UNICEF launches new scheme to conduct enquiry on maternal deaths

Aarti Dhar

- Social audit to identify ways to prevent avoidable deaths
- Women have little or no role in decision to seek healthcare
- UNICEF for sustained political commitment for safe motherhood

GWALIOR (M.P.): Concerned over the high maternal mortality ratio (MMR) in the country — 301 per 100,000 live births — the United Nations Children's Fund (UNICEF) has launched a new scheme to conduct maternal death inquiry. The Maternal and Perinatal Death Inquiry (MAPEDI) or the social audit — also known as verbal autopsy — is aimed at providing an understanding of the contributing factors that can be used by decision-makers and stakeholders to address obstacles to quality obstetric care and to identify ways to prevent avoidable deaths.

Survey of healthcare facilities

One such survey was conducted in Purulia district of West Bengal between July 2005 and June 2006 and its findings made the State Government order a review of every maternal death and initiate a survey of the health care facilities. All maternity beds in public sector facilities in the State have now been made non-paying for all and the Government is now working on a cashless referral transport system.

Of the 106 maternal mortalities reported, 62 per cent died during labour or delivery, 26 per cent during pregnancy and 12 per cent during abortion. As many as 61 per cent died at the health facility, 24 per cent died at home, 13 per cent en route to health facility and three per cent due to related causes. Fifty one per cent deaths were due to direct obstetric causes like bleeding, infection, eclampsia, and obstructed labour, 27 per cent due to indirect causes like anaemia, malaria, hepatitis, tuberculosis and cardiac, while 22 per cent died due to other causes.
The women were illiterate, most of them belonged to the Scheduled Castes, followed by the Scheduled Tribes and 42 per cent were below poverty line (BPL) cardholders.

According to Sudha Balakrishnan of UNICEF, husbands played a major role in deciding to seek healthcare and the women themselves had little or no role in this decision. The survey also revealed that 46 per cent sought formal health care after complications arose, 80 per cent sought formal care at some point of time and 20 per cent did not seek any.

Sadly, 16 per cent did not think the woman was sick enough, 8 per cent thought the problem required traditional care, for 23 per cent the cost and transportation was unaffordable. For another 11 per cent transport was not available at all. A similar audit conducted on 104 maternal mortality deaths in Shivpuri and Guna districts of Madhya Pradesh indicated that 83 per cent died after delivery, 5 per cent during delivery, 11 per cent during pregnancy and one per cent after abortion.

The UNICEF has been advocating sustained political commitment and strengthening policies for safe motherhood, ensuring availability of skilled maternal heath care provider and increasing awareness of communities and families for timely recognition of danger signs and deciding for referral besides improving availability of round-the-clock emergency obstetric care services.