Maternal mortality -- aetiological factors: analytic study from a teaching hospital of Punjab.

PIP: A review of maternal deaths at Rajendra Hospital, Punjab, from January 1978 to December 1991 yielded important data for the planning of maternal health services in this area of India, During the 14 year study period, there were 33,160 births and 339 deaths, for a maternal mortality rate of 1002/100,000 live births. Women who had received no prenatal care accounted for 47.4% of deliveries but 92.8% of maternal deaths. In addition, a disproportionate number of deaths involved rural women (74.6%) and poor women (76.4%). 57.8% of maternal deaths involved women 21-30 years of age; 37.1% occurred among primigravidas. Direct obstetrical causes were considered the etiologic factor in 83.1% of these deaths. Primary among these causes were sepsis (37.1%), obstetric hemorrhage (26.2%), hypertensive disorders of pregnancy (21.4%), and obstructed labor (15.3%). 30.6% of deaths occurred during pregnancy, 50.3% during labor, and 19.1% in the postpartum period. Indirect obstetrical causes, notably severe anemia and anesthesia complications, were implicated in 15.3% of the maternal deaths. Critical analysis of the maternal deaths in this series suggested that 89.6% were totally preventable, 9.6% were probably preventable, and only 0.8% were not avoidable. Factors that would reduce the high rate of maternal mortality in this region include more widespread use of prenatal care, training of traditional birth attendants in asepsis, referral of high-risk pregnancies, and improved transportation in rural areas.^ieng

Indian women's reproductive health -- challenges and remedies.

PIP: The state of Indian women's health is appalling. At least 50% of women of all age groups suffer from anaemia. The pregnant woman in India faces a risk of death due to pregnancy that is 50 times higher than for women in industrialized countries. According to the recently released provisional figures of the 1991 census, India's population has reached 844 million, showing an increase of 23.5% during the previous decade. The all-India growth rate of 2.11% annually is only marginally less from 2.23% of the earlier decade. Another disheartening feature of the 1991 census is the declining sex ratio. The number of females in India was 929 per 1000 males compared to 934 in 1981. Only 39.42% of females are literate, compared to 63.86% of males. A trial of the reproductive health care approach for population control and women's health could be a remedial measure. The existing programs such as family welfare, child survival, maternal and child health, safe motherhood initiative, and all-India hospital postpartum programs could serve as useful building blocks for broad-based reproductive health care. It is estimated that out of all pregnancies 50% are high risk pregnancies and require referral to an apex hospital, but so far only 6.2% of cases have access to such a facility. Thus, speedy transportation of such cases is urgently needed. The emphasis also has to be shifted from curative medicine to preventive medicine. The primary health care concept combining traditional and modern medicine is still needed. It is estimated that fewer than 30% of deliveries are in institutions, and the rest are conducted by traditional birth attendants (TBAs). TBAs should be trained in the techniques of asepsis and how to recognize high-risk pregnancy cases.^ieng