ACROSS the state, while fewer pregnant women are dying of sepsis or haemorrhage than previously, eclampsia or blood pressure-induced convulsions has emerged as a common cause for maternal deaths. A review of maternal deaths across Maharashtra in 2015-16 has shown that pregnant women with pre-existing hypertension or diabetes are most prone to eclampsia, though experts claim healthy women can suffer pregnancy-induced hypertension as well. In 2015-16, 1,333 maternal deaths were reported and reviewed in Maharashtra. Eclampsia was responsible for 24.8 per cent of the total deaths, followed by haemorrhage (excessive bleeding) at 18.5 per cent and sepsis responsible for 13.2 per cent of these deaths.
Compared to 2014-15, maternal deaths on account of eclampsia rose from 16.9 per cent to 24.8 per cent of the total, while fatality due to haemorrhage reduced from 19.4 per cent to 18.5 per cent, in the same period. Maternal deaths due to sepsis also reduced from 13.6 per cent to 13.3 per cent.
“We have been able to control haemorrhage and sepsis by training health workers on infection control mechanism and promoting institutional deliveries,” said Dr Madhusudan Karnataki, who handles the subject of maternal health at the Directorate of Health Services (DHS). In case of eclampsia, he added, pregnant women do not go for regular check-ups and pregnancy-induced hypertension sometimes remains undiagnosed. “Free anti-hypertensive pills are available but its awareness amongst mothers is low. This can be diagnosed by health workers and referred to a gynaecologist for follow up but women do not turn up,” he said.
Seventeen per cent of the 1,333 expectant mothers who died were illiterate, and over 40 per cent had not studied beyond Class VIII. Educating such women about ante-natal care has been a challenge, officials concede. The maternal deaths’ review also found that 58 per cent of those who died lived below the poverty line.
The regions reporting the highest maternal deaths are Nagpur, Nashik, Thane and Mumbai which have tertiary care hospitals and receive the most complicated cases. Maternal mortality review data (2015-16) accessed by The Indian Express showed that maximum deaths (42 per cent) were of young mothers in age group 20-24 years.
“The major challenge in curbing maternal mortality is early registration. If pregnant women are enrolled within first trimester, early diagnosis and timely treatment is possible,” said Dr Mangala Gomare, who heads BMC-run maternity homes. In 2016, Mumbai saw 200 deaths per lakh live births, a rise from 180 deaths per lakh live births in 2015. Of these, hepatitis, hypertensive disorder that includes eclampsia and haemorrhage accounted for 51 per cent.
The Health Management Information System also showed that of 21.8 lakh pregnant women in Maharashtra, at least 74 per cent (16.1 lakh) had anaemia, or a poor haemoglobin count. The mortality review report showed that severe anaemia was responsible for 6.6 per cent deaths.
In 2016-17, Maharashtra’s maternal mortality rate (MMR) stood at 61. The government planned to further reduce it to 47 this year but the goal has so far not been achieved. According to Dr Archana Patil, director of family planning at DHS, Maharashtra, has already achieved the millennium development goal of reducing MMR below 70 in 2013. By 2030, the state plans to bring MMR further down to 19. A review of maternal deaths began in 2010 following a government resolution to investigate each death, its causes and strategise policies to reduce MMR. In several cases, it was found that ante-natal care workers were not doing enough home visits to identify pregnant women. The report showed that in 360 deaths, the antenatal care (ANC) worker visited the pregnant women only once or twice.
The Union government has initiated Pradhan Mantri Surakshit Matritva Abhiyan in November 2016 to reduce infant and maternal deaths by providing specialised gynaecology services and free antenatal care, including ultrasound, urine and blood tests. Private gynaecologists, obstetrics, radiologists and physicians have been invited to provide voluntary services at government hospitals under this scheme. In Maharashtra, 342 private doctors have registered with the scheme till now. Madhya Pradesh leads with 625 doctors volunteering.