India: Combating Maternal Mortality
In India, where a woman dies in childbirth every four and a half minutes, a new strategy introduced by UNICEF to save mothers’ lives has come not a moment too soon.
Known as MAPEDIR — the Maternal and Perinatal Death Inquiry and Response — the project, funded by the British Government, is developed and implemented with technical assistance from Johns Hopkins University. The new tool uses verbal autopsies to gain insights from people in the communities who have had firsthand experience with the tragedy of maternal death.
One–on–one interviews are conducted with family members in 15 high–mortality districts across India. The data collected through these interviews are then analyzed for local communities to increase their understanding and awareness of maternal deaths and to enable them to take life–saving measures.
Common factors leading to death during pregnancy include anaemia, haemorrhage, eclampsia, obstructed labour and unsafe abortion. But underlying causes exist which are more difficult to document, including the low social status of women, lack of awareness or sheer distance from appropriate health care facilities. Many health care centres in India still suffer from limitations such as inadequate delivery facilities, lack of transport and limited availability of blood.
With its vast population and a ratio of 450 maternal deaths per 100,000 live births, India accounts for more than 20 percent of global maternal deaths — most of which could be prevented with access to the right kind of information. Speaking directly to the community will make it easier to identify not only the biological factors that contribute to maternal and perinatal death, but also the social and cultural factors.
Significant underreporting of maternal deaths – either because the underlying cause was never determined or the relevant information was not recorded – makes it difficult to evaluate why maternal mortality rates in India are so high. This strategy encourages communities to report the deaths of all women of reproductive age. Then, if maternal deaths are suspected, interviews are conducted.
This grassroots approach aims not only to identify the causes of maternal death and act upon them, but to empower local communities to assess the quality of care they receive and create demand for better services.
India’s Ministry of Health and Family Welfare has already stressed the need for providing skilled birth attendants and hospitals adequately equipped with emergency obstetric care, yet India continues to lose women to preventable causes. If the reasons behind these deaths remain unknown and unreported, it will be difficult to make significant improvement in maternal health in India. MAPEDIR seeks to provide the missing information and lower these numbers by raising awareness.