Maternal death - Are we lagging behind in our effort?

Prof L Ranjit Singh *

Death of women during pregnancy and childbirth is a tragedy not only for the family but also for the society. Loss of precious human life is always painful for all of us including doctors and nurses. Unfortunately, women are the nonparticipating majority in terms of access to health, literacy, information and skill till today. India definitely needs to strengthen Primary Health Care System so that it reaches every single person with high quality health services.

According to the Bhore Committee Report (1946), number of mothers dying during pregnancy and childbirth related complications, up to six weeks post delivery (Maternal Mortality Ratio) was 2000 per 100,000 live births. Today, the figure stands at approximately 178 per 100,000 live births according to unpublished report (2010-2012). Well, this is far below the goal set by the United Nation in its Millennium Development Goals (MDGs).

Several pertinent questions arise as to how we have collectively failed to achieve this goal. We frequently ask ourselves; is it because the target set is too high or is there lack of effort on the part of the Government, both National as well as State. At this point of time, it is worthwhile to mention that health as such is a state subject.

According to MDGs on maternal death, Maternal Mortality should be less than100 by the end of 2015. The goal set may not be high or something unachievable as shown by some South Indian States including Tamil Nadu, Kerala and North Indian state like Himachal Pradesh where the target was achieved. Manipur probably has achieved the MDGs long before the target year. Several other States are going to miss the target by a narrow margin; that include Andhra Pradesh, Karnataka and Maharashtra.

Whereas several other States of India that belong to BIMARU: a cluster of States of Bihar, Madhya Pradesh, Rajasthan and Uttar Pradesh are far behind in the run up to reach the MDGs. Our neighbor State Assam has significantly high level of Maternal Death that stands at 200-300 per 100,000 live births approximately. Hence in the word BIMARU, 'A' probably stands for Assam.

In the biggest hospital in the State, the number of Maternal Death ranges from 60 to 80 per 100,000 live births in the past five years. Well, this may not actually reflect the state of affairs in Manipur as a whole because of not reporting of cases from the peripheral areas of the State. In fact, this impressive figure (even with added unreported cases) is far less than that of the State of Tamil Nadu which has the best Primary Health Care System in the country.

The tiny State's spectacular success in saving mother's lives so far means that it has not just met but surpassed the UN's ambitious Millennium Development Goal on Maternal Mortality. This is due to the coordinated and concerted efforts of the State Government and dedicated team of doctors, nurses and other ancillary staffs working tirelessly.

Can we have Zero Maternal Mortality? Even the industrialized nations in the world have not been able to achieve this. Hence the answer is a big "NO". The Taj Mahal at Agra, one of the wonders of the world was built in 1632 by Mughal Emperor Shah Jahan to house the tomb of his beloved wife Mumtaz Mahal who died during childbirth. Today, the magnificent tomb stands as a tall testimony to the Maternal Death of a queen of a powerful dynasty who ruled the country from early 16th to mid 18th century. Till date it is difficult to find any country in the world with zero Maternal Mortality.

In pregnancy and childbirth, there are unforeseen and unpredictable factors that can cause death of a woman. Some of the pregnancy and childbirth complications: Placenta Praevia (abnormal location of placenta at the lower part of the womb), High Blood Pressure, Disseminated Intravascular Coagulation, Amniotic Fluid Embolism, Bleeding and Anaemia (lack of blood in the woman's body) can cause death in spite of the best efforts of the doctors. This is true not only in Manipur, in India but anywhere in the world. We must remember that during Caesarean delivery (as for any other major operation), some of the anaesthesia-related complications may be fatal.

The National Rural Health Mission launched as a flagship programme during the UPA regime (2005) has helped in reducing Maternal Mortality. This is reflected quite well in the Maternal Mortality figures of our State and also for other States as well. Even though the target year for MDGs is fast approaching, the goal remains a distant dream for many States in India.

Today, the MDGs are being replaced by a new set of goals, the Sustainable Development Goals (SDG), beginning from 2015 to 2030 with a bold vision. As we all know that every vision costs money, hence both the National and State governments need to enhance the public spending in health care. After all, resources matter and how these resources are used are even more important. Mothers will continue to die from pregnancy related causes unless and until societies decide to allocate resources to the health of women.

The challenge is to harness the political will to act now to redress the imbalance in the health sector. This is not only for the women and families of today but also for the children of tomorrow. We strongly and sincerely believe that Maternal and Child Health is the cornerstone of the health of a nation.