http://www.financialexpress.com/news/Maternal-mortality-This-India-story-is-a-shame/370599/

Maternal mortality: This India story is a shame!
Economy Bureau
Posted online: Oct 08, 2008 at 0255 hrs

New Delhi, Oct 7Over 67% of maternal deaths in eight districts in
Orissa were among SC/ST groups. Illiteracy is as much a factor as lack
of primary health care. In Purulia, West Bengal , 48% of the women who
had died had no formal schooling.

Haemorrhage is the most common cause of delivery-related deaths, with
almost all haemorrhages occurring after delivery. In Bihar's Vaishali,
42% of the deaths occurred due to this. Many women who delivered at
home also died from postpartum haemorrhage.

Eclampsia, a serious complication during pregnancy that is attributed
to under-developed arteries in the placenta, was the second most
common cause of death (17% in Dholpur, 19% in Purulia, and 27% in
Guna/Shivpuri). However, the standard treatment for eclampsia,
magnesium sulfate, was often not available in these places.

These are the shocking findings of an ongoing survey across six states
being conducted in co-ordination with the United Nations Childrens'
Fund (Unicef). India is still quite far from achieving the Millennium
Development Goal of reducing maternal mortality rate (MMR) by three
quarters by 2015. On an average, there are at least 301 women dying
annually for every 100,000 live births. In some states the MMR is even
higher—358 in Orissa, 371 in Bihar and 379 in Madhya Pradesh.

A new tool, Maternal and Perinatal Death Inquiry and Response
(MAPEDIR), has been developed to analyse the underlying medical and
social reasons behind maternal death and is being used across 16
districts in Rajasthan, Madhya Pradesh, West Bengal, Jharkhand, Orissa
and Bihar providing an ongoing, systematic collection of data to
reconstruct and analyse the cases of 1,600 women—the highest number of
audited maternal deaths in the world. MAPEDIR also informs health
officials about the challenges local women face in accessing
reproductive health care.

"The tragic reality is that too often maternal deaths are not visible.
They don't leave any trace behind, and their deaths are not accounted
for. Unicef is committed to continue working with the National Rural
Health Mission to promote surveillance as a key strategy to lower
maternal and child mortality," Chris Hirabayashi, Unicef India deputy
director of programmes, said at a meeting with health officials from
the six states who are using MAPEDIR.

"Unless we know the main reasons for maternal deaths we cannot take
effective measures to tackle them. The traditional system did not deal
with the issues adequately. Now using MAPEDIR, we can know if the
deaths are due to delays in decision making at household level or lack
of transport or delay at the facility or a cumulative of all three," S
P Yadav, director of medical and health services in Rajasthan said.

A team made up of state government health and nutriti on officials and
NGO members, headed by a member of the local village council or
Panchayati Raj Institution, conducts interviews with surviving family
members at community-level with technical support from Unicef and
funds from the United Kingdom's department of international
development (DFID) work under MAPEDIR.

Social and economic factors like the low status of women in
communities, the poor understanding of families on when to seek care,
lack of transport, poor roads, the cost of seeking care, multiple
referrals to different health facilities and a delay in life-saving
measures in rural areas have been listed out by Unicef as the reasons
behind the high MMR.

Many of these deaths happen in the anonymity of women's homes or on
the way to a medical facility and so they often go unrecorded. An
estimated 80,000 pregnant women or new mothers die each year in India
often from preventable causes including hemorrhage, eclampsia, sepsis
and anemia.

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