Maternal Mortality Rate (MMR) is very high in India. Our neighbour, Sri Lanka, has brought it down to 50-60/1 lakh births, just by single intervention i.e no home delivery. It is said, 40 per cent women have one or the other problem during the pregnancy and 15 per cent have life threatening problem in labour. If the problems during pregnancy are diagnosed early, mother'slife can be easily saved. If there is slight delay in referral, we can lose the very precious life of a mother.
It takes a small effort to motivate a woman not to deliver at home, which makes a great difference. Right now for India, especially in rural and slum setting, a major worry is that National Family Health Survey has not been reporting changes in the extent of complications leading to maternal deaths, categorised as ?obstetrical causes?. These complications include haemorrhage, sepsis (infections leading to shock), obstructed labour (vaginal delivery not possible), fits caused by pregnancy-induced hypertension and anaemia. Because more of these complications can be predicted, medical preparedness at village level among health workers has to be high enough to avert maternal death following such complications.
Experts feel that ?following any such complication, the mother can only be saved within a specified period i.e, an hour in case of haemorrhage (heavy bleeding), 12 hours in case of obstructed labour (no progress of labour) and seven hours if she is experiencing fits late in pregnancy. Unfortunately, none of Dais are trained to handle these complications. They refer the mothers to hospital but because much times has been lost, mothers invariably die.
In Kerala, the institutional delivery is high and so is in Gujarat. Having reeled long enough under poor health indicators including the grim statistic of 450 maternal deaths per one lakh live births, Haryana is busy turning around destiny of pregnant mothers these days.
With a simple but special scheme called the Delivery Hut (Prasuti Griha) Scheme, launched last year to provide 24 hour institutional delivery service in rural areas, Harayna has recovered its institutional delivery rate drastically from 23 per cent in 2004-2005 to almost 50 per cent in 2005-2006. The scheme was launched after the National Family Health Survey-II found that Haryana's high domiciliary delivery rate was exposing 75 per cent expectant mothers and children to the risk of unsafe deliveries by untrained attendants in unhygienic home conditions.
It was to address the problems of maternal deaths and related issues including home deliveries, rampant anaemia among pregnant women, poor antenatal and post-natal care that the Haryana health department conceived the Prasuti Griha Scheme by providing rural women quality institutional delivery facilities by trained ANMs.
Success of the project has been tremendous, so much so that the Government of India has taken up the scheme as one of the best health practices for replication elsewhere. Data retrieved from the office of the Chief Registrar Birth and Death, Haryana, offers many interesting insights into the success of a humble plan, which seeks to seal the exceptionally high domiciliary delivery rate in the State. It shows how low and almost static institutional delivery rate of the State shot up within a year when the scheme was launched to reach out to as many rural expectant mothers as possible.
Within a year, 328 delivery huts were set-up in 20 districts across Haryana. Soon these huts became catalysts and functional in the improvement of health of Haryanavi women and children.
These huts have already facilitated 10,000 over institutional deliveries. An equal number (10/100) of birth certificates have been issued and over 1100 high risk cases of pregnancies have been referred to the First Referral Unit (FRU) by the ANMs posted at the huts.
Potential of ANMs and Dais is tremendous and remain unexploited due to lack of monitoring. Village women report to ANMs for the lure of free medicine and Tetanus Toxoid. One such packet contains at least 100 tablets of iron and folic acid (IFA), 100 tablets of calcium and 100 multi-vitamin or B complex capsules.
Interesting part of the scheme is its negligible cost as it uses the existing buildings of sub centers or primary health centers. Only minor renovations are made to ensure round the-clock water and electricity supply with backup in the form of emergency light or an inverter.
The key element of a hut delivery is therefore the provision of clean, free and safe delivery facility with the required privacy to pregnant women, counselling on family welfare practices and immunisation of both mother and child and post delivery care. Each delivery hut has a provision for helper to assist the ANM in counselling services. Mostly, such helpers are local Dais who feel encouraged to participate in the system of institutional deliveries and also to build on their capacity to handle an emergency in case the ANM is not around. Each such helper gets Rs. 500 per month for assisting the ANMs in the hut. Also, the ANM is supported by Accredited Social Health Activists (ASHAs), whose role has been defined under the National Rural Health Mission. ASHAs get money against every institutional delivery and immunisation efforts they inspire. The delivery hut project draws from such participatory approaches and encourages them further to achieve the goal of maternal and child health in the country.
For pregnant women of Haryana, the scheme is no less than a boon, as it does not require them to spend anything. I visited one such centre in Karnal district. When I asked a beneficiary, she said, ?I had a emergency during pregnancy and the ANM didi arranged for my transport to the FRU. I did not have to pay a thing. It is a great scheme.?
Till now, India has not been able to develop a strategy to increase women health awareness in masses and how to decrease MMR and audit maternal deaths. We have trained over 100 Basti Sevikas in 2004-2005 at Vatsalya Women, Child and Youth Development Centre. These women did tremendous community awareness and helped to boost immunisation and no home delivery, to promote movement against anaemia by doing Hb detection camps and distribution of Iron-Folic acid tablets, promoting no abortion by quacks and early STI treatment in East Delhi.
(The writer is Chairperson, Women Wing of IMA.)
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