'Tracking and monitoring each high-risk pregnancy still a challenge’

In light of the recent maternal deaths in Karnataka, State Minister for Health and Family Welfare Dinesh Gundu Rao speaks with DH's Udbhavi Balakrishna on challenges and initiatives taken up by the government to promote maternal health.

In light of the recent maternal deaths in Karnataka, DH reached out to State Minister for Health and Family Welfare Dinesh Gundu Rao. In conversation with DH's Udbhavi Balakrishna, he discusses the high maternal mortality rate, challenges and initiatives taken up by the government to promote maternal health. 

Karnataka has the highest number of maternal deaths compared to other states in south India. What challenges persist in bringing this Maternal Mortality Ratio (MMR) down?

The state has achieved the sustainable development goal of an MMR less than 70, and the proportionate decline in MMR in Karnataka over the last 15 years is high compared to other southern states. Karnataka has seen a reduction of 109 points in MMR between 2007-09 and 2018-20.

Tracking and monitoring each high-risk pregnancy for timely management and follow-up is still a challenge. C-section rates have also been increasing over the past four to five years, and we have taken up measures to reduce this across public and private hospitals.

I’m also coming out with a new policy to have zero preventable maternal deaths and will be presenting it at the next cabinet meeting.

There reportedly has not been an audit of maternal deaths conducted since 2005 until this year. Why is this so? 

Maternal death audits have been conducted on a regular basis and the information of a maternal death is provided to the state within 24 hours. Based on the audits, districts and blocks with high MMR and gaps in human resources or equipment have been identified.

A facility-based audit is performed within a week after a death and a community-based audit is performed within three weeks. The technical audit of maternal deaths for the entire district is conducted monthly by the district health officer. The Deputy Commissioner conducts the audit of all maternal deaths once in two months and submits a report to the state. 

What is the standard operating procedure (SOP) in place to prevent maternal mortality in government hospitals?

As per the National Quality Assurance Standards (NQAS), Kayakalpa and LaQshya programs, SOPs have been developed for each delivery to provide quality antenatal, intra and postnatal services. These define the flow of care for mothers in hospitals to follow essential investigations, clinical protocols, standard treatment guidelines, manage complicated cases, and put up grievance redressal systems, including guidelines for conducting maternal and neonatal death audits by facility nodal officers.

How have you been able to fill the gap in the availability of gynaecologists and maternal health specialists in the government set-up? 

Concerted efforts have been taken to fill the gaps across the districts and taluk hospitals and CHCs under the regular cadre. Mother and child hospitals have been set up and additional human resources have been allocated for them. The National Health Mission enables filling posts in maternal and child health services under a contract basis. The state is able to provide MCH specialists in all district hospitals, 90% of all taluka hospitals and 50% of CHCs in Karnataka.

What are some of the programmes that have been initiated to aid maternal health in the state?

Several programmes are being implemented to reduce maternal mortality in Karnataka, including the centrally-sponsored Janani Suraksha Yojane, Janani Shishu Suraksha Karyakrama and the Pradhan Mantri Surakshit Matritva Abhiyan schemes. A National Midwifery Centre has been established at the Vani Vilas Hospital and three State Midwifery Training centres have been established at Mysuru, Belagavi and Bengaluru. Training is underway for midwifery practitioners to manage the normal deliveries in midwifery-led care units.