Post on 12-Nov-2014
description
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 ?