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Need to promote safe motherhood

Last Updated 27 May 2009, 17:37 IST

The recently announced programme that aims at promoting safe delivery by the deprived women in Karnataka’s seven backward districts has been prompted by the Gujarat government’s Chiranjeevi Yojana (CY) that envisages encouraging safe and reproductive child health (RCH), health services and advancing services like maternal and neonatal mortality. Over the past two decades, a number of international funding agencies, including the Unicef and the World Bank invested enormous technical and financial resources to bring down maternal/infant mortality. These steps have met with little success.

Part of the reason for the failure of such programmes is we do not learn from ground realities on how mothers and families tackle RCH. The latest Unicef report on the State of the World Children 2009 (SWCR-2009) says “India’s maternal ratio stood at 450 per 100,000 live births in 2005, while the neo-natal mortality rate was 39 per 1000 live births in 2004.

Although India’s economy grows rapidly, disparities in health outcomes between income groups and between caste and social groups continue to widen. Growing inequities, combined with shortages in provisions of primary health care and the escalating cost of care are complicating the country’s efforts to meet the health-related Millenium Development Goals.”

In Gujarat, CY’s private-public partnership model is based on cash incentives for mothers to approach approved hospitals for delivery. In all states, hospital deliveries are not even 70 per cent and the presumption is that if mothers are given cash incentives it will promote safe deliveries as well as protect the new-born. This is absurd to say the least. Years back when Unicef launched what was called the baby-friendly hospitals very few mothers availed of the services because of bad behaviour on the part of the hospital staff and poor quality of nursing care.

There is a mistaken belief among health policy-planners that cash incentives to promote safe deliveries will work. Over the years, traditional birth attendants (TBAs) and community health workers have saved many lives. Even WHO has recognised the services of TBAs. A large number of BPL families depend on the TBAs because they are the first line of contact for pregnant mothers in the hinterland. The first hour, the first day and the first month are crucial for the survival of both the mother and the new born and, in a typical Indian village, the TBA is available on call. The village folks have a traditional relationship with the TBAs who are trusted more than any ANM or government hospital gynaecologist.
WHO believes in effective training for the TBAs. By observing five simple Cs -- clean delivery place, clean hands, clean cutting of the umbilical cord, clean bath and clean thread) many delivery-related complications can be avoided at the household level. Only those complicated cases, such as neonatal sepsis  or post-partum haemorrhage, can be taken to the hospitals. According to SWCR-2009, new data from Bangldesh show that a home visit on the first or second day after birth can reduce neonatal deaths by two-thirds, with late visits being less effective.

Good chain of referrals

Karnataka has a good chain of referrals from the village sub-centre to the primary health centre to the referral hospitals. By effectively using TBAs at the village level neonatal and maternal mortality rates can be reduced. The TBA could get her cash incentive if she promotes safe delivery at the mother’s home. What is crucial is not where the delivery takes place, but the safe delivery procedure.
In the information age, a “doctor in your pocket” has several advantages. South Africa’s MTA mobile phones have been effectively used by a KwaZulu-Natal health centre in sending out HIV/AIDS-related messages and counselling, making patients more forthcoming in seeking diagnosis, including testing.

In Karnataka, mobile telephony has penetrated the villages. The Rockefeller Foundation, which has supported this initiative in South Africa, says that “mobile phones enable multi-directioal flows of information in even the most remote parts of the world. They have the power to transform health care.” The traditional roles of doctors and nurses is now changing and patients (including village mothers) are getting more smart to seek help from anywhere and anytime.

Karnataka could take the lead in promoting the ‘bhagya’ of our ‘tayis’ by using existing health traditions of TBAs and modern information technologies.

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(Published 27 May 2009, 17:37 IST)

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