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Archives for : Maternal death

Historic UN Maternal Death Case – Brazilian Government gives Monetary Reparations #Goodnews

BRAZILIAN GOVERNMENT GIVES MONETARY REPARATIONS AS PART OF HISTORIC UNITED NATIONS MATERNAL DEATH CASE

03/25/2014 – (PRESS RELEASE) In a ceremony today, the Brazilian government gave monetary reparations to Maria Lourdes da Silva Pimentel, the mother of Alyne—an Afro-Brazilian woman who did not receive immediate medical attention for her pregnancy complications and later died. The reparations are part of the first United Nations ruling on human rights violations in her maternal death case.

 

Almost three years after the U.N. Committee on the Elimination of Discrimination against Women (CEDAW) declared Brazil responsible for the death of Alyne and called on the state to provide access to quality maternal health care without discrimination, the Brazilian government provided her mother with reparations and will place a plaque telling Alyne’s story on April 3, at a maternity ward in Nova Iguaçu Hospital that was renamed in Alyne’s honor last year.

 

“All women have a right to the best maternal health care when they need it—regardless of where they live, their income, or their ethnic background,” said Nancy Northup, president and CEO of the Center for Reproductive Rights. “Yet more than 4,000 Brazilian women die from pregnancy complications every year—most of which could be prevented if only timely medical care was accessible. Brazil must not only improve maternal health care for women like Alyne, but also commit to ending the deeply seated discrimination poor and Afro-descendent women face when seeking medical treatment in their country.”

 

Alyne, a 28-year-old Afro-Brazilian woman, was six-months pregnant with her second child when she was admitted to the private Health Centre Belford Roxo complaining of nausea in November 2002. Although she presented signs of a high-risk pregnancy, she was discharged without any medical treatment. Two days later, she returned to the private clinic in even worse condition. Doctors discovered that the fetus was no longer viable and removed it, but Alyne’s health continued deteriorating. It took more than eight hours to get an ambulance to take her to Hospital Geral de Nova Iguaçu—where Alyne then suffered more than 21 hours of additional delays before she was finally given medical treatment. She later slipped into a coma and died on November 16, 2002—five days after she initially sought medical attention.

 

The Center for Reproductive Rights and Advocacia Cidadã Pelos Direitos Humanos submitted a petition on behalf of Alyne’s family before CEDAW in November 2007—the first maternal mortality case brought to the human rights body. In 2011, the committee declared Brazil responsible for violating Alyne’s human rights and ordered the state to provide individual reparations to her family and implement general measures to prevent maternal deaths.

 

“It is beyond shameful and inexcusable that doctors and hospital officials repeatedly denied Alyne the very medical attention that could have saved her life,” said Mónica Arango, regional director for Latin America and the Caribbean at the Center. “Today the Brazilian government has taken an important step towards righting this terrible wrong by providing these long overdue reparations to Alyne’s mother. But it’s time for state officials to expedite the additional financial reparations for Alyne’s daughter, and finally prioritize meaningful public policies that will improve and guarantee maternal health care for all women.”

 

On February 28, 2014, the CEDAW Committee backed an agreement between the Brazilian government and the Center for Reproductive Rights, representing Alyne’s family, on the monetary compensation that was given to Maria Lourdes da Silva Pimentel. The individual reparations for Alyne’s daughter are still pending. The CEDAW Committee also underscored that the follow up dialogue would continue regarding the other recommendations, particularly the reparations for Alyne´s daughter and the general recommendations to improve quality maternal healthcare for all women in Brazil.

 

According to the World Health Organization, approximately 800 women die every day worldwide from pregnancy complications. Brazil accounts for a quarter of all maternal deaths in Latin America and 90 percent of them could be prevented with prenatal care. Although Brazil has reduced its maternal mortality rate in the last decade, maternal mortality remains the leading cause of death among women of childbearing age, disproportionately affecting low-income, Afro-Brazilian, indigenous women, and those living in rural areas and the Brazilian North and Northeast.

 

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#India – One woman doctor for entire district of Mewat #Believeitornot

Aditya Dev, TNN May 16, 2013,
GURGAON: There is an acute shortage of doctors in government hospitals of Mewat. Surprisingly, the district with the worst maternal mortality rate and infant mortality rate, there is only one woman doctor available for the whole of Mewat. However, the apathy could be judged by the fact that the gynecologist has joined the health department only about 10 days ago.

The institutional delivery rate in Mewat is 42% implying only 42 out of 100 deliveries take place at hospital. A health official said these deliveries are done by staff nurses in absence of doctors. Sources said the health institutions are in a bad shape with two of the three community health centres (CHCs) at Punhana and Ferozepur Jhirka in the districts are without senior medical officers (SMOs) for a long time. In their absence, medical officers (MOs) have been made incharge of these CHCs.

Moreover, instead of two medical officers at each of 10 primary health centres (PHCs), there is only one medical officer appointed at present, said sources.

At CHC, Nuh, against the staff postings of 12 medical officers (MOs) and one SMO, there are only 3 MOs and one SMO are deputed.

The population of Mewat is 11 lakh and out of that 5.5 lakh alone lives in Nuh. In such a scenario, the medical facilities are too little to provide any kind of service to residents. A health official said the burden could be gauged that there should be one CHC over a population of 1.2 lakh. There is also a shortage of ASHAs (Accredited Social Health Activists) in the district. ASHA, a trained female community health activist from the village itself who work as an interface between the community and the public health system, plays an important role in providing key services to mother and child and spread awareness. A health official informed that out of 1,200, only 500 are available in Mewat.

This is when the criteria of appointing an ASHA was relaxed from class VIII literate to just any woman who can carry basic duties. Even after that we have not been able to fill the postings, the official added.

When contacted, BK Rajora, chief medical officer, Mewat, said, “There is a shortage of doctors, but the government gives priority to their appointment in the district. The problem is that many of them do not join here even after appointment. What can one do in such a scenario? Doctors do not want to come because of basic living facilities in Mewat.”

The government is also providing difficult area allowance to doctors posted in Mewat, Rs 25,000 per month for specialist and Rs 10,000 per month for other doctors.

Rajora added that besides one gynaecologist joining the office, four doctors have been given training in this field and providing emergency services. There are 53 MOs available out of 79. Almost 50% of positions are filled.

 

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Maternal Health Activist Madhuri of JADS arrested #Vaw #Tribalrights

 

English: National Rural Health Mission of India

English: National Rural Health Mission of India (Photo credit: Wikipedia)

 

Five Years of NRHM-JSY and more than a decade of RCH: continuing maternal deaths in Barwani and MP
Background
Janani Suraksha Yojana (JSY) was launched under the National Rural Health Mission (NRHM) in
April 2005 as a safe motherhood intervention, with the specific objective of reducing maternal and
neo-natal mortality by relying on institutional delivery as the primary strategy for making available
medical care during pregnancy, delivery and post delivery period, and thus promoting safe
motherhood. All women are encouraged to avail institutional care during pregnancy and delivery,
and through ASHAs recruited specifically for this purpose institutional delivery is being promoted
among poor pregnant women. JSY is a 100 % centrally sponsored scheme, and it links cash
incentives to pregnant women with hospital delivery and post-delivery care. Reproductive and
Child Health (RCH-I) has been operational since 1997 as a project to provide a variety of
reproductive and child health services in rural areas to bring down maternal and infant mortality, in
order to reduce fertility rates and achieve population control. The second phase of the program
(RCH-II) also commenced in 2005. NRHM itself was launched with the promise to improve
availability and accessibility to health care services to the rural population, especially the
disadvantaged groups including women and children, by strengthening public health systems for
efficient service delivery, improving access, enabling community ownership and demand for
services, enhancing accountability and promoting decentralization.
It is against this context of programmes and interventions and associated fund flows from
the central government and several international agencies that one needs to view the status of
public health services, of maternal and child health in the country in general and specifically in the
high-focus states like MP, and the developments in Badwani that is the focus of this report.
Mass protest against maternal deaths in District Hospital, Barwani
On 28th December 2010 a rally was held in Barwani town, the headquarters of a predominantly
adivasi district in south-western MP. Nearly a thousand people gathered under the banner of
Jagrit Adivasi Dalit Sangathan (JADS), a mass organisation, to protest against extremely
negligent treatment of women in pregnancy and labour, particularly the death on 29th November
2010 of Vypari bai, an 8-months’ pregnant woman admitted in the District Hospital.
The people had come for this rally
from far-flung adivasi villages of the
district, and sought to draw attention to and
to protest against extreme callousness and
ill-treatment regularly meted out to women
in pregnancy and labour by the public
health system, particularly the District
Hospital (DH). A quick perusal of the DH
records indicated that between April-
November 2010 there had been 25 maternal
deaths, and 9 maternal deaths had been
recorded in this hospital in the month of
November 2010 alone. In addition, deaths
of 21 neonates (within 24 hours of birth) had been recorded, related to 511 deliveries conducted
in the hospital during November 2010. People complained that women with problems during
pregnancy and labour were frequently referred to Indore Medical College Hospital, located 150
kms away, despite the DH being supposed to deal with such cases.
The tragic story of Vypari bai – ‘institutional death’ instead of ‘institutional delivery’
Vypari bai, a 22 year old woman had travelled over 55 kms from her village Ban since the
morning of 27th November 2010 to reach the District Hospital, having been referred from the
PHC at Bokrata, and then from the CHC at Pati. She had been carried in a `jhuli’ (cloth sling)
over the first 10 kms from her village to Bokrata, from where the family managed to get the
Janani Express ambulance. She had experienced a convulsion that morning, and had high blood
pressure (BP) and eclampsia at the time of admission in the DH around 1.30 pm on 27th
November.
Following her examination by a gynaecologist at the time of admission in the DH on 27th
Nov., she was visited only once by another doctor during the entire day on 28th Nov. She had been
prescribed medicines after admission to control her BP, but her treatment sheets show only two
measurements of BP during the entire stay from 27th to 29th Nov. No attempt seems to have been
made to deliver the baby, by either induction or cesarean, as is the standard procedure in such
cases. An ultrasound scan on 28th November (for which the woman was taken by auto-rickshaw to
a private centre even though the hospital has this facility) showed the presence of live foetus.
Both the mother and mother-in-law of Vyparibai are trained health workers, presently
working as ASHAs in the NRHM. The mother-in-law Dunabai in desperation attempted to contact
the gynaecologist, who never turned up to see the patient in spite of repeated pleas from the
patient’s family. Moreover the doctor on duty, after checking the patient only once on 28th, was
also absent from the hospital premises. After repeated efforts to contact her, at late night at around
11 pm on 28th November, she instructed the nurse on duty that the relatives could take the patient to
Indore, but did not bother to examine the patient or modify the treatment. When the family went to
the doctor’s residence (which is within the hospital premise at a stone’s throw from the ward) on
28th night to ask her to attend to the woman as she was in great pain, the doctor refused to go,
saying she would phone the instructions to the nurse. The young woman finally breathed her last at
5 am on 29th November 2010, without medical attention despite being admitted in the District
Hospital.
Both the block CHC and Barwani DH are CEMONC (Comprehensive Emergency Obstetric
Neonatal Care) centres, and the DH is equipped with a Blood Bank. Such centres are supposed
to provide emergency services related to pregnancy/ delivery round the clock and 365 days a year.
In any case, a hospital at the level of district hospital is supposed to provide emergency services at
all times, whether or not it is a CEMONC. Further, there is provision that in case of complications,
CEMONC centers can contract-in services of private medical practitioners. So she could have been
referred under the ‘Janani Sahayogi Yojana’ to one of the two local private hospitals. The DH has
four gynaecologists and two anaesthetists, who could have ensured Vypari bai’s delivery. However,
the case paper shows that nearly 35 hours after admission, the patient had been referred to the
medical college hospital in Indore at around 11 PM on 28th. Further, the family was asked to sign
an undertaking, stating that they were refusing to take her to Indore and they took responsibility for
the consequences. It has been repeatedly experienced that, rather than using the institutional
provisions, patients are generally referred to Indore. And are also made to sign such undertakings.
Several other cases of denial of services leading to complications and ill-treatment at all
levels of health services have been documented by JADS. Few illustrative ones are described
below.
District Hospital, Barwani – Baltabai, 20 years, Village- Ubadagad, Pati Block,
On 6th June 2010, 9-months’ pregnant Baltabai was taken to Pati CHC with labour pains, by bus at around 12
o’clock in the afternoon. There was no doctor in the CHC. When the family contacted the BMO and
requested him to see Baltabai, the BMO did not do so, but simply arranged for the Janani Express
Ambulance and referred the patient to the District Hospital. Around 3 PM Baltabai was admitted in the
female ward of the DH. Not a single doctor was present in the female ward, ostensibly because `it was
Sunday’. The nurse on duty informed the doctor who was supposed to be on duty, but was not physically
present in the hospital premises, about the serious condition of Baltabai. She was advised some blood test,
and after the blood report was available, referred by the doctor to M.Y. Hospital, Indore. During this period
the relatives were not adequately informed about the condition of the patient and need for referral. What is
more serious is that the family was not informed about intrauterine foetal death. Following the nurse’s
advice to go to the local hospital instead of Indore, the family took Baltabai to the private trust hospital in
the Barwani town, where the doctor examined Baltabai and informed them that the foetus was dead. She
recommended an emergency operation to remove the dead foetus and save the mother. The family had no
option but to go ahead with this surgery. They incurred a cost of around Rs 10,000/- and an additional Rs.
7000/- were spent on medicine. The family, dependent on daily-wages, had to borrow money from local
money lenders at very high interest rate.
On 14th June Baltabai was discharged from the trust hospital. However, her agony was not
over yet. On reaching home that evening she complained of abdominal distension and pain. On 15th
June, at 4 am she was taken to a private practitioner, where she was cathetarised, and again referred
to the DH, where she was treated till 21st June. On 21st June Baltabai was referred to M. Y. Hospital
Indore for treatment of paraplegia. What exactly happened to Baltabai from15th – 21st June is not
very clear, largely because there are no trustworthy clinical records. Why and how Baltabai
developed paraplegia was never explained to the family members and other concerned people.
Fortunately Baltabai’s condition improved in the M.Y. Hospital and she was subsequently
discharged on 1st July. The ordeal of Baltabai lasted for 24 days (6th June to 30th June), and has left
the family severely indebted.
In September 2008 a woman in labour at the District Hospital was referred by the attending
doctor to Indore as a case of obstructed labour. The family took her to the local Trust hospital,
where a caesarean operation was performed and the child delivered safely. However, due to the
delay the child developed complications and had to be admitted in the neo-natal intensive care unit
(NICU) in the DH.
CHC-Pati block – Meera, Patel phaliya , Pati
Meera had symptoms of threatened abortion since the second month of pregnancy; and was treated
at CHC, Pati. However, the doctor advised her that she should not rely on the medicines available
in the hospital, and made the family purchase injections and medicines from outside the hospital,
worth about Rs 1000-1200. Meera followed all the instructions given by the doctor, as she was told
that she would have a difficult labour. Despite this treatment Meera had intrauterine bleeding one
morning. When she called up the CHC for the Janani Express ambulance she was told that since
she was from Pati itself, she should go to the hospital by herself, and would not be provided the
ambulance. The lady walked over 5-8 km, for almost 2 hours, bleeding and in terrible pain, to reach
the CHC. At the CHC, she was informed that the baby had died in the womb. The family was
forced to purchase few special medicines from outside for the operation to remove the dead foetus.
PHC Menimata – Baniya Bai
On the night of 11th November 2008 Baniya bai went to the PHC Menimata for delivery. The
compounder and nurse asked her family for Rs 100, which the family did not give. The next
morning she was forced to leave the hospital on grounds of being anaemic. Baniya Bai, in
labour pain, managed to crawl out to the road outside the PHC, where she delivered with the help
on the local dai. She was then sent by members of JADS to CHC Silawad by the Janani
ambulance.
These are not isolated cases; there are reports of similar incidents of maternal deaths and
denial of treatment at the health centres, including the DH in Barwani.
Demanding Accountability for Negligence
We were visiting Barwani to get a firsthand
account of the situation there
concerning health services, particularly
in the District hospital. On the morning
of 28th December when we tried to meet
the CMHO and the concerned lady duty
doctor (who happens to be the CMHO’s
daughter) we were told that they were
out of town. The gynaecologist who had
admitted Vypari bai on 27th November
said she had anemia and eclampsia and
was not in a condition to be operated
upon; and that they did not have a
ventilator in the hospital. This
gynaecologist was not around the day
after admission (28th November) to monitor the progress; she is usually out of the hospital four
days of the week performing sterilization operations in family planning camps.
We observed the rally taking place outside the DH on 28th December. About 500 people
(nearly half of them women) had gathered at the entrance of the DH at around 12 noon, by which
time the OPD was almost over. The 2-3 doctors present there left when they heard the rally
approaching. The police tried to snatch away from the rallyists their microphone and the cart on
which it was placed; however the rallyists managed to convince them that they would leave very
soon. About fifteen minutes later the people moved away from the hospital premises and
continued their dharna on the road in front of the Collectorate office, well away from the DH.
Several activists and ordinary village women, including the mother-in-law of the deceased
Vyaparibai spoke of their travails at the DH. A set of 22 issues concerning the District hospital,
which were mentioned in the memorandum of demands, were read out to the assembled people.
The Civil Surgeon was asked for, but he refused to come out to receive the petition; finally the
ADM came and just gave a brief assurance that the issues would be responded to in writing in 15
days time. By around 4 PM the rally had dispersed.
Response by the administration – ‘the message is secondary, crack down on the messenger’
We met the Collector on 28th December evening after the rally and apprised him of the state of
affairs in the DH. It emerged that the process of carrying out maternal death reviews had not
been carried out in case of any of the 25 maternal deaths. During our meeting with the Collector,
the CMHO and CS came when they were summoned. According to the CMHO such maternal
deaths keep occurring, that women here were very anaemic, and it was ‘not possible to bring
them down to zero’. When pointed out that the DH was a CEMONC centre, that there were 4
serving gynaecologists and 2 anaesthetists, and it was enquired why such institutional deaths
were still taking place, there was no satisfactory response. The Collector appreciated our
bringing things to his notice, and said he would initiate
the task of Maternal Death Reviews. At the same time,
he also hinted at linkages of the mass organisation with
‘Bastar’ and ‘Andhra Pradesh’, thereby seeking to
discredit the people’s organisation as being associated
with the ‘Naxalites’, who have been outlawed by the
central government.
We are now extremely shocked and dismayed
that two days after this rally (on 30th Dec.) as per local
press reports, the police has foisted several charges on
the leaders of JADS and 200 people who participated
in the protest. They have been charged with Sec 146 of
IPC (unlawful assembly, rioting, armed with deadly weapon which when used is likely to cause
death), Sec 186 IPC (obstructing public servant in discharge of public functions), and Sec 16(3)
of MP Kolahal Rules. On 31st December one of the activists of the organisation, Bachhiya bhai,
was arrested and sent to jail on charges that were slapped on him and others in 2008, when they
had protested against the denial of services in PHC Menimata (described above).
It needs to be mentioned that the pilot phase of community-based monitoring of rural
health services in MP under NRHM had been implemented in Barwani during 2007-08. Even
prior to this the mass organisation JADS had been actively addressing the health problems in the
area in several ways. In May 2008 a three-day programme of monitoring of services at the CHC
Pati and dialogue with health officials (with the intention to improve them), was followed up
with a rally at Barwani town on the dismal state of health services in the DH. So the area has a
history of peaceful rallying for improvement of rural health services. However, there seems to
have been hardly any concerted response from the administration to address the genuine
problems faced by and raised by the people.
Is the situation restricted to Badwani?
The situation regarding maternal deaths seems to be similar in many other districts of MP. The
audit report of NRHM in MP by the CAG gives an idea of the serious situation in the state.
According to the CAG audit report for the period 2005-06 to 2008-09 incidences of maternal and
infant deaths in MP remained high. In the 12 districts surveyed for the audit there had been 1377
maternal deaths in all in the four-year period – Betul recorded 152, Bhopal 269, Indore 162,
Shahdol recorded 393, Dhar recorded 125, Ujjain 124, and so on. Shahdol district reported 55
maternal deaths in 2008-09. The audit report also points out that despite increase in number of
institutional deliveries, post-delivery mortality remained alarmingly high. The Maternal Mortality
Rate remained high at 379 per lakh live births. Interestingly, the state government has fixed a
lower target than that of the central government for reduction of MMR and IMR. While NRHM
envisages MMR of less than 100 per lakh live births and IMR of 30 per 1000 live births by 2012,
the MP government has set these at less than 220 and 60 respectively. It has said that due to
shortage of manpower it was not possible to achieve the NRHM targets! The audit also found that
Maternal Death Review Committees were to be constituted at each district, but had not been done.
A large number of neo-natal deaths also seem to be occuring: according to figures (collected by
RCH – NRHM for monitoring and evaluation) between April-November 2010, there were 154 neonatal
deaths in the entire district of Badwani, of which 133 have been recorded at the District
Hospital (3879 deliveries recorded at the DH in the same period).
Some other findings of the CAG audit indicate that even after four years of NRHM the
state government was not taking adequate measures to address the long-standing problems of
lack of basic medical facilities, lack of physical infrastructure, and of doctors and other staff.
For instance: the number of health centres fell short of the prescribed norms; several centres,
particularly sub-centres were functioning without buildings; none of the institutions had been
upgraded to Indian Public Health Standards (IPHS); of the 82 CHCs designated as first referral
units (FRUs) 80 percent were non-functional and the rest were only partially functional. The
state government itself acknowledged that the health centres are non-functional due to shortage
of man-power. 101 out of 297 PHCs in the 12 districts studied were running without doctors,
despite the provision for hiring contractual staff under NRHM. Monitoring Committees too at
state and at lower levels to review the activities under NRHM had not been formed till 2009.
One also finds that several hundreds of crores of rupees have been spent over the past few
years under RCH-JSY. Government reports show that the allocations for RCH-JSY had increased
since 2005, and expenditure too had increased from Rs 26.29 crores in 2005-06 to Rs 344.87
crores in 2008-09. By 2009-10 Rs 797.65 crores from NRHM funds had been spent on activities
to improve maternal and child health.
Issues and Concerns
We wish to draw attention to the grave situation that seems to be building up in places like
Barwani. It is now more than a decade of RCH and five years since NRHM, RCH-II, JSY etc,
were launched as flagship programmes. On one hand, the government is spending several
hundreds of crores of rupees annually, is vigorously promoting institutional deliveries as a
panacea for high maternal and infant mortality, and talks of safe and guaranteed health services;
through processes such as community monitoring it is promoting the idea of demanding
accountability from the public health machinery. On the other hand, the ground reality in places
like Barwani shows little change. And when people get organized to demand accountability
through peaceful actions, attempts are made to discredit and ‘brand’ their leaders, to intimidate
and repress them, and to shield the responsible officials who seem to be to completely indifferent
to the plight of the patients.
One finds that in spite of several interventions and expenses of crores of rupees, women
continue to die in large numbers. Majority of these deaths are avoidable and completely
unacceptable. It is precisely these preventable deaths that JSY claims to address, right from
ante-natal care (ANC) to post-delivery care of mother and new-born, by getting the pregnant
women to register soon after pregnancy and `motivating’ them to go to a hospital for delivery.
However, the ground reality indicates that the government is not improving the `health’ of the
health facilities in order that they treat satisfactorily women in labour, especially those with
complications. This is corroborated by the findings of the audit of the performance of NRHM in
MP. The experiences of ill-treatment narrated by the rural women also point to the apathy of the
doctors and the poor quality of care they receive when they come in pain and suffering.
How many more such `institutional deaths’, complications and denial of services, are to
occur before the hospital doctors become responsible and accountable; before the state health
department, the health ministry, the rogi kalyan samitis, the district health societies, the
numerous managers, planners, consultants, and international agencies look beyond their
ritualistic exercises of working on technical assistance, planning, evaluating, re-evaluating, replanning,
merely recording numbers of pregnant women registered, of institutional deliveries and
of beneficiaries etc., in the name of safe motherhood and child health, and seriously take note of
the reality of the deaths of women and infants?
Dr Abhay Shukla – National Joint Convenor, Jan Swasthya Abhiyan
Dr Indira Chakravarthi – Public Health Researcher, Delhi
Rinchin – Bhopal
8.1.2011

 

 

Related posts

Madhuri of JADS has been arrested for fighting against contnuing Maternal Deaths In Barwani #Vaw #Tribalrights

 

 

English: National Rural Health Mission of India

 

Five Years of NRHM-JSY and more than a decade of RCH: continuing maternal deaths in Barwani and MP

 
Background
Janani Suraksha Yojana (JSY) was launched under the National Rural Health Mission (NRHM) in
April 2005 as a safe motherhood intervention, with the specific objective of reducing maternal and
neo-natal mortality by relying on institutional delivery as the primary strategy for making available
medical care during pregnancy, delivery and post delivery period, and thus promoting safe
motherhood. All women are encouraged to avail institutional care during pregnancy and delivery,
and through ASHAs recruited specifically for this purpose institutional delivery is being promoted
among poor pregnant women. JSY is a 100 % centrally sponsored scheme, and it links cash
incentives to pregnant women with hospital delivery and post-delivery care. Reproductive and
Child Health (RCH-I) has been operational since 1997 as a project to provide a variety of
reproductive and child health services in rural areas to bring down maternal and infant mortality, in
order to reduce fertility rates and achieve population control. The second phase of the program
(RCH-II) also commenced in 2005. NRHM itself was launched with the promise to improve
availability and accessibility to health care services to the rural population, especially the
disadvantaged groups including women and children, by strengthening public health systems for
efficient service delivery, improving access, enabling community ownership and demand for
services, enhancing accountability and promoting decentralization.
It is against this context of programmes and interventions and associated fund flows from
the central government and several international agencies that one needs to view the status of
public health services, of maternal and child health in the country in general and specifically in the
high-focus states like MP, and the developments in Badwani that is the focus of this report.
Mass protest against maternal deaths in District Hospital, Barwani
On 28th December 2010 a rally was held in Barwani town, the headquarters of a predominantly
adivasi district in south-western MP. Nearly a thousand people gathered under the banner of
Jagrit Adivasi Dalit Sangathan (JADS), a mass organisation, to protest against extremely
negligent treatment of women in pregnancy and labour, particularly the death on 29th November
2010 of Vypari bai, an 8-months’ pregnant woman admitted in the District Hospital.
The people had come for this rally
from far-flung adivasi villages of the
district, and sought to draw attention to and
to protest against extreme callousness and
ill-treatment regularly meted out to women
in pregnancy and labour by the public
health system, particularly the District
Hospital (DH). A quick perusal of the DH
records indicated that between April-
November 2010 there had been 25 maternal
deaths, and 9 maternal deaths had been
recorded in this hospital in the month of
November 2010 alone. In addition, deaths
of 21 neonates (within 24 hours of birth) had been recorded, related to 511 deliveries conducted
in the hospital during November 2010. People complained that women with problems during
pregnancy and labour were frequently referred to Indore Medical College Hospital, located 150
kms away, despite the DH being supposed to deal with such cases.
The tragic story of Vypari bai – ‘institutional death’ instead of ‘institutional delivery’
Vypari bai, a 22 year old woman had travelled over 55 kms from her village Ban since the
morning of 27th November 2010 to reach the District Hospital, having been referred from the
PHC at Bokrata, and then from the CHC at Pati. She had been carried in a `jhuli’ (cloth sling)
over the first 10 kms from her village to Bokrata, from where the family managed to get the
Janani Express ambulance. She had experienced a convulsion that morning, and had high blood
pressure (BP) and eclampsia at the time of admission in the DH around 1.30 pm on 27th
November.
Following her examination by a gynaecologist at the time of admission in the DH on 27th
Nov., she was visited only once by another doctor during the entire day on 28th Nov. She had been
prescribed medicines after admission to control her BP, but her treatment sheets show only two
measurements of BP during the entire stay from 27th to 29th Nov. No attempt seems to have been
made to deliver the baby, by either induction or cesarean, as is the standard procedure in such
cases. An ultrasound scan on 28th November (for which the woman was taken by auto-rickshaw to
a private centre even though the hospital has this facility) showed the presence of live foetus.
Both the mother and mother-in-law of Vyparibai are trained health workers, presently
working as ASHAs in the NRHM. The mother-in-law Dunabai in desperation attempted to contact
the gynaecologist, who never turned up to see the patient in spite of repeated pleas from the
patient’s family. Moreover the doctor on duty, after checking the patient only once on 28th, was
also absent from the hospital premises. After repeated efforts to contact her, at late night at around
11 pm on 28th November, she instructed the nurse on duty that the relatives could take the patient to
Indore, but did not bother to examine the patient or modify the treatment. When the family went to
the doctor’s residence (which is within the hospital premise at a stone’s throw from the ward) on
28th night to ask her to attend to the woman as she was in great pain, the doctor refused to go,
saying she would phone the instructions to the nurse. The young woman finally breathed her last at
5 am on 29th November 2010, without medical attention despite being admitted in the District
Hospital.
Both the block CHC and Barwani DH are CEMONC (Comprehensive Emergency Obstetric
& Neonatal Care) centres, and the DH is equipped with a Blood Bank. Such centres are supposed
to provide emergency services related to pregnancy/ delivery round the clock and 365 days a year.
In any case, a hospital at the level of district hospital is supposed to provide emergency services at
all times, whether or not it is a CEMONC. Further, there is provision that in case of complications,
CEMONC centers can contract-in services of private medical practitioners. So she could have been
referred under the ‘Janani Sahayogi Yojana’ to one of the two local private hospitals. The DH has
four gynaecologists and two anaesthetists, who could have ensured Vypari bai’s delivery. However,
the case paper shows that nearly 35 hours after admission, the patient had been referred to the
medical college hospital in Indore at around 11 PM on 28th. Further, the family was asked to sign
an undertaking, stating that they were refusing to take her to Indore and they took responsibility for
the consequences. It has been repeatedly experienced that, rather than using the institutional
provisions, patients are generally referred to Indore. And are also made to sign such undertakings.
Several other cases of denial of services leading to complications and ill-treatment at all
levels of health services have been documented by JADS. Few illustrative ones are described
below.
District Hospital, Barwani – Baltabai, 20 years, Village- Ubadagad, Pati Block,
On 6th June 2010, 9-months’ pregnant Baltabai was taken to Pati CHC with labour pains, by bus at around 12
o’clock in the afternoon. There was no doctor in the CHC. When the family contacted the BMO and
requested him to see Baltabai, the BMO did not do so, but simply arranged for the Janani Express
Ambulance and referred the patient to the District Hospital. Around 3 PM Baltabai was admitted in the
female ward of the DH. Not a single doctor was present in the female ward, ostensibly because `it was
Sunday’. The nurse on duty informed the doctor who was supposed to be on duty, but was not physically
present in the hospital premises, about the serious condition of Baltabai. She was advised some blood test,
and after the blood report was available, referred by the doctor to M.Y. Hospital, Indore. During this period
the relatives were not adequately informed about the condition of the patient and need for referral. What is
more serious is that the family was not informed about intrauterine foetal death. Following the nurse’s
advice to go to the local hospital instead of Indore, the family took Baltabai to the private trust hospital in
the Barwani town, where the doctor examined Baltabai and informed them that the foetus was dead. She
recommended an emergency operation to remove the dead foetus and save the mother. The family had no
option but to go ahead with this surgery. They incurred a cost of around Rs 10,000/- and an additional Rs.
7000/- were spent on medicine. The family, dependent on daily-wages, had to borrow money from local
money lenders at very high interest rate.
On 14th June Baltabai was discharged from the trust hospital. However, her agony was not
over yet. On reaching home that evening she complained of abdominal distension and pain. On 15th
June, at 4 am she was taken to a private practitioner, where she was cathetarised, and again referred
to the DH, where she was treated till 21st June. On 21st June Baltabai was referred to M. Y. Hospital
Indore for treatment of paraplegia. What exactly happened to Baltabai from15th – 21st June is not
very clear, largely because there are no trustworthy clinical records. Why and how Baltabai
developed paraplegia was never explained to the family members and other concerned people.
Fortunately Baltabai’s condition improved in the M.Y. Hospital and she was subsequently
discharged on 1st July. The ordeal of Baltabai lasted for 24 days (6th June to 30th June), and has left
the family severely indebted.
In September 2008 a woman in labour at the District Hospital was referred by the attending
doctor to Indore as a case of obstructed labour. The family took her to the local Trust hospital,
where a caesarean operation was performed and the child delivered safely. However, due to the
delay the child developed complications and had to be admitted in the neo-natal intensive care unit
(NICU) in the DH.
CHC-Pati block – Meera, Patel phaliya , Pati
Meera had symptoms of threatened abortion since the second month of pregnancy; and was treated
at CHC, Pati. However, the doctor advised her that she should not rely on the medicines available
in the hospital, and made the family purchase injections and medicines from outside the hospital,
worth about Rs 1000-1200. Meera followed all the instructions given by the doctor, as she was told
that she would have a difficult labour. Despite this treatment Meera had intrauterine bleeding one
morning. When she called up the CHC for the Janani Express ambulance she was told that since
she was from Pati itself, she should go to the hospital by herself, and would not be provided the
ambulance. The lady walked over 5-8 km, for almost 2 hours, bleeding and in terrible pain, to reach
the CHC. At the CHC, she was informed that the baby had died in the womb. The family was
forced to purchase few special medicines from outside for the operation to remove the dead foetus.
PHC Menimata – Baniya Bai
On the night of 11th November 2008 Baniya bai went to the PHC Menimata for delivery. The
compounder and nurse asked her family for Rs 100, which the family did not give. The next
morning she was forced to leave the hospital on grounds of being anaemic. Baniya Bai, in
labour pain, managed to crawl out to the road outside the PHC, where she delivered with the help
on the local dai. She was then sent by members of JADS to CHC Silawad by the Janani
ambulance.
These are not isolated cases; there are reports of similar incidents of maternal deaths and
denial of treatment at the health centres, including the DH in Barwani.

 
Demanding Accountability for Negligence
We were visiting Barwani to get a firsthand
account of the situation there
concerning health services, particularly
in the District hospital. On the morning
of 28th December when we tried to meet
the CMHO and the concerned lady duty
doctor (who happens to be the CMHO’s
daughter) we were told that they were
out of town. The gynaecologist who had
admitted Vypari bai on 27th November
said she had anemia and eclampsia and
was not in a condition to be operated
upon; and that they did not have a
ventilator in the hospital. This
gynaecologist was not around the day
after admission (28th November) to monitor the progress; she is usually out of the hospital four
days of the week performing sterilization operations in family planning camps.
We observed the rally taking place outside the DH on 28th December. About 500 people
(nearly half of them women) had gathered at the entrance of the DH at around 12 noon, by which
time the OPD was almost over. The 2-3 doctors present there left when they heard the rally
approaching. The police tried to snatch away from the rallyists their microphone and the cart on
which it was placed; however the rallyists managed to convince them that they would leave very
soon. About fifteen minutes later the people moved away from the hospital premises and
continued their dharna on the road in front of the Collectorate office, well away from the DH.
Several activists and ordinary village women, including the mother-in-law of the deceased
Vyaparibai spoke of their travails at the DH. A set of 22 issues concerning the District hospital,
which were mentioned in the memorandum of demands, were read out to the assembled people.
The Civil Surgeon was asked for, but he refused to come out to receive the petition; finally the
ADM came and just gave a brief assurance that the issues would be responded to in writing in 15
days time. By around 4 PM the rally had dispersed.
Response by the administration – ‘the message is secondary, crack down on the messenger’
We met the Collector on 28th December evening after the rally and apprised him of the state of
affairs in the DH. It emerged that the process of carrying out maternal death reviews had not
been carried out in case of any of the 25 maternal deaths. During our meeting with the Collector,
the CMHO and CS came when they were summoned. According to the CMHO such maternal
deaths keep occurring, that women here were very anaemic, and it was ‘not possible to bring
them down to zero’. When pointed out that the DH was a CEMONC centre, that there were 4
serving gynaecologists and 2 anaesthetists, and it was enquired why such institutional deaths
were still taking place, there was no satisfactory response. The Collector appreciated our
bringing things to his notice, and said he would initiate
the task of Maternal Death Reviews. At the same time,
he also hinted at linkages of the mass organisation with
‘Bastar’ and ‘Andhra Pradesh’, thereby seeking to
discredit the people’s organisation as being associated
with the ‘Naxalites’, who have been outlawed by the
central government.

 
We are now extremely shocked and dismayed
that two days after this rally (on 30th Dec.) as per local
press reports, the police has foisted several charges on
the leaders of JADS and 200 people who participated
in the protest. They have been charged with Sec 146 of
IPC (unlawful assembly, rioting, armed with deadly weapon which when used is likely to cause
death), Sec 186 IPC (obstructing public servant in discharge of public functions), and Sec 16(3)
of MP Kolahal Rules. On 31st December one of the activists of the organisation, Bachhiya bhai,
was arrested and sent to jail on charges that were slapped on him and others in 2008, when they
had protested against the denial of services in PHC Menimata (described above).
It needs to be mentioned that the pilot phase of community-based monitoring of rural
health services in MP under NRHM had been implemented in Barwani during 2007-08. Even
prior to this the mass organisation JADS had been actively addressing the health problems in the
area in several ways. In May 2008 a three-day programme of monitoring of services at the CHC
Pati and dialogue with health officials (with the intention to improve them), was followed up
with a rally at Barwani town on the dismal state of health services in the DH. So the area has a
history of peaceful rallying for improvement of rural health services. However, there seems to
have been hardly any concerted response from the administration to address the genuine
problems faced by and raised by the people.
Is the situation restricted to Badwani?
The situation regarding maternal deaths seems to be similar in many other districts of MP. The
audit report of NRHM in MP by the CAG gives an idea of the serious situation in the state.
According to the CAG audit report for the period 2005-06 to 2008-09 incidences of maternal and
infant deaths in MP remained high. In the 12 districts surveyed for the audit there had been 1377
maternal deaths in all in the four-year period – Betul recorded 152, Bhopal 269, Indore 162,
Shahdol recorded 393, Dhar recorded 125, Ujjain 124, and so on. Shahdol district reported 55
maternal deaths in 2008-09. The audit report also points out that despite increase in number of
institutional deliveries, post-delivery mortality remained alarmingly high. The Maternal Mortality
Rate remained high at 379 per lakh live births. Interestingly, the state government has fixed a
lower target than that of the central government for reduction of MMR and IMR. While NRHM
envisages MMR of less than 100 per lakh live births and IMR of 30 per 1000 live births by 2012,
the MP government has set these at less than 220 and 60 respectively. It has said that due to
shortage of manpower it was not possible to achieve the NRHM targets! The audit also found that
Maternal Death Review Committees were to be constituted at each district, but had not been done.
A large number of neo-natal deaths also seem to be occuring: according to figures (collected by
RCH – NRHM for monitoring and evaluation) between April-November 2010, there were 154 neonatal
deaths in the entire district of Badwani, of which 133 have been recorded at the District
Hospital (3879 deliveries recorded at the DH in the same period).
Some other findings of the CAG audit indicate that even after four years of NRHM the
state government was not taking adequate measures to address the long-standing problems of
lack of basic medical facilities, lack of physical infrastructure, and of doctors and other staff.
For instance: the number of health centres fell short of the prescribed norms; several centres,
particularly sub-centres were functioning without buildings; none of the institutions had been
upgraded to Indian Public Health Standards (IPHS); of the 82 CHCs designated as first referral
units (FRUs) 80 percent were non-functional and the rest were only partially functional. The
state government itself acknowledged that the health centres are non-functional due to shortage
of man-power. 101 out of 297 PHCs in the 12 districts studied were running without doctors,
despite the provision for hiring contractual staff under NRHM. Monitoring Committees too at
state and at lower levels to review the activities under NRHM had not been formed till 2009.
One also finds that several hundreds of crores of rupees have been spent over the past few
years under RCH-JSY. Government reports show that the allocations for RCH-JSY had increased
since 2005, and expenditure too had increased from Rs 26.29 crores in 2005-06 to Rs 344.87
crores in 2008-09. By 2009-10 Rs 797.65 crores from NRHM funds had been spent on activities
to improve maternal and child health.
Issues and Concerns
We wish to draw attention to the grave situation that seems to be building up in places like
Barwani. It is now more than a decade of RCH and five years since NRHM, RCH-II, JSY etc,
were launched as flagship programmes. On one hand, the government is spending several
hundreds of crores of rupees annually, is vigorously promoting institutional deliveries as a
panacea for high maternal and infant mortality, and talks of safe and guaranteed health services;
through processes such as community monitoring it is promoting the idea of demanding
accountability from the public health machinery. On the other hand, the ground reality in places
like Barwani shows little change. And when people get organized to demand accountability
through peaceful actions, attempts are made to discredit and ‘brand’ their leaders, to intimidate
and repress them, and to shield the responsible officials who seem to be to completely indifferent
to the plight of the patients.
One finds that in spite of several interventions and expenses of crores of rupees, women
continue to die in large numbers. Majority of these deaths are avoidable and completely
unacceptable. It is precisely these preventable deaths that JSY claims to address, right from
ante-natal care (ANC) to post-delivery care of mother and new-born, by getting the pregnant
women to register soon after pregnancy and `motivating’ them to go to a hospital for delivery.
However, the ground reality indicates that the government is not improving the `health’ of the
health facilities in order that they treat satisfactorily women in labour, especially those with
complications. This is corroborated by the findings of the audit of the performance of NRHM in
MP. The experiences of ill-treatment narrated by the rural women also point to the apathy of the
doctors and the poor quality of care they receive when they come in pain and suffering.
How many more such `institutional deaths’, complications and denial of services, are to
occur before the hospital doctors become responsible and accountable; before the state health
department, the health ministry, the rogi kalyan samitis, the district health societies, the
numerous managers, planners, consultants, and international agencies look beyond their
ritualistic exercises of working on technical assistance, planning, evaluating, re-evaluating, replanning,
merely recording numbers of pregnant women registered, of institutional deliveries and
of beneficiaries etc., in the name of safe motherhood and child health, and seriously take note of
the reality of the deaths of women and infants?
Dr Abhay Shukla – National Joint Convenor, Jan Swasthya Abhiyan
Dr Indira Chakravarthi – Public Health Researcher, Delhi
Rinchin – Bhopal
8.1.2011

 

 

 

 

 

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National Urban Health Mission (NUHM) as a sub-mission under the National Health Mission (NHM)

PIB PRESS RELEASE

The Union Cabinet gave its approval to launch a National Urban Health Mission (NUHM) as a new sub-mission under the over-arching National Health Mission (NHM). Under the Scheme the following proposals have been approved :

1.        One Urban Primary Health Centre (U-PHC) for every fifty to sixty thousand population.

2.        One Urban Community Health Centre (U-CHC) for five to six U-PHCs in big cities.

3.        One Auxiliary Nursing Midwives (ANM) for 10,000 population.

4.        One Accredited Social Health Activist ASHA (community link worker) for 200 to 500 households.

The estimated cost of NUHM for 5 years period is Rs.22,507 crore with the Central Government share of Rs.16,955 crore. Centre-State funding pattern will be 75:25 except for North Eastern states and other special category states of Jammu and  Kashmir, Himachal Pradesh and Uttarakhand for whom the funding pattern will be 90:10.

The scheme will focus on primary health care needs of the urban poor. This Mission will be implemented in 779 cities and towns with more than 50,000 population and cover about 7.75 crore people.

The interventions under the sub-mission will result in

·         Reduction in Infant Mortality Rate (IMR)

·         Reduction in Maternal Mortality Ratio (MMR)

·          Universal access to reproductive health care

·         Convergence of all health related interventions.

The existing institutional mechanism and management systems created and functioning under NRHM will be strengthened to meet the needs of NUHM. Citywise implementation plans will be prepared based on baseline survey and felt need. Urban local bodies will be fully involved in implementation of the scheme.

NUHM aims to improve the health status of the urban population in general, particularly the poor and other disadvantaged sections by facilitating equitable access to quality health care, through a revamped primary public health care system, targeted outreach services and involvement of the community and urban local bodies.

Background

The Union Cabinet in its meeting held in April 2012 has already approved the continuation of the National Rural Health Mission (NRHM) and the other sub-mission under NHM till 31.3.2017.

 

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#Fellowship- Maternal Health #India #mustshare

THE MATERNAL HEALTH YOUNG CHAMPIONS PROGRAM

 

 

 
Maternal mortality is a major threat to women’s lives in developing countries. While maternal health outcomes have improved in some countries over the past few decades, rates of maternal death remain alarmingly high. Every minute, a woman dies in pregnancy or childbirth and over 300 million women in poor countries suffer from maternal morbidity. In many very poor countries the majority of mothers do not receive even the most basic health care, and quality care during childbirth – when both the mother and child are most at risk – is often unavailable.
 
Program Overview
To reduce maternal mortality and morbidity over the long-term, emerging public health leaders need to be equipped with the skills, commitment, and vision to respond fully to multiple causes and consequences of this threat.
 
Maternal Health Young Champions are students or young graduates in public health or a related field who are committed to improving maternal mortality and morbidity through either research or innovative field work in their home country.
Maternal Health Young Champions Program, a partnership between the Institute of International Education and Harvard School of Public Health, offers a unique fellowship to 10 young people who are passionate about improving maternal health in their home country. The Young Champions who are selected will be matched with in-country mentors from selected organizations for a nine-month research or field project internship focusing on a particular area of maternal health. The fellowship includes leadership training and participation in the Global Maternal Health Conference 2013 in Arusha, Tanzania.
 
Eligibility Requirements Applications are currently being accepted from candidates from Ethiopia, India, Mexico, and Nigeria who meet the following minimum criteria:
  • Bachelor’s or equivalent degree
  • 20-35 years of age
  • Clearly articulated plans for continued technical experience, research, or study
  • Demonstrated career commitment to improvement of maternal health, especially in developing countries
  • Interest in academic research or technical service provision in the field (excluding policy advocacy)
  • Articulated work/study project goals
Please circulate this information widely within your institution or networks, particularly to candidates whom you think would be excellent applicants for this program.

For more information on the program or to apply, go to www.iie.org/mhyc or contact:

John Bodra
Program Officer India
Tel: +91-11-2651-6873                     Email: info@iieindia.org.in

APPLICATION DEADLINE-NOVEMBER 10, 2012

 

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Ray of hope for tribal infants, moms

 

English: National Rural Health Mission of India

English: National Rural Health Mission of India (Photo credit: Wikipedia)

 

Saturday, Aug 4, 2012, 8:49 IST
By Dilnaz Boga | Place: Mumbai | Agency: DNA

 

Despite the slim chances, Mayur Bhagat survived.

 

In Waghwadi’s Shahapur block in Thane, two-month-old was breathless and suffering from acute nasal and chest congestion when he was rushed to Dhakne’s sub-centre. But no doctor was present there. He was treated by a doctor on a field visit.

 

Bhagat received treatment through Community Health Initiative (CHI), an initiative of Impact India Foundation (IIF). Two million tribals in Thane are reaping its benefits.

 

CHI is a part of the National Rural Health Mission and is being implemented in the Parali primary health centre of Wada block in Thane. “Since May 2012, it has been working to reduce malnutrition, infant and maternal mortality,” said IIF’s general manager (special projects) Neelam Kshirsagar. The Wada block is home to approximately 60,000 tribals

 

Read more here

 

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U.S. Health Law May Curb Rising Maternal Deaths

 

By Malena Amusa

WeNews correspondent

Monday, July 30, 2012

As the U.S. maternal mortality rate continues to increase, the new health care law could offer improvements in preventative care for women. Yet, definitive answers to why more American mothers are dying remain scarce

Credit: Celine Vignal on Flickr, under Creative Commons 2.0 (CC BY-NC-SA 2.0)

(WOMENSENEWS)–The future of pregnant women in the United States will significantly change Aug. 1.

That is when the new health care law, the Affordable Care Act, will require insurance providers and Medicaid to cover clinical preventative services for women, including pre-natal care, all without charging a co-pay, co-insurance or a deductible.

Under the new guidelines, millions of women will gain access to health care services for free, including well-woman preventative care visits and screenings for gestational diabetes and sexually transmitted infections. These guidelines do not include maternity care or simply any service the doctor orders. However, starting in 2014, all maternity care will be covered by all new individual, small business and government exchange plans.

“This will provide an extraordinary opportunity to improve women’s health not only during pregnancy but before, between and beyond pregnancy, and across the life course,” said Dr. Michael C. Lu, the associate administrator of the Maternal and Child Health Bureau of the Health Resources and Services Administration, an agency of the U.S. Department of Health and Human Services.

Not only will preventative care be provided next year without cost to women, under the new health care law, $125 million will go this year to the Maternal, Infant and Early Childhood Home Visiting Program to expand maternal and newborn support for mothers at home.

The changes are being introduced amid a wealth of data indicating that the number of mothers dying in America during or shortly after pregnancy is consistently growing. The rate of maternal mortality in the United States has more than doubled, rising from 6.6 deaths per 100,000 live births in 1987 to 16. 1 per 100,000 live births in 2009 – the highest among developed nations, Lu’s agency reports.

Various studies have attributed higher risk of maternal death to race, income, region, C-section rates, obesity-related problems and chronic disease. States where poverty exceeded 18 percent, the immigrant population exceeded 15 percent and the C-section rate exceeded 33 percent had 77 percent, 33 percent and 21 percent higher risks of maternal mortality, respectively, a 2007 report by Gopal K. Singh of the Health Resources and Services Administration indicated.

Women’s eNews has also reported previously that African American women’s maternal mortality rates are higher than those of other American women. African American women, regardless of levels of income and education, are three to four times more likely to die as a result of pregnancy. Yet conclusive data answering the question of why are scarce.

Government Funding

Ahead of the federal health insurance reform, several states have already been using funds provided by the federal government’s Maternal and Child Health Services Block Grant Program to improve pregnancy care.

For example, the California Maternal Quality Care Collaborative develops toolkits, protocols and recommendations for hospitals to tackle the leading causes of maternal death and morbidity, including hemorrhage (excessive bleeding) and preeclampsia (extreme high blood pressure).

At least two-thirds of California hospitals have adopted the toolkits. At the same time, the collaborative is devising a program to reduce first-birth C-sections, which range from 15 percent to 45 percent of births in California.

“The challenge is getting hospitals to adopt recommendations and change, but this is an area that we are making real progress in,” said Dr. Elliot Main, medical director of the collaborative. “It’s a shame mothers are still bleeding to death in the United States.”

In addition to the block grant, the Maternal and Child Health Bureau has developed intervention programs for low-income women at risk of having a low-birth weight baby, including the Home Visiting program and Healthy Start.

In 2009, 685 U.S. mothers – up from 548 in 2007 – died of pregnancy-related complications during or within 42 days of the end of their pregnancy, according to unpublished data provided by the Health Resources and Services Administration.

As a result, the United States is one of 23 countries – including Zimbabwe and Costa Rica – where maternal mortality rates have increased, according to a 2010 World Health Organization report “Trends in Maternal Mortality: 1990- 2008.”

Many pregnant mothers go into labor with chronic health problems, the top being diabetes, hypertension, obesity and cardiovascular disease. The federal maternal health agency reports that these contribute to poor maternal outcomes, but these studies are not conclusive and do not explain the maternal mortality difference between white, African American and Hispanic mothers.

Higher rates of health disorders are reported during pregnancy as well. In 2008, among the 27 states that collect this information, gestational diabetes and pregnancy-related hypertension were reported in 40.6 mothers per 1,000 live births and 38.7 mothers per 1,000 live births, respectively.

Clear Backsliding Trend

Final maternal mortality and morbidity data for 2010 are not yet available but the trend is clear. While developing countries are lowering their maternal mortality rates, the United States is backsliding.

The problem here does not correlate to monetary expenditure. The United States spends more on health care than any other country and more on maternal health than any other type of hospital care, according to a 2010 report by the London-based human rights group Amnesty International.

Lu, at the Maternal and Child Health Bureau, has been researching maternal distress for years.

“To improve maternal mortality in America, there are two things we must do,” he said in an e-mail interview. “First, we need to improve women’s health before they get pregnant. Second, we need to improve the quality of care that women receive during pregnancy.”

That echoes an international consensus that maternal deaths are preventable in most cases and that maternal morbidity can be foreseen and addressed long before the mother gives birth.

Improving women’s health before pregnancy involves what Lu has described as a “life course model” that begins in early life and extends to checkups for teens and access to contraceptives, all of which are covered by the health reforms about to take effect.

“Programs and policies that improve women’s health before they get pregnant, including those that address social determinants of health over the life course, as well as those that improve the quality of care women receive during pregnancy, will be critical for offsetting the risks which contribute to increased maternal deaths,” Lu said.

Malena Amusa is a freelance reporter based in St. Louis.

 

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Adding It Up: Costs and Benefits of Contraceptive Services Estimates for 2012

Wekker voor anti-conceptiepil / Alarm clock fo...

Wekker voor anti-conceptiepil / Alarm clock for birth control pills (Photo credit: Nationaal Archief)

HIGHLIGHTS
June 2012

  1. In 2012, an estimated 645 million women in the developing world were using modern methods—
  2. 42 million more than in 2008. About half of this increase was due to population growth.
  3. The proportion of married women using modern contraceptives in the developing world as awhole barely changed between 2008 (56%) and 2012 (57%). Larger-than-average increases were seen in Eastern Africa and Southeast Asia, but there was no increase in Western Africa and Middle Africa.
  4. n  The number of women who have an unmet need for modern contraception in 2012 is 222 million. This number declined slightly between 2008 and 2012 in the developing world overall, but increased in some subregions, as well as in the 69 poorest countries.
  5. Contraceptive care in 2012 will cost $4.0 billion in the developing world. To fully meet the exist-ing need for modern contraceptive methods of all women in the developing world would cost$8.1 billion per year.
  6. n Current contraceptive use will prevent 218 million unintended pregnancies in developing coun-tries in 2012, and, in turn, will avert 55 million unplanned births, 138 million abortions (of which0 million are unsafe), 25 million miscarriages and 118,000 maternal deaths.
  7. n  Serving all women in developing countries who currently have an unmet need for modernmethods would prevent an additional 54 million unintended pregnancies, including 21 millionunplanned births, 26 million abortions (of which 16 million would be unsafe) and seven million miscarriages; this would also prevent 79,000 maternal deaths and 1.1 million infant deaths.
  8. n  Special attention is needed to ensure that the contraceptive needs of vulnerable groups suchas unmarried young women, poor women and rural women are met and that inequities in knowledge and access are reduced.
  9. n  Improving services for current users and adequately meeting the needs of all women whocurrently need but are not using modern contraceptives will require increased financial com-mitment from governments and other stakeholders, as well as changes to a range of laws, poli-cies, factors related to service provision and practices that significantly impede access to and use of contraceptive service.

Download full report here

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Maternal Deaths Halved in 20 Years, but Faster Progress Needed

Eritrean women

Eritrean women (Photo credit: Wikipedia)

UN News
The report “Trends in maternal mortality: 1990 to 2010”, shows that from 1990 to 2010, the annual number of maternal deaths dropped from more than 543,000 to 287,000 – a decline of 47 per cent. While substantial progress has been achieved in almost all regions, many countries particularly in sub-Saharan Africa will fail to reach the Millennium Development Goal (MDG) target of reducing maternal death by 75 per cent from 1990 to 2015.

Every two minutes, a woman dies of pregnancy-related complications, the four most common causes being: severe bleeding after childbirth, infections, high blood pressure during pregnancy, and unsafe abortion. Ninety-nine per cent of maternal deaths occur in developing countries; most could have been prevented with proven interventions.

“We know exactly what to do to prevent maternal deaths: improve access to voluntary family planning, invest in health workers with midwifery skills, and ensure access to emergency obstetric care when complications arise. These interventions have proven to save lives and accelerate progress towards meeting the Millennium Development Goal 5,” said Dr. Osotimehin.

Disparity exists within and across countries and regions. One third of all maternal deaths occur in just two countries – in 2010, almost 20 per cent of deaths (56,000) were in India and 14 per cent (40,000) were in Nigeria. Of the 40 countries with the world’s highest rates of maternal death, 36 are in sub-Saharan Africa.

Similarly, Eastern Asia, which made the greatest progress in preventing maternal deaths, has a contraceptive prevalence rate of 84 per cent as opposed to only 22 per cent in sub-Saharan Africa, a region that has the highest rates of maternal death.

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