Maternal morbidity, a new problem in rural India

Rapid rollout of institutional child delivery in the last five years without adequate trained manpower in rural India has spawned a new problem of “maternal morbidity” in which women suffer from serious health consequences, claim public health specialists who alerted the government on the emerging crisis.

Women in rural India are suffering primarily because of the inability of people managing PHC centres to recognise clinical symptoms resulting in their failure in timely referral to a bigger hospital. Poor quality medical intervention and absence of even basic facilities like electricity in labour rooms further compound the problem.

Health ministry officials, however, argued that institutional delivery and improved family planning helped reduce an annual estimated 8 lakh maternal deaths in the last three years.  “Out of the estimated 24 lakh death averted in the last 3 years, more than 10 lakh deaths were in the age group of 15-19 years while the remaining were mothers above 35 years,” said S K Sikdar, deputy commissioner (family planning) in the health ministry.

“For every woman who die due to pregnancy related complications, there are 20 who suffer from acute and chronic morbidity, some of them are life-threatening,” K Srinath Reddy, president of Public Health Foundation of India told Deccan Herald.
Maternal morbidity includes obstetrics fistula, damage of the reproductive tract, loss of child-bearing ability after the first birth and uterine prolapse, a genital problem that comes from traumatic childbirth.

Risk factor

In addition, high diabetes, which often leads to bigger babies, and mental suffering also come under maternal morbidity. “Earlier the would be mother died at home or in between home and a health care centre. Now they die between a primary health centre and referral institution because the persons attending a PHC – many of them are Indian system of medicine doctors – have little training to recognise clinical symptoms,” Gita Sen, a professor at the IIM-Bangalore, and an adjunct professor at Harvard School of Public Health, said at a national consultation meeting on maternal health here on Wednesday.

While cities have on an average 9-13 doctors per 10,000 population, the number dips to 2-3 doctors in the countryside. Nurse density is down by one-third in villages compared to cities, according to Union health ministry December 2012 data.

Absence of easy access to blood banks in remote areas was yet another contributing factor behind maternal morbidity, the public health experts said, while stressing on the need to launch an audit to find out the extent of maternal morbidity.  “Without quality manpower, hurried roll out of institutional delivery policy has backfired. Babies are being delivered in PHC labour room without electricity connection,” said Abhijit Das, assistant professor at the University of Washington.

While the maternal mortality ratio improved from 254 in 2004-06 to 212 in 2007-09 per 100,000 live births, its still way above India’s target of 150 as per the Millennium Development Goals.