(Author – Dr Prathima Reddy MBBS, MRCOG (London), FRCOG (London), FACOG (USA)
Director, Senior Obstetrician and Gynaecologist – Fortis La Femme Hospital, Richmond Road Bangalore)
“Today we grow concerned about pregnancy & child birth not being natural enough, having become too medical. Historically, it was thoroughly natural, wholly un-medical and gravely dangerous”.
Did you know that women can die during one of the most joyous events in of their lives? Losing a young fit healthy wife, mother, daughter, sister during pregnancy and childbirth can be devastating.
Maternal death as this is called refers to 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.
The maternal mortality rate (MMR) in India was 130 maternal deaths per 100,000 live births in 2016. In the western world it varies between 3 – 18/100000.
Why do Women Die?
The main killers of women in this country are:
- Haemorrhage – excessive bleeding after the delivery of the baby (or in pregnancy) can be life threatening. If this is not recognized and treated promptly it can lead to severe maternal complications and death. Availability of blood, operating theatres, ICU facilities and skilled personnel with the ability to perform a hysterectomy (surgery to remove the womb) to save the mother’s life are essential in the battle against this complication.
- Anaemia – refers to the haemoglobin or blood count being low. After delivery a woman loses a certain amount of blood naturally. If the woman is anaemic even this normal blood loss is not well tolerated. And especially if she bleeds excessively, she is at grave risk of succumbing to the blood loss.
- Sepsis and Obstructed labor – Sepsis refers to infection which enters the blood and can happen during pregnancy or post-delivery. Sepsis is very insidious and can kill very quickly unless it is recognized early and treated aggressively.
Women who do not have access to medical care, especially in the rural areas may remain in labour for a few days if the baby is too large to pass through the birth canal or if the birth canal is too narrow to allow a normal delivery. This can result in the death of the baby and the mother.
- Pre-eclampsia and Eclampsia – these are conditions which are associated with high BP, fits, damage to the kidneys, brain and death.
- Abortion – performed by untrained personnel can give rise to infection and bleeding and death.
The Indian Scenario
India reduced its MMR from 556/100,000 in 1990 to 130/100,000 in 2016 which is a very commendable achievement.
Women who do not attend medical check-ups regularly during their pregnancy are at greater risk of having complications and succumbing to them. So,the following measures were taken to increase attendance at pregnancy clinics and encourage institutional deliveries: increased access to quality maternal health, schemes like the Janani Shishu Suraksha Karyakram – which allows all pregnant women delivering in public health institutions access to free transport and no-expense delivery, including caesarean section.
Women in India are more literate now and they also get married at an older age now with only 27% getting married before the age of 18.
Finally, the government has put in substantive efforts with campaigns such as the Pradhan Mantri Surakshit Matritva Abhiyan to facilitate positive engagement between public and private health care providers.