Safe motherhood, still a far cry

Expressbuzz.com, 15th October, 2008

Universalisation of safe motherhood might bring out cries of ‘impossible’ in Orissa but the fact is more than 50 per cent of the maternal mortality rate (MMR) in the State is avoidable.
The results of the first phase of implementation of Unicef’s maternal and perinatal inquiry and response (MAPEDIR) have brought to the fore the enormity of the prevailing maternal care indices, pointing out that more than half of maternal deaths are due to delay in obstetric interventions. The fact-sheet puts maternal mortality rate (deaths per lakh live births) in Orissa at 358 against 301 nationally and 194 in neighbouring West Bengal.
Data collected from the eight districts of Koraput, Rayagada, Malkangiri, Nawarangpur, Kalahandi, Nuapada, Balangir and Sonepur reveals that 67 per cent of the maternal deaths were from the Scheduled Tribe and Scheduled Caste population against 50-57 per cent nationally.
The report outlines high level of illiteracy among women in Orissa, poor maternal health care delivery apparatus, lack of all-weather roads, low propensity to bear the cost and above all no decisive role even on their own health as the cardinal factors behind high MMR. The need of medical care for pregnant mothers is decided either by husbands, mothers or mothers-in-law.
The belief that bleeding after delivery is a usual phenomenon proves fatal for most women as haemorrhage is a major cause of high maternal mortality in Orissa. Eclampsia, Sepsis and Anemia are also contributors.
The report also finds that households have not considered it important to seek formal preventive health care for these complications. Further, delays were encountered when women were referred to a second or third health facility often due to a lack of specialists or blood availability. Lack of blood was particularly acute and multiple referrals meant extra costs to families who could ill-afford them. The Unicef report also finds that many health centres don’t stock sufficient magnesium sulfate to treat the Eclampsia cases.
The report has outlined measures like the policy of free maternity beds and a voucher-based referral transport system in West Bengal, an obstetric helpline and referral transport system in Dholpur, Rajasthan, and a referral transport system linking remote villages to a health sub-centre providing 24x7 safe delivery in Guna as worthy instances to emulate.