Mother and Child Health in India
Thursday, March 11th, 2010Child birth should be a boon and blessing for a woman which she can cherish for life and should not be a bane to her life and health because mentally and physically harassed and is left with in a state of health detrimental for herself and for baby.
“Six months into her pregnancy, with no medical care to look after, no iron-FA tablets, and no TT immunization. Talking of advanced facilities is irrelevant when there is lack of proper food to meet the extra demand of pregnancy and she is toiling up and down with a heavy load on her head.” I came across such a case in my neighborhood where a construction of a house was taking place. This was the state of a lady living in a so called mega city where the health care facilities are said to be par excellence. I am a student from pre-final year of medicine and the most important part of our curriculum is Preventive and Social Medicine, which teaches us about how our government is working for the improvement of mother and child health in India. No doubt the facilities are excellent but how far they are reaching the population is our main point of concern.
An Introduction to the Problem
Improving maternal health is one of the eight Millennium Development Goals adopted by the international community at the United Nations Millennium Summit in 2000 [2], but every day, 1,500 women die from complications in pregnancy childbirth. In 2005, there were an estimated 536,000 maternal deaths worldwide. Most of these deaths occurred in developing countries, and most were avoidable [1]. It has been reported that 99% of maternal mortality occurs in developing country where 85% of the world population lives [3]. India is just another developing country which nurtures 16.7% of the world’s population [4].
Today, the Maternal Mortality Rate of India is 301 per 1,00,000 as compared to 9 per 1,00,000 of the developed countries and the Infant Mortality Rate is 54 per 1000 [1]. In spite of the growing concern about reproductive health, information on levels, trends and differentials in maternal mortality remains fragmentary in most developing countries and that certainly includes India. Policy initiatives often rest on judgments made on the basis of a small, selective cross section of the population.
Women in our country have many pregnancies on average, therefore their lifetime risk more accurately reflects the overall burden of these women. Maternal mortality in our country is high because of high complications associated with pregnancy, childbirth and postpartum period. The four major killers are severe bleeding (mostly bleeding postpartum), infections (also mostly soon after delivery), hypertensive disorders in pregnancy (eclampsia) and obstructed labor [5]. Complications after unsafe abortion are another cause of maternal deaths. Women die because of poor health at conception and a lack of adequate care needed for the healthy outcome of the pregnancy [5].
My Personal Experience as a Medical Student:
Our school, Lady Hardinge Medical College, is known for its excellence in Pediatrics and Gynecology, so we often see mothers and children seeking health care. And it is very sad to see that most of the childhood diseases and maternal morbidities can be easily prevented. It is sad to see that in India, most of the women and children suffer from infectious diseases which are almost always either an result of poor hygiene or is a sequel to superimposed infection due to deficiency disorders and malnutrition.
During our family rotations to the slums in Delhi we got a chance to closely observe the state of the community. There are many malpractices and skepticism in the society prevalent that is resulting in the poor maternal and child health status in India. Despite many pleas to people to change habits which will give rise to these problems, these issues are still prevelent. Most of the malpractices that we came across were detrimental to the health status of mother and child and as a result, the antenatal attendance was found to be very low. We carried out a study on 500 pregnant women and found that 25% were not registered and 21% of them did not seek medical attention in their last pregnancy. Further enquiry revealed that the reasons for not attending ANC clinics were tragic; 39% did not have any knowledge about them, 42% said that they could not go because of distance of the ANC clinic from their home, rest did not go because they had no time and no one to accompany them.
A study in the slums of Delhi reveals that while 91% of women recieved antenatal care, and an average of three visits were made, a large proportion of these visits were motivated by a health complication; routine monitoring accounted for no more than one-third of all first and second visits and the first contact was typically made in the fifth or sixth month of pregnancy [6].
More Deplorable Facts
Major hindrances include the fact that pregnant women often do not have knowledge of things like TT immunization, the importance of iron folic acid tablets and a balanced diet during pregnancy. Sepsis is one of the most common causes of maternal death in our society, resulting from lack of reproductive hygene.
Deaths of newborns during the first week or month of life are largely the result of inadequate or inappropriate care during pregnancy, childbirth or the first critical hours after birth. Indeed, neonatal mortality is largely dependent on maternal and pregnancy-related health. Major causes of neonatal mortality include neonatal infections (tetanus, sepsis, meningitis, pneumonia and congenital syphilis), birth asphyxia and trauma, pre-term birth and/or low birth weight. These reasons can be easily attributed to fact in our society some people prefer delivery by a Dai (most deliveries in rural areas of India are handled by the local lady who is immediately available to the pregnant lady during the perinatal period) who may not be skilled enough to handle the adversities and complications associated with pregnancy and parturition. Most of the times these Dai’s do not have knowledge of the importance of disinfection and hygiene while handling a delivery. We also observed that early onset of marriage and childbearing in India continues to have disturbing consequences for maternal health. Most of the women we came across in our society were married during their teenage years and majority were illiterate or barely had a primary education. The median age at first cohabitation with husband is 17 years among women aged 25-49 [7] and cultural pressures make it imperative for a women’s security in her marital home for her to conceive as soon as possible after marriage. Higher parity is another cause of concern that is prevalent in our community.
A recent study of pregnant women in Delhi slums reports that 45% of pregnant women were malnourished, that is their caloric intake was less than 60% of the recommended diet during pregnancy, and 80% consumed less than the recommended daily amount; 40% weighed less than 45 kg and 7% were less than 145 cm in height; two-thirds were anemic and 12%were severely anemic [6].
During our rotations we also observed that in most of the families child and mother are kept separated for the initial 40 days depriving the child of immediate nursing by mother. Neonatal health care is constrained by traditional practices that forbid women from leaving the home after they have given birth and the health system’s failure to provide home-based care in this period.
Early weaning is another practice and discarding the colostrums – the first milk – predisposes the child to various infections and deprives the child from the benefits of mother’s milk. Breast milk protects the baby from respiratory and diarrheal diseases which are the major cause of morbidity and mortality in children. In Indian setup exclusive six months of breast feeding is recommended [8].
India Fights Back
There are many national programmes functioning in India which aim at the development of Maternal and Child Health in India. Some of the programmes are Janani Suraksha Yojna under National Rural Health Mission, Reproductive Child Health Care, Integrated Management of Newborn and Childhood Illness. Under the leadership of Smt. Indira Gandhi, Integrated Child Development Services was launched which also has Nursing and Pregnant mothers as its beneficiary and children below 6 years [9]. All the programmes are being designed in a way that their main objective can be summed up as “to improve the availability of and access to quality health care by people, especially for those residing in rural areas, the poor, women and children.” India is currently spending US$109 per capita on the improvement of health and 4.9% of GDP on health [10]. Sadly even with so much expenditure and so many efforts by the government of India, the situation is very slow to improve.
Conclusions and What We Can Do
Pregnant women, their families, and indeed the whole community have not yet recognized the need for skilled attendance at delivery or the array of skills that a birth attendant needs. To summarize, in the communities misconceptions abound, danger signals in the pregnancy are poorly understood, provider-client interactions fail to build awareness, women’s lack of decision making authority, women’s restricted mobility, economic burden, and domestic violence are some of the major issues which we need to fight and to date no national programme has been designed to overcome these obstacles.
Actions are required to inform pregnant women and their families of danger signals and the required responses, ways of gaining appropriate care, nutrition and rest during pregnancy, and their right to recieve skilled and affordable attendance at birth. Efforts are needed to mobilize women, inform them of their rights, enable them to exert a voice in family affairs and make contingency plans for unforeseen pregnancy-related problems, and create amongst them a feeling of entitlement to health care and other services.
Shipra Goel is a third year medical student at Lady Hardinge Medical College in India
goelship(at)gmail.com
References
[1] Maternal mortality in 2005: estimates developed by WHO, UNICEF, UNFPA and the World Bank. Geneva, World Health Organization, 2007 (http://www. who.int/reproductive-health/publications/maternal_mortality_2005/index.html, accessed 14 August 2008).
[2] WHO (2003), The World Health Report 2003, Shaping the future.
[3] The World Health Report – Make every mother and child count, Geneva, World Health Organization, 2005
[4] Govt. of India (2001), Census of India 2001, Provisional Population Totals, Paper-1 of 2001
[5] WHO (2005), Regional Health forum, Vol.9, No.1, 2005
[6] Bhandari, N. and S. Mayank. 1999. A study on the perceptions, prevalence and health seeking behaviour of maternal morbidities in an urban slum. Unpublished report.
[7] IIPS and ORC Macro, 2000; MOHFW, 2000
[8] Govt. of India (2004) National Guidelines on Infant and Young Child Feeding (2004) , Department of Women and Child Development, Govt. of India.
[9] Govt. of India (1978), National Plan of Action for the International Year for the children 1979, Ministry of Education and Social Welfare, New Delhi.
[10] WHO (2003), Health Situation in South East Asia, Basic Indicators 2002

