Causes and prevention of maternal deaths

IndiaState: StateDate: Day, Month, Year

What is a maternal death?

The death of a woman: while pregnant or within 42 days of

termination of pregnancy irrespective of the duration or site of

pregnancy from any cause related to or aggravated

by the pregnancy or its management but not from accidental or incidental

causes

Maternal Mortality Ratio (MMR)

The number of maternal deaths per 100,000 live births.

In India, the MMR is estimated at the national and State levels by the Sample Registration System (SRS)

District and sub-district levels are unknown due to incomplete reporting of deaths

How many maternal deaths take place?

In the world – more than one death every minute: 530,000 deaths/yr

In India – about one death every 6-7 minutes: about 78,000 deaths/yr

About 15% of all maternal deaths in the world are in India

In State – #,### deaths/yr

Average block -- ## deaths/month

When do maternal deaths occur?

25%

50%

20%

5%

During Pregnancy

Within 24 hrs ofdelivery2-7 days afterdelivery2-6 weeks afterdelivery

Biological causes of maternal deaths

25%

14%

13%7%

13%

8%

20%BleedingInfectionHigh BPObstructed labourAbortionOther direct causesIndirect causes

There are several cultural and social factors that also contribute to maternal deaths

Factors contributing to maternal death

What are some common practices and beliefs underlying maternal deaths?

Too early and too many pregnancies Inadequate birth spacing Son preference contributes to this

Delivery in unclean Due to belief that labor process is dirty

Unskilled birth attendant Because its never caused a problem

Inadequate food while pregnant–due to belief that more food leads to: Larger baby: difficult delivery for mother Larger baby: will get squashed

What are some common social factors contributing to the “three delays”?

Low social status of women Last to eat, receive health care, etc.

Lack of knowledge of danger signs Preference for traditional health care Lack of economic resources for care Not knowing where to go for care of

severe illness Hospital provides inadequate care

The first delay

Delay in decision making – Delay in recognizing the need for

health care Lack of knowledge of danger signs

Delay in deciding to seek formal care Women’s low social status Lack of economic resources Preference for traditional care Other responsibilities, etc.

The second delay

Delay in reaching the appropriate health facility Arranging money for transportation and health careLocating the transport Knowing where to goDistance to the appropriate facilityInfrastructure for transporting the patient – bad or no roads, etc.

The third delay

Delay in receiving health care at the facilityInadequate resources at the facility

Health personnel, supplies, equipmentInappropriate treatment and referrals

Which of these delays do you think contributes most to maternal deaths in District(s)?

Preventing maternal deaths

All pregnant woman are at risk for life-threatening labour and delivery complications It is not possible to accurately predict

which women will have a complicationTherefore, all women require skilled

birth attendance (ideally in a health facility) and referral and access to emergency obstetric care when needed

Preventing maternal deaths

Individual birth preparedness All pregnant women have a “birth plan” Includes “complication readiness”

Community birth preparedness Communities take responsibility and

action to prevent maternal deaths Maternal death inquiries identify local

causes of death and suggest effective action plans

MAPEDIR plans for State (below is an example – modify according to State plans)

Block meetings to sensitize Panchayat secretaries

VHC and SHG meetings to sensitize the community regarding causes of maternal deaths, birth preparedness, and the need for maternal death inquiries

Identify and interview every family with a suspected maternal death

Analyze and share the information with the community and health officials

Help the community take effective action and advocate for improved services

MAPEDIR plans for State (below is an example – modify according to State plans)

Train state-level trainers Trainers train 3-4 staff at each block

(interviewer, recorder, supervisor) Community death notifiers ? Health facility inquiries ?