Causes for the Decline in the Maternal Mortality Ratio in Maharashtra, India. The Period From 1990-2009


Term Paper, 2013

36 Pages, Grade: 75.00% 1st Class w. Distinction


Excerpt

Table of Contents

INTRODUCTION

OBJECTIVE

RESEARCH QUESTIONS

RESEARCH METHODOLOGY

LIMITATIONS OF THE STUDY

DEFINITIONS

ACKNOWLEDGEMENTS:

MAIN CAUSES IDENTIFIED FOR MATERNAL MORTALITY IN MAHARASHTRA
DIRECT CAUSES
INDIRECT CAUSES

SOCIAL AND OTHER CORRELATES OF MATERNAL MORTALITY

TRENDS IN THE DIRECT CAUSES AFFECTING MMR
COMPLICATIONS DURING PREGNANCY AND DELIVERY

MATERNAL NUTRITION

TRENDS IN THE SOCIAL AND OTHER CORRELATES AFFECTING MMR
PARITY
AGE
ACCESS TO HEALTH CARE INSTITUTIONS

GOVERNMENT INTERVENTIONS TO IMPROVE ACCESS TO MATERNAL HEALTH CARE
JANANI SURAKSHA YOJANA
OTHER INTERVENTIONS
ECONOMIC STATUS
EDUCATION LEVELS

CONCLUSION

RECOMMENDATIONS

REFERENCES

INTRODUCTION

India accounts for 19% of all maternal deaths globally.1 Maternal mortality is thus one of the most serious public health issues facing India today. During the period 1990-2009, Maharashtra’s Maternal Mortality Ratio (MMR) dropped from around 216 to 104, making it a 52% decrease in 19 years.2 The MMR in Maharashtra is the third lowest in the country. In 2009 Maharashtra became one of the three states (along with Tamil Nadu and Kerala) in India to have achieved the Millennium Development Goal of an MMR of 109 by the year 2015.3 This remarkable drop in the MMR deserves to be studied in order to identify the reasons for its occurrence and to see whether it can be replicated in the rest of the country.

OBJECTIVE

To identify the reasons for the decline in the maternal mortality ratio from around 216 to 104 in Maharashtra during the period 1990-2009.

RESEARCH QUESTIONS

- What are the factors that affect maternal mortality in Maharashtra?
- What have been the trends amongst these factors during the period 1990-2009?
- Have these trends helped to bring down the MMR in Maharashtra?

RESEARCH METHODOLOGY

- The objective of the study was framed.
- A literature review on the subject was done.
- Based on the review of literature (see references), a list of the factors affecting maternal mortality in India and Maharashtra were drawn up.
- Based on the review of literature and the perusal of the available sources of secondary data, those factors which seemed to be highly relevant and/or for which reliable time-series data could be found were chosen for analysis. These factors were:
- Maternal nutrition
- Complications during pregnancy and delivery
- Parity
- Access to healthcare institutions
- Economic status
- Education levels
- Age
- Research was done to find data sources for the selected factors. The processes of data searching and the determination of the factors that would be finally selected for study went on in tandem until a list of the factors that would be studied was drawn up.
- Selection criteria for data sources: Research on all the available sources of data was done and only those data that fulfilled the following criteria were selected:
- The data should be for India or Maharashtra.
- It should have been collected at regular intervals of time.
- It should be from reliable sources, such as national or state government bodies or respected international organizations such as WHO or UNICEF.

However, for the literature evidence, scientific communications available through publications on authentic websites were included. These include the website of the British Council Library, Pubmed and Mendeley.

Abbildung in dieser Leseprobe nicht enthalten

Abbildung in dieser Leseprobe nicht enthalten

- The factors which could not be taken into account due to paucity of data were:
- S ocial status of the women
- Awareness of the women regarding maternal health issues
- Place of delivery
- No. of health facilities from which treatment was taken, i.e. no. of referrals
- Whether the women had been booked for ante-natal care checkups or not i.e. antenatal supervision
- The selected factors were then grouped into three categories: Direct Causes, Indirect Causes and Social and Other Correlates of maternal death. This method of categorization was selected after careful study of the available literature. Direct Causes refer to direct obstetric causes (i.e., complications of pregnancy, labor, delivery or the postpartum period). Indirect Causes account for women who die from any other disease during the maternal period (pregnancy and up to 42 days postpartum or post abortion).4 Social and Other Correlates refer to the socio-economic and other factors that affect the ability of women to receive adequate and timely maternal health care, such as poverty, distance, cultural practices, and lack of adequate information5
- Secondary data were analysed in order to discern the trends in the selected factors.
- Conclusions were drawn based on this analysis.
- Policy recommendations were made.

LIMITATIONS OF THE STUDY

Lack of data was a major problem faced in the course of conducting the study. Government documents only state the number of maternal deaths along with their direct medical causes. No time series data were available on the indirect causes of maternal deaths in Maharashtra, as well as for the nutritional status of pregnant women in Maharashtra, or of the anaemia levels and BMI of pregnant women in Maharashtra. As a consequence of this lack of data, information on age and parity were taken from the following hospital-based studies:

1. Vidyadhar B. Bangal, Purushottam A. Giri , Ruchika Garg. Maternal Mortality at a Tertiary Care Teaching Hospital of Rural India: A Retrospective Study International Journal of Biological and Medical Research, 2011; 2(4): 1043 – 1046. This study was carried out at a hospital in Loni.
2. Varsha N. Patil , M. A. Shinde, Meenakshi Surve, Shital G. Sonone. Maternal Mortality - A Challenge? Journal of Krishna Institute of Medical Sciences University (Karad Mah India) Jan-Jun 2013; Vol. 2 No. 1. This study was carried out a hospital in Karad.
3. Surekha Tayade , Madhuri Bagde, Poonam V Shivkumar, Atul Tayade, Nilajkumar Bagde. Maternal Death Review To Know The Determinants Of Maternal Mortality In A District Hospital Of Central India. International Journal of Biological and Medical Research, 2012; 303: 157‐163. This study was carried out at a hospital in Wardha.
4. Bhaskar K Murthy, Mangala B Murthy, Priya M Prabhu. Maternal Mortality in a Tertiary Care Hospital: A 10-year Review. International Journal of Preventive Medicine (Iran) 2013 Jan; 4(1): 105–109. This study was carried out at a hospital in south-west Maharashtra (the exact location has not been specified in the study).
5. B.R. Ganatra, K.J. Coyaji, V.N. Rao. Too far, too little, too late: a community-based case-control study of maternal mortality in rural west Maharashtra, India. Bulletin of the World Health Organization (Gen Swi).1998; 76 (6): 591-598

The limitation of hospital-based studies is that they do not reflect the population at large. Those pregnancies which are not registered, such as home deliveries, may not be reflected in the analysis.

DEFINITIONS

- MATERNAL MORTALITY RATIO: It is defined as the number of women aged 15-49 years dying due to maternal causes per 1,00,000 live births.
- MATERNAL DEATH: It is 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.6
- TOTAL FERTILITY RATE (TFR): The TFR per women in a given year is average number of children born to a women during the reproductive span (age 15-49 years) provided she experiences the current age-specific fertility rate.7
- UNMET NEED FOR FAMILY PLANNING: It is defined as the percentage of currently married women who either want to space their next birth or stop childbearing entirely but are not using contraception.8

ACKNOWLEDGEMENTS:

- Professor Aneeta Gokhale-Benninger, Executive Director, CDSA Pune

MAIN CAUSES IDENTIFIED FOR MATERNAL MORTALITY IN MAHARASHTRA

DIRECT CAUSES

Direct causes refer to direct obstetric causes responsible for maternal mortality (i.e., complications of pregnancy, labor, delivery or the postpartum period).

According to the report ‘Maternal Mortality In India: 1997-2003, Trends, Causes And Risk Factors’ published by the Registrar General of India in 2006, the following are the direct causes of maternal mortality in India:

Abbildung in dieser Leseprobe nicht enthalten

Source: ‘Maternal Mortality In India: 1997-2003 , Trends, Causes And Risk Factors’, Registrar General of India, 2006

A haemorrhage is an escape of blood from a ruptured blood vessel, especially when profuse. Sepsis refers to septic conditions arising in the mother’s reproductive tract. Hypertensive disorders refer to problems relating to high BP during pregnancy. Other Conditions, listed according to whose International Classification of Diseases Codes (ICD-10 Codes), are:

020-043: Haemorrhage in early pregnancy, excessive vomiting in pregnancy, venous complications in pregnancy, infections of genitourinary tract in pregnancy, Diabetes mellitus in pregnancy, malnutrition in pregnancy, maternal care for other conditions predominantly related to pregnancy (such as excessive weight gain in pregnancy, low weight gain in pregnancy, pregnancy care of habitual aborter, retained intrauterine contraceptive device in pregnancy, liver disorders in pregnancy, childbirth and the puerperium, exhaustion and fatigue, etc. ), abnormal findings on antenatal screening of mother, complications of anaesthesia during pregnancy, multiple gestation, etc.

047-063: False labour, prolonged pregnancy, preterm labour and delivery,etc.

068-071: labour and delivery complicated by foetal stress [distress], labour and delivery complicated by umbilical cord complications, etc.

073-075: Retained placenta and membranes without haemorrhage, etc.

087-099: Complications predominantly related to the puerperium, other obstetric conditions not elsewhere classified

INDIRECT CAUSES

No data were available on the indirect causes of maternal deaths in Maharashtra.

SOCIAL AND OTHER CORRELATES OF MATERNAL MORTALITY

- PARITY: First deliveries and deliveries of an order greater than 2 are more at risk than second deliveries. This could be because a woman who is delivering for the first time is generally young and thus her body is not as well prepared for the stress of delivery as at later ages; deliveries of an order greater than two could be high risk because the stress of more than two deliveries is too much for the mother’s body.
- ACCESS TO HEALTH CARE INSTITUTIONS: Adequate availability of and accessibility to quality health care facilities reduces the risk of maternal deaths.
- ECONOMIC STATUS: Women from lower income groups are at an increased risk of maternal mortality.
- EDUCATION LEVELS: Illiterate and poorly educated women are more at risk of maternal mortality than better educated women.
- AGE: For both physiological and social reasons, mothers aged 15 to 19 are twice as likely to die in childbirth as those in their 20s9.

TRENDS IN THE DIRECT CAUSES AFFECTING MMR

COMPLICATIONS DURING PREGNANCY AND DELIVERY

Abbildung in dieser Leseprobe nicht enthalten

The data for these charts has been taken from the three District Level Household Surveys (DLHS) that have been conducted in Maharashtra since 1999. As can be seen from the graphs, the percentage of women who suffered from post-delivery complications has not reduced from the period 1998-99 to 2007-2008. The percentage of women who suffered complications during pregnancy has decreased only to 58.2% in 2007-2008 from 63.6% in 1998-1999. The percentage of women who suffered post- delivery complications has similarly declined by only a small amount- from 44.4% in 1998-99 to 38.7% in 2007-08.

Abbildung in dieser Leseprobe nicht enthalten

The percentage of women who suffered complications during delivery has actually increased, from 37% in 1998-99 to 65% in 2007-08.

It can thus be seen that the incidences of complications during pregnancy, delivery and in the post- delivery period have not decreased during the period 1998-99 to 2007-08. Thus there has been no fluctuation in the pattern of pregnancy and delivery complications that can be said to have contributed to the decline in MMR in Maharashta.

[...]


1 WHO Fact Sheet No.348

2 ‘Too far, too little, too late: a community-based case-control study of maternal mortality in rural west Maharashtra, India’, B.R. Ganatra, K.J. Coyaji, & V.N. Rao.

3 ‘Maternal and Child Mortality and Total Fertility Rates’, Office of Registrar General, India, July 2011

4 Prata N, Passano P, Sreenivas A, Gerdts CE. Maternal mortality in developing countries: challenges in scaling-up priority interventions. Womens Health (Lond Engl). 2010 Mar;6(2):311-27. doi: 10.2217/whe.10.8. Review. PubMed PMID:20187734.

5 WHO Fact Sheet No.348, May 2012

6 WHO

7 ‘Health And Healthcare In Maharashtra :A Status Report’- Centre for Enquiry into Health and Allied Themes’, 2005

8 NFHS 3 (2005-06)

9 UNFPA (2004). State of World Population, 2004;http://www.unfpa.org/swp/2004/english/ch9/page5.htm; accessed 9/07/2013

Excerpt out of 36 pages

Details

Title
Causes for the Decline in the Maternal Mortality Ratio in Maharashtra, India. The Period From 1990-2009
College
Savitribai Phule Pune University, formerly University of Pune  (Centre for Development Studies and Activities (CDSA), Pune, India)
Course
M.A. Development Planning and Administration
Grade
75.00% 1st Class w. Distinction
Author
Year
2013
Pages
36
Catalog Number
V1010202
ISBN (eBook)
9783346406682
ISBN (Book)
9783346406699
Language
English
Notes
Received the highest grade in the class.
Tags
public health, sustainable development, maternal health, development studies, India, Maharashtra
Quote paper
Sanjana Mulay (Author), 2013, Causes for the Decline in the Maternal Mortality Ratio in Maharashtra, India. The Period From 1990-2009, Munich, GRIN Verlag, https://www.grin.com/document/1010202

Comments

  • No comments yet.
Read the ebook
Title: Causes for the Decline in the Maternal Mortality Ratio in Maharashtra, India. The Period From 1990-2009



Upload papers

Your term paper / thesis:

- Publication as eBook and book
- High royalties for the sales
- Completely free - with ISBN
- It only takes five minutes
- Every paper finds readers

Publish now - it's free