboos and lack of awareness, only 55 per cent of infants are exclusively breastfed up to 4 months, which is a contributing factor to over 50 per cent of child deaths due to malnutrition. Both high levels of illiteracy and young age of marriage in rural areas contribute significantly and negatively to maternal and infant health.
The preference for sons due to cultural and economic factors leads to unsafe abortions, as well as an increased death rate for female infects due to neglect.
Problems In Context: Uttar Pradesh
Looking specifically at Uttar Pradesh, the following are direct barriers that will hinder the identification of issues and preventative measures for maternal and infant health:
Most complications that lead to maternal death are avoidable as health care solutions are well known, but it is the lack of access to antenatal care and support after childbirth which contributes to high rates of mortality.
In order to identify health challenges we must break down the conditions and what can be done to prevent or manage complications before, during and after pregnancy.
Planning and First Trimester
Prior to pregnancy or in the initial stages of pregnancy, family planning is necessary to combat issues or questions of safe pregnancy practices such as maintaining a healthy diet, as well as any inquiries surrounding abortion. It is important that men be equally included in all parts of the family planning process to ensure a safe foundation to raise a child. At this stage, it is necessary to address what pregnancy means in terms of changes in the menstruation cycle, bodily changes, morning sickness and what are normal pains versus what are indicators of more serious complications.
Asking about the medical history of the patient is important to address any history of sustained illness which may affect and or hinder a healthy child birth. A urine test can be used to determine pregnancy, which can be done easily in low-resource settings rather than trying to gain access to a health clinic.
Second and Third Trimesters + Recovery
Throughout the trimesters blood pressure should be taken frequently, in which readings of 140/90 can be considered abnormal. Prenatal exercises/activities should be encouraged to ensure a healthy birth. During labour/birth close attention needs to be attributed to timing contractions, whether or not the water breaks or needs to be broken by the village health care worker and whether there are increases in blood pressure.
Furthermore, the place where the delivery takes place needs to be sanitized and hygienic in order to ensure a healthy birth. Post birth is an important stage in terms of further family planning and how to properly care for the baby, addressing any post-haemorrhaging, and the full recovery of the mother.
Although many maternal and infant health complications are preventable, their treatment and identification is often limited in rural areas of Uttar Pradesh due to a lack of funding and a variety of complex socio-economic factors. If a village health worker is aware of these barriers, they can understand their limits and provide referral recommendations and proper planning at the early stages to avoid emergency situations that they do not have the resources or skills to attend to.
Furthermore, it is also important to prevent unwanted and too-early pregnancies, which is why there is such a heavy importance placed on the use of family planning as abortions are the third leading single cause of maternal mortality.
Continuous contact with the health care system is useful for detecting and treating conditions such as:
If you would like a full, unabridged version of this report on maternal health care in India, please help yourself to this downloadable, printable PDF document.
If you would like a printable, downloadable PDF version of this section of the website (Identifying Maternal Health Problems in India), please feel free to download the document provided below:
Emergency Procedures Checklist
To download a copy of the emergency procedures checklist, you can find it listed below in PDF format. To view the complete checklist in simple text format, please click HERE.