Report by FOGSI: ‘Most pregnancy-related deaths occur in transit’

image ‘Maternal Death Reviews — Implications for Quality of Care,’ (MDR) a review of maternal deaths done by the Federation of Obstetric and Gynaecological Societies of India (FOGSI) in Jhunjhunu and Sikar districts of Rajasthan b/w November 2010 and March 2012 has revealed that 90% of these deaths had occurred during transit to a higher health centre. Thus, as per the study conducted on pregnancy-related deaths, a large number of women die during transit to a health facility or returning home after a delivery.

What is Maternal death?

Maternal death is defined as the death of a woman who dies from any cause related to or aggravated by pregnancy or its management (excluding accidental or incidental causes) during pregnancy or child birth or within 42 days of termination of pregnancy, irrespective of duration and site of the pregnancy.

What is Maternal Mortality Ratio (MMR)?

Maternal Mortality Ratio (MMR) is the number of women who die from any cause related to or aggravated by pregnancy or its management (excluding accidental or incidental causes) during pregnancy and childbirth or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, per 1,00,000  live births.

What is Maternal Death Review?

The Maternal Death Review (MDR) was rolled out in 2010 under the Reproductive and Child Health programme as an important strategy to improve the quality of obstetric care and to reduce maternal mortality and morbidity. It provides detailed information on various factors at the facility, district, community, regional and national levels that need to be addressed to reduce maternal deaths. Analysis of these deaths can identify the delays that contribute to maternal deaths at various levels and the information can be used to adopt measures to fill the gaps in service.

What is FBMDR (Facility Based Maternal Death Review) and CBMDR (Community Based Maternal Death Review)?

Maternal Death Review is contemplated to be implemented in two forms – Facility Based Maternal Death Review (FBMDR) and Community Based Maternal Death Review (CBMDR), which are defined as below:

  • FBMDR is a process to investigate and identify causes, mainly clinical and systemic, which lead to maternal deaths in the health facilities; and to take appropriate corrective measures to prevent such deaths. Page 3 of 56
  • CBMDR is a process in which deceased’s family members, relatives, neighbours or other informants and care providers are interviewed, through a technique called Verbal Autopsy, to elicit information for the purpose of identification of various factors – whether medical, socio-economic or systemic, which lead to maternal deaths; and thereby enabling the health system to take appropriate corrective measures at various levels to prevent such deaths.

What are the major causes of deaths in maternal deaths in India?

Major medical causes:

  • Abortion
  • Obstructed labour
  • Haemorrhage
  • Hypertensive disorders
  • Sepsis

Other factors:

  • Delay in initiating treatment
  • Substandard care in hospital
  • Lack of blood, equipment and drugs in hospitals coupled with lack of staff at health facility
  • At the community level, absence of ante-natal check ups, delay in seeking care, referral, getting transport, mobilising funds and not reaching the appropriate facility in time are some other factors of maternal deaths, besides prevailing beliefs and customs that prevent women from going to a health facility at the appropriate time.

Experts believe such deaths could possibly have increased because of an emphasis on institutional deliveries and a lack of corresponding clinical infrastructure — the Janani Suraksha Yojana gives women financial incentives for delivering at a health facility, but are often taken to the health facility as a mere formality and often asked to go home immediately after delivery because of lack of infrastructure to deal with the heavy patient load, which puts the life of the child and mother at huge risk.

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