Maternal mortality in Haryana dips by 17 points in 2 years
According to the latest Sample Registration System (SRS) data on maternal mortality in India, Haryana's MMR dropped to 89 per lakh live births in 2020–22, compared to 106 per lakh live births in 2019–21—marking an impressive reduction of 17 points.
State Health and Family Welfare Minister Arti Rao Singh attributed this achievement to Haryana's sustained efforts in strengthening maternal healthcare services.
She noted that the reduction indicates that numerous mothers' lives were saved due to the dedicated work of medical and health professionals across the state.
State officials say the health department remains committed to further reducing MMR, aiming to meet the target of fewer than 70 maternal deaths per 100,000 live births.
To enhance the quality and accessibility of maternal healthcare, several key initiatives have been implemented.
All government delivery points have been modernized and equipped with essential drugs, medical equipment, and logistics to ensure safe and dignified childbirth experiences.
Additionally, the number of designated First Referral Units– healthcare facilities to provide comprehensive emergency obstetric and newborn care including C-section surgeries and blood transfusion services has been increased.
Systematic identification and management of high-risk pregnancies are also being prioritized by ensuring quality antenatal care for pregnant women. Furthermore, the Surakshit Janani Maah (SJM) campaign, conducted monthly, focuses on screening and supporting high-risk pregnancies to enable early detection and intervention.
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The Hindu
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In childbirth in India, why should 93 women lose their life while one lakh women have a safe delivery? For the time period 2019-21, the Maternal Mortality Ratio (MMR) estimate for India was 93, in other words, the proportion of maternal deaths per 1,00,000 live births, reported under the Sample Registration System (SRS). 'Maternal death is the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes'. But the MMR in India has declined over the years — it was 103 in 2017-19, then 97 in 2018-20 and now 93 in 2019-21. 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But empowered, neighbourhood mothers and women's self-help-groups have resulted in a remarkable change; no longer is a mother-to-be neglected by lethargic family members. Ever since Accredited Social Health Activists (ASHA) began networking with Auxiliary Nurse Midwives (ANM) since 2005 (when the National Rural Health Mission (NHRM) was launched), institutional over home deliveries have become the better option. The financial incentives for the mother and ASHA were the turning point. The second delay is in transportation. From remote rural hamlets and forest settlements or faraway islands it may take many hours, or an overnight journey for a mother-to-be to reach a health facility with a skilled birth attendant (midwife/staff nurse) or a doctor or an obstetrician. Many women die on the way. However, the 108 ambulance system and other Emergency transport mechanisms under the National Health Mission has made a difference. Other problems The third delay, an unpardonable one, is in initiating specialised care at the health facility. The excuses are plenty and difficult to justify — a delay in attending to a woman in the emergency room; a delay in reaching the obstetrician; a delay in getting a blood donor, in laboratory support, the operation theatre not being ready, an anaesthetist not being available is a list that can go on. The concept of the operationalisation of a 'minimum four FRUs [first referral units] per district of two million population, is crucial. The 'first level referral unit' with specialists such as an obstetrician, anaesthetist, paediatrician, blood bank and operation theatre was aimed at preventing maternal death at the doorstep of a hospital. Unfortunately, this has not worked out as expected since 1992. There are problems such as 66% vacancies of specialists in 5,491 community health centres out of which 2,856 are supposed to be FRUs in 714 districts. The lack of blood banks or blood storage units in these designated FRUs was another reason for many mothers not receiving adequate blood transfusion within two hours of the onset of massive bleeding after delivery, leading to fatalities. The biggest killer is bleeding after delivery. This could be due to inadequate and timely contraction of an overstretched uterus with a baby of three-kilogram weight floating in amniotic fluids. When the placenta is separated after delivery, the raw opened surfaces of the uterine wall will bleed profusely unless it immediately contracts. From a total reserve of five litres of blood, more than half is lost in such a short duration, resulting in the mother going into shock and death. If there is underlying anaemia, which has not been treated with iron folic acid supplements in pregnancy, it will also result in tragedy. Thus, there is a need for immediate blood transfusion and emergency surgical care. The next emergency is obstructed labour where the contracted bony pelvis of an already stunted young mother (who is also malnourished and has low body mass index) does not allow the normally grown baby to emerge. Prolonged labour can lead to foetal distress and a lethal rupture of the uterus. This can be avoided by a Caesarean section. Thus, there is a need for a well-equipped operation theatre and obstetrician/ surgeon and an anaesthetist on call. The third medical cause is hypertensive disorders of pregnancy that are not recognised and treated on time. They can result in a dire emergency with convulsions and coma and very little time to medically control high blood pressure. There are some home deliveries by untrained birth attendants which lead to trauma and puerperal infection, resulting in sepsis and death. Antibiotics could have saved their lives, but the patient is admitted to hospital late. A failure of contraceptive devices, resulting in unwanted pregnancies and crude abortion techniques by quacks, also leads to sepsis and death. In EAG States, associated illnesses such as malaria, chronic urinary tract infections and tuberculosis are also high risk factors. The focus areas for States The prescription for averting maternal deaths is early registration and routine antenatal care and ensuring institutional delivery. Many of these systemic deficiencies will be highlighted in the mandatory reporting and audit of all maternal deaths under the NHM. While the EAG States have to focus on the implementation of basic tasks, the southern States group and probably Jharkhand, Maharashtra and Gujarat need to fine tune the quality of their emergency and basic obstetric care. The Kerala model of a Confidential Review of Maternal deaths, initiated by Dr. V.P. Paily, has some analytical leads on how Kerala can further reduce its already low MMR of 20. It is a model other southern States can emulate. The use of uterine artery clamps on the lower segment, application of suction canula to overcome atonicity of the uterus, and a sharp lookout for and energetic management of amniotic fluid embolism, diffused intravascular coagulation, hepatic failure secondary to fatty liver cirrhosis are strategies taught to obstetricians, which even developed countries have yet to practise routinely. They even address antenatal depression and post-partum psychosis as there were a few cases of pregnant mothers ending their life. Finally, if there is a commitment and a will to stop preventable maternal deaths there is no limit to the varieties of proactive interventions. Dr. K.R. Antony is a Public Health Consultant in Kochi, Kerala, and drafted the first Safe Motherhood module for the Ministry of Health on behalf of UNICEF. The writer acknowledges inputs on the Confidential Review of Maternal Deaths in Kerala from Dr. Smithy Sanel, a Spokesperson of the Kerala Federation of Obstetrics and Gynaecology
