Maternal mortality in rural India: a hospital based, 10 year retrospective analysis

Wealth and education-related inequalities in the utilisation of reproductive, maternal, newborn, and child health interventions within scheduled tribes in India: an analysis of Odisha and Jharkhand

BACKGROUND

The utilisation of Reproductive, Maternal, Newborn and Child Health (RMNCH) services remains lower among the Scheduled Tribes (ST) in India than among the rest of the country's population. The tribal population's poorest and least-educated households are further denied access to RMNCH care due to the intersection of their social status, wealth, and education levels. The study analyses the wealth- and education-related inequalities in the utilisation of RMNCH services within the ST population in Odisha and Jharkhand.

METHODOLOGY

We have constructed two summary measures, namely, the Co-coverage indicator and a modified Composite Coverage Index (CC), to determine wealth- and education-related inequalities in the utilisation of RMNCH indicators within the ST population in Odisha and Jharkhand. The absolute and relative inequalities with respect to wealth and education within the ST population are estimated by employing the Slope Index of Inequality (SII) and the Relative Index of Inequality (RII).

RESULTS

The results of the study highlight that access to RMNCH services is easier for women who are better educated and belong to wealthier households. The SII and RII values in the co-coverage indicator and modified CCI exhibit an increase in wealth-related inequalities in Odisha between NFHS-4 (2015-16) and NFHS-5 (2019-21) whereas in Jharkhand, the wealth- and education-related absolute and relative inequalities present a reduction between 2016 and 2021. Among the indicators, utilisation of vaccination was high, while the uptake of Antenatal Care Centre Visits and Vitamin A supplementation should be improved.

INTERPRETATION

The study results underscore the urgent need of targeted policies and interventions to address the inequalities in accessing RMNCH services among ST communities. A multi-dimensional approach that considers the socioeconomic, cultural and geographical factors affecting healthcare should be adopted while formulating health policies to reduce inequalities in access to healthcare.

Measuring unsafe abortion-related mortality: a systematic review of the existing methods

BACKGROUND

The WHO estimates that 13% of maternal mortality is due to unsafe abortion, but challenges with measurement and data quality persist. To our knowledge, no systematic assessment of the validity of studies reporting estimates of abortion-related mortality exists.

STUDY DESIGN

To be included in this study, articles had to meet the following criteria: (1) published between September 1(st), 2000-December 1(st), 2011; (2) utilized data from a country where abortion is "considered unsafe"; (3) specified and enumerated causes of maternal death including "abortion"; (4) enumerated ≥100 maternal deaths; (5) a quantitative research study; (6) published in a peer-reviewed journal.

RESULTS

7,438 articles were initially identified. Thirty-six studies were ultimately included. Overall, studies rated "Very Good" found the highest estimates of abortion related mortality (median 16%, range 1-27.4%). Studies rated "Very Poor" found the lowest overall proportion of abortion related deaths (median: 2%, range 1.3-9.4%).

CONCLUSIONS

Improvements in the quality of data collection would facilitate better understanding global abortion-related mortality. Until improved data exist, better reporting of study procedures and standardization of the definition of abortion and abortion-related mortality should be encouraged.

Determinants of maternity care services utilization among married adolescents in rural India

BACKGROUND

Coupled with the largest number of maternal deaths, adolescent pregnancy in India has received paramount importance due to early age at marriage and low contraceptive use. The factors associated with the utilization of maternal healthcare services among married adolescents in rural India are poorly discussed.

METHODOLOGY/PRINCIPAL FINDINGS

Using the data from third wave of National Family Health Survey (2005-06), available in public domain for the use by researchers, this paper examines the factors associated with the utilization of maternal healthcare services among married adolescent women (aged 15-19 years) in rural India. Three components of maternal healthcare service utilization were measured: full antenatal care, safe delivery, and postnatal care within 42 days of delivery for the women who gave births in the last five years preceding the survey. Considering the framework on causes of maternal mortality proposed by Thaddeus and Maine (1994), selected socioeconomic, demographic, and cultural factors influencing outcome events were included as the predictor variables. Bi-variate analyses including chi-square test to determine the difference in proportion, and logistic regression to understand the net effect of predictor variables on selected outcomes were applied. Findings indicate the significant differences in the use of selected maternal healthcare utilization by educational attainment, economic status and region of residence. Muslim women, and women belonged to Scheduled Castes, Scheduled Tribes, and Other Backward Classes are less likely to avail safe delivery services. Additionally, adolescent women from the southern region utilizing the highest maternal healthcare services than the other regions.

CONCLUSIONS

The present study documents several socioeconomic and cultural factors affecting the utilization of maternal healthcare services among rural adolescent women in India. The ongoing healthcare programs should start targeting household with married adolescent women belonging to poor and specific sub-groups of the population in rural areas to address the unmet need for maternal healthcare service utilization.

Maternal mortality in a Nigerian teaching hospital - a continuing tragedy

The aim of this review is to determine the maternal mortality ratio (MMR) in a Nigerian tertiary health institution (University of Ilorin Teaching Hospital, Ilorin, Nigeria). The review was done through a retrospective analysis of maternal mortality records. The MMR for the 6-year period (1997-2002) was 825 per 100,000 live births. The common causes of maternal mortality included severe pre-eclampsia/eclampsia, 30 (27.8%); haemorrhage, 22 (20.4%) and complications of unsafe abortion 16 (14.8%). Grandmultiparous and patients aged 40 years and above were at the highest risk. This hospital-based MMR is very high and when compared with previous reports showed a 150% increase. Most of the maternal deaths are, however, preventable. Increased efforts at educating women, improvement of the socioeconomic conditions of the populace and strong political commitment in making emergency obstetric care available in rural and district hospitals are some of the measures that need to be adopted to reduce this avoidable tragedy.

Septic abortion: a review of social and demographic characteristics

Septic abortion is a significant health problem with short- and long-term complications that affect the quality of life of those fortunate enough to avoid mortality. Both spontaneous and induced abortion can result in septic complications, with the latter disproportionately higher. Its incidence is high in environments with restrictive abortion laws, as clandestine procedures by non-doctors in unhygienic settings are prevalent. This study shows that it is still more common among teenagers and mainly performed by health professionals, which means that health care interventions should be re-evaluated and appropriately directed to preserve the reproductive health status of this vulnerable population.

Induced septic abortion: a major factor in maternal mortality and morbidity

BACKGROUND

Septic abortion is an infection of the uterus and its appendages following any abortion especially, illegally performed induced abortions. It is characterized by a rise of temperature to at least 100.4 degrees F, associated offensive or purulent vaginal discharge and lower abdominal pain and tenderness.

AIM

To study maternal mortality and morbidity in induced septic abortions.

METHODS

Induced septic abortions were analyzed between April 1992 and September 1999 in TU Teaching hospital. Morbidity indicators were surgery other than curettage, prolonged hospitalization and permanent damage.

RESULTS

In 92 cases of induced septic abortions, comprising 6% of total abortions; nine deaths occurred because of disseminated intravascular coagulation, acute renal failure and adult respiratory distress syndrome. Vaginal, intraperitoneal and gum bleeding; epistaxis and malaena resulted in severe anemia (Hb < 6 gm/L) in 11 cases. Wound debridement and skin graft cured two cases of necrotizing fasciitis. One of four conservatively managed tubo-ovarian masses spontaneously drained rectally. In 15 cases laparotomy for pus drainage, salpingectomy, salpingo-oophorectomy, hysterotomy/uterine rent repair was conducted, along with four bowel surgeries and six hysterectomies were performed. Post-operative complications included burst abdomen (one case) and reopened pyoperitoneum, which resulted fecal fistula in three cases, one of these patients died.

CONCLUSION

: Induced abortion was proven to be a major detrimental factor for maternal mortality. Morbidity was four times higher than mortality to the extent that patients suffered hemiplegia and forced barrenness.

Characteristics of antepartum and intrapartum eclampsia in the National Maternal and Child Health Center in Cambodia

AIM

To measure maternal and perinatal outcome and analyze risk factors for antepartum and intrapartum eclampsia, which is one of main causes of high maternal mortality at the top referral hospital in the Kingdom of Cambodia.

METHODS

A hospital-based retrospective study of 164 antepartum and intrapartum eclampsia cases out of 20,449 deliveries.

RESULTS

Overall case-fatality rate was 12%. Rate of stillbirth and low birth weight were 20% and 44%, respectively. Eighty percent of the cases presented signs of severe pre-eclampsia and 27% of the patients who gave birth received cesarean section. Living outside the capital city, teenage pregnancy and twin pregnancy are more frequently associated with eclampsia.

CONCLUSION

Antepartum and intrapartum eclampsia is associated with severe pre-eclampsia and with poor maternal and perinatal outcome. Recommendations to reduce the burden of eclampsia are promoting and improving quality of antenatal care and health education especially in the third trimester; increasing access to high-quality essential obstetric care; improving the service delivery in rural areas; and monitoring the progress by hospital data.

Unsafe abortion: the silent scourge

An estimated 19 million unsafe abortions occur worldwide each year, resulting in the deaths of about 70,000 women. Legalization of abortion is a necessary but insufficient step toward improving women's health. Without skilled providers, adequate facilities and easy access, the promise of safe, legal abortion will remain unfulfilled, as in India and Zambia. Both suction curettage and pharmacological abortion are safe methods in early pregnancy; sharp curettage is inferior and should be abandoned. For later abortions, either dilation and evacuation or labour induction are appropriate. Hysterotomy should not be used. Timely and appropriate management of complications can reduce morbidity and prevent mortality. Treatment delays are dangerous, regardless of their origin. Misoprostol may reduce the risks of unsafe abortion by providing a safer alternative to traditional clandestine abortion methods. While the debate over abortion will continue, the public health record is settled: safe, legal, accessible abortion improves health.