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Ways Of Preventing Maternal Death Health And Social Care Essay

A maternal death is "the death of women while pregnant or within 42 days of termination of pregnancy, irrespective of the duration or site of the pregnancy, from any cause related to or aggravated by pregnancy or its management, but not from accidental causes". [1] Many people die from pregnancy-related causes and over 90% of them occur in developing or under-developed countries. Reducing maternal mortality by 75% by 2015 has been one of the United Nations Millennium goals. [2] The causes of maternal death vary from infection to gestational hypertension to complications of unsafe or unhygienic abortions and many more. Many developing countries lack adequate health care and family planning. Basic emergency obstetric interventions, essential family planning methods, adequate health care are far from the reach of a pregnant woman in a developing country. Forty-five percent of postpartum deaths happen within the first day itself and little more than 60% occur during the first week. Of the estimated 211 million pregnancies, 46 million results in induced abortions, more than 50% of these abortions are unsafe and cause 68,000 deaths annually. [3]

The International Safe Motherhood Conference was held in Kenya in 1987. It brought to the attention of the world communities of the devastating effects of rising maternal mortality rates in developing nations and formally established the Safe Motherhood Initiative. The primary aim was to diminish maternal mortality by 50% by 2000, also bring to the attention of the global community the predicament of pregnant women. In the beginning sponsors, United Nations (UN) agencies and governments of nations focused on the betterment of antenatal care, training of birth attendants, since these strategies failed, the world reaffirmed its commitment in 2000 and stipulated a reduction in maternal mortality of 75% by 2015. [2]

Target 5.A:

Reduce by three quarters, between 1990 and 2015, the maternal mortality ratio

5.1 Maternal mortality ratio 5.2 Proportion of births attended by skilled health personnel

The contributing factors to maternal mortality in most developing countries circulate around 3 delays. [4] The first delay would be that of the mother, the family or the community who fail to recognize an impending problem or life -threatening condition. [4] Many deaths occur within first 24 hrs of postpartum. In most rural communities births occur at home with unskilled attendants who do not have the skill to determine and prevent serious outcomes and medical knowledge to diagnose and act on their complications. The second delay would is the that in accessing a health care facility.[4] It can be either due to poor road conditions, lack of adequate transportation or even due to locations of these facilities. The third delay is the health- care facility itself.[4] Resource -poor nations with their fragile health care systems and facilities which do not have much needed technology or services necessary to provide critical care. Due to inefficient treatment, and lack of skill and supplies many women die each year.

CONCEPTS AND PROGRESS

The highest numbers of births per year(27 million) in the world takes place in India.[4] It has a maternal mortality of about 300-500 per 100,000 births and approximately 150000 maternal deaths take place every year in India, which is about 20% of global maternal death.[5,6] The tragedy is these deaths are that they are largely preventable. Therefore India's proficiency in the reduction of maternal health is vital to the global achievement of Millennium Development Goal 5(MDG 5). Based on evidence, interventions for reducing maternal mortality should strategically target the main causes of maternal death.

EMERGENCY OBESTERTIC CARE (EMOC)

EMOC is one of the most cost effective strategies implemented to reduce maternal deaths. [7] As it has been found that many maternal deaths occur due to obstetric emergencies that erupt suddenly at the onset of labor or immediately after. Availability of EMOC services in India is highly deficient due to lack of focus and limited management capacity. EMOC was not successfully implemented and the government does not monitor how they function. The official approach is to promote institutional deliveries and develop community health care. It is doubted that this strategy will have any effect as majority of deliveries in India take place at homes in distant villages. In 1992 India launched its first Child Survival and Safe Motherhood program followed by Reproductive and Child health in 1997.[8] The former program aimed at promoting medical assistance at delivery, provision of aseptic delivery kits and strengthening referral units that deal with high risk and obstetric emergencies through Emergency obstetric care(EOC).The latter program aimed at management of unwanted pregnancies and one of their main aims was to provide quality integrated and sustainable primary health care services to women of reproductive age group.[8]

Recently The National Rural Health Mission was launched in 2005 that aimed to specifically reach the families living below the poverty line with much required health services. Also, new reforms which aimed at training village health care workers and promoting institutional deliveries were to be patronized.[9] Under the NHRM a new scheme known as `janani express' was launched in a state called Madhya Pradesh to provide nonstop free transportation facilities to pregnant women to health care centers and hospitals in rural regions thereby ensuring best possible care when pre and post- delivery emergency conditions would arise both for the mother and the infant involved.[10]

ANTENATAL, INTRA NATAL AND POSTNATAL CARE

The consensus among international organizations and India is that maternal quality care is required throughout a women's reproductive life. From designing incentives to increase outcomes during from ante-partum period through intra-partum to postpartum period. Promoting maternal and child health has been an integral of the Government of India.

Safe motherhood and Child health services were incorporated into the Reproductive and Child health program (Ministry of health and family welfare 1997,1998b).The important constituents of these programs include providing antenatal care, which includes at least 3 antenatal care visits, iron prophylaxis for pregnant and lactating mothers, detecting and treating anemia in mothers, two doses of tetanus toxoid vaccine and management and referral of high-risk pregnancies. Encouragement of institutional deliveries or home deliveries assisted by trained health personnel was advocated. Providing postnatal care including three postnatal visits. Various interventions such as efforts to address and treat postpartum hemorrhage and infections by providing oxytocins and antibiotics in health care facilities have been implemented. Also manual removal of placenta, blood transfusion, hysterectomy procedures, treatment of eclampsia with anticonvulsants have been addressed. [11]

MIDWIFES

In pre independent India, many attempts were made for improving safe midwifery skills. From setting up an Advisory committee on Maternal mortality in India to establishments of a `dai's" (midwifery) school in Amristar in 1980. However, the focus on safe motherhood and skilled assistance shifted when India adopted new policies. In 1960, to provide essential maternal and child health services, India created a framework of two year trained rural midwifes (ANMs).Their designation as " auxillairy" unfortunately threatened their status and function as midwives though they considerably fitted the definition of a skilled birth attendant. Majority of the ANM's lacked the required knowledge and skills to provide maternal care and support. Under intense government pressure , The INC (Indian nursing council) revised the ANM training course, and the role of ANM changed from a maternal health care worker to family planning and immunization (1966).Abolishment of institution-based midwives and replacing them with general nurse midwives led to annulment of these training programs that were exclusively set up for midwifery. These general nurses were alternated between departments of the hospital and are also automatically registered as midwives. Since most births in India are domiciliary deliveries, the need to provide skilled birth attendance at community level is high. [12] Also, in certain areas such as the state of Tamil Nadu, cash incentives were provided in a scheme targeting women under poverty line known as the Dr. Muthulakshmi Reddy Scheme to help women support themselves during pregnancy period, childbirth and postal natal period through nutrition and adequate transport. [13]

HEALTH CARE SYSTEM AND POLICIES IN INDIA

Improved health-care system ensures reduction of maternal mortality, thereby improving the general health of a nation. Measuring and evaluating the progress a nation makes poses a challenge. The government of India has been implementing various problems to tackle these issues. In 1997, the Reproductive and Child health (RCH) program was launched aimed at universalizing immunization, antenatal care and skilled attendance during delivery. Reduction maternal mortality was an important goal RCH-2 that was launched in 2005. Incentives were given to staff to encourage round the clock obstetrics services at health care facilities. [11] The National Rural health mission (NRHM) which was formed in 2005 aimed at strengthening health care systems in rural areas. Under NRHM, the Janani Suraksha Yojana(JSY) program, the maternity benefit scheme, was introduced in 2005, cash assistance was provided to women who deliver in health facilities.[9] NGO's such as SAHAYOG are working to promote maternal health through partnerships with other organizations to increase community women's access to maternal health services, also to promote women reproductive rights. To fulfill these objectives the Maternal Health and Right programs uses human rights-based approaches through case documentation, campaigns research, monitoring, advocacy and policy makers, and media. This program seeks to understand realities of maternal health. They work at state level with the help of Women's Health Rights Forum (Mahila Swasthya Adhikar Manch) in raising awareness of maternal health services of rural women, at the national level in building coalitions around stake holders i.e. women, health service providers and policy makers for improving maternal health and at the international level by collaborating among safe motherhood and human rights organizations from around the world. [14]

Target 5.B:

Achieve, by 2015, universal access to reproductive health

5.3 Contraceptive prevalence rateÿ 5.4 Adolescent birth rate 5.5 Antenatal care coverage (at least one visit and at least four visits) 5.6 Unmet need for family planning

Over the decades there has been a substantial increase in the need for awareness of reproductive health in India to curb the ever growing birth rate. In 1951, The Family Welfare Program was set up with an objective of reducing birth rate and making it consistent with the requirement of national economy. Also to affirm the government commitment towards the citizens availing reproductive health care services. Due to increase in financial investments of the government, various programs dealing with immunization, pregnancy, delivery and preventive and curative health has been provided. In order to reduce the birth rate, condoms and oral contraceptives pills were provided free or sold at subsidized rates. Intrauterine devices such as CU-T were supplied free of cost to all the states.[15] A scheme known as the Sterilization beds scheme was introduced in 1964 in order to provide facilities like tubectomy operations in health care centers when cases such as these could not be admitted due to lack of beds. Also No-Scalpel Vasectomy Project is being implemented to help men adopt male sterilization and thus enforcing male participation in the race to limit ever growing birth rates.[16] The Integrated Child Development Scheme (1975) provides supplement nutrition, health care checkups before and after delivery and health and nutrition education to pregnant women and breast feeding mothers.[17] Many schemes were introduced with aims of setting health posts in slums areas and providing referral services involving distribution of contraceptives. The 90's witnessed a change in the quality of family planning services, usage of contraception etc. During the fifth five year plan, the Indian government designed strategies to promote and motivate family planning methods with the help of an advertising agencies of India which was huge step in a conservative society like India.

At the start of the millennium, India aimed at reducing the fertility rate by introducing incentives such as supplying contraceptives. India claims to be the first nation in the world to launch a nationwide program by supplying contraceptive devices to limit the population growth. Many goals from improving poverty, delaying marriage, rewarding Panchayats and Zilla Parshads for their role in universalizing the small family norm, promoting literacy programs, achieving reduction birth rates were brought about. Also cash incentives were provided to mothers who have their first child after 19 yrs of age, rewarding couples who come below the poverty line if they decide to marry after reaching legal marriageable age of 21.

CONCLUSION

India has shown remarkable progress in reducing maternal mortality by introducing ingenious changes within the existing framework of organizational set-up, resources and constraints. Overshadowing political priority and constituent policies of state governments to reduce maternal mortality has been a guiding force. India is moving slowly towards achieving target of MDG 5, but to achieve them within the stipulated time limit, it will need to accelerate pace of interventions, despite isolated examples of progress, national and global attention to maternal and child health.

REFRENCES

[1] The International Classification of Diseases, Injuries and Causes of Death - 9th revision (ICD9)

[2] World Health Organization (WHO), authorsÿThe World Health Report 2005: Make Every Mother and Child Count.ÿGeneva, Switzerland: WHO; 2005. [Accessed June 25, 2008].http://www.who.int/whr/2005/whr2005_en.pdf.

[3] 1.ÿUnited Nations, authors.ÿUN Millennium Development Goals Web site.ÿ[Accessed June 25, 2008].http://www.un.org/millenniumgoals/

[4] 3.ÿMaternal United Nations Population Fund (UNFPA), authorsÿMaternal Mortality Update 2002: A Focus on Emergency Obstetric Care.ÿNew York: UNFPA; 2003. [Accessed July 7, 2008].http://www.unfpa.org/upload/lib_pub_file/201_filename_mmupdate-2002.pdf.

[5] Maternal mortality in India: 1997-2003. Trends, causes and risk factors. New

Delhi: Registrar General; 2006.

[6] National Family Health Survey (NFHS-2) Key Findings. International Institute

for Population Sciences; 1998-99. p.12.

.[7] Maine D. Safe motherhood programs: options and issues. Columbia

University; 1993.

[8] Ved RR, Dua AS. Review of women and children's health in India: focus on safe motherhood [Background paper for "Burden of Disease in India"]. National Commission on Macroeconomics and Health Publication, India; 2005.

[9] National Rural Health Mission framework for Implementation 2005 - 2010. New Delhi: Ministry of Health and Family Welfare, Government of India; 2005.ÿÿ

[10] Janani Express Yojana: Madhya Pradesh, http://india.gov.in/citizen/health/viewscheme.php?schemeid=2055

[11] The National Child Survival and Safe Motherhood Programme. Ministry of Health and Family Welfare, Government of India, 1992.ÿÿ ÿÿ

[12]ÿ Mavalankar D, Vora K. Changing role of auxiliary nurse midwife in India.

[13] World Health Organization Regional Office for South East Asia, 2009. Safer Pregnancy in Tamil Nadu: From vision to Reality 2009

[14] SAHAYOG, http://www.sahayogindia.org/

[15] Family Welfare Programme in India, http://mohfw.nic.in/dofw%20website/family%20welfare%20programme/intro.htm

[16] Family Welfare Programme in India, No-Scalpel Vasectomy program, http://mohfw.nic.in/dofw%20website/family%20welfare%20programme/nsv/intro.htm

[17]Integrated Child development Services(ICSD) Scheme, http://wcd.nic.in/icds.htm

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