|
-
|
Marriage and childbirth at an early
age About 50 per cent of the women in India marry before they are 18. By 19 years of age, half the women in the country have had their first birth. The proportion of such women is higher in the rural areas. A disproportionate number of maternal deaths occur among adolescent mothers aged between 15 and 19.
|
|
-
|
Lack of access to Emergency Obstetric Care
(EmOC) The majority of pregnant women in India have very poor access to appropriate emergency obstetric care due to the distance to health facilities with trained medical personnel and perceived costs of medical care. Lack of access and inadequate utilisation of healthcare, especially essential or EOC services, are directly associated with maternal deaths.
In India, only 34 per cent of deliveries take place in health facilities. In rural areas, three out of four births take place at home.
|
|
-
|
Inadequate nutrition is a significant factor contributing to maternal deaths. In India, the average weight gain of pregnant women is just 7 kg compared to almost 9 kg in Thailand and the Philippines and 12 kg in the developed countries.
|
|
-
|
Over 80 per cent of maternal deaths in India, as elsewhere in the world, are due to
six medical causes
haemorrhage, eclampsia, obstructed labour, sepsis, unsafe abortion and pre-existing conditions such as anaemia and malaria.
|
|
-
|
Absence of skilled personnel at delivery is another factor contributing to maternal deaths and complications. Skilled personnel attend only 42 per cent of deliveries in India. In some districts, that figure drops to 5-10 per cent.
|
|
-
|
Short birth
intervals Nearly 3 out of 10 recent births occur after a birth interval of less than 24 months.
|
|
-
|
High parity Over one-fourth of the births are high parity, i.e women who have had four or more deliveries
|
|
-
|
Lack of blood transfusion
facilities Currently, there are only 350 certified blood banks in India, the majority in metropolitan areas.
|
|
-
|
Contributing
factors Poor health and nutrition, lack of physical access to healthcare (including transportation and finances), medical causes and socio cultural factors that obstruct and underplay the importance of healthcare for women all contribute to maternal mortality.
|
|
-
|
Lack of support from men and other members of the family leads to poor utilisation of prenatal, natal and postnatal services by pregnant women. Several studies and reports indicate that men do not pay much attention to the health problems of women.
|
| Maternal deaths can be explained through the conceptual three delay model |
| - |
Delay 1- delay in seeking care; |
| - |
Delay 2- delay in transport to appropriate health facility |
| - |
Delay 3 - delay in provision of adequate
care |
|
|
|
|
 |
|
Fig 1. Causes of Maternal Mortality in Rural India |
|
Source: Registrar General India, Survey of Causes of Death (Rural) 1998 |
