Reducing maternal mortality in remote villages spread far and wide in forest and forest fringe areas, is a huge challenge. A reputed public health organisation Jan Swasthya Sahyog (JSS) has attempted to meet this challenge at several levels in Bilaspur district of Chattisgarh.
Traditional midwives already working in these villages have been identified and provided training to first, significantly improve the medical quality of their work, and second, help them better recognise the signs of complicated cases, so that such cases can be immediately referred to the main hospital. The work of dais, particularly with reference to hygiene and important precautions, has been significantly improved. The dais, helped by village health workers look out for early signs of complicated pregrancy cases so that those women can get hospital care at the proper time. They are also trained in matters like simple ways of making the new born cry (if the baby doesn’t cry on its own), such as massaging the back of the baby, rubbing the soles, cleaning the head etc. In case of heavy bleeding after birth, they can take emergency steps to check the bleeding till the mother can be taken to the hospital.
Secondly, several ANC (Ante-Natal Care) centres have been set up where all expectant mothers (including those from outside the project area) and from nearby villages, can come for essential tests as well as overall guidance on safe motherhood. Along with counselling, the women go for essential tests relating to sickle-cell, haemoglobin, hepatitis B, proteins in urine, HIV, VDRI and anaemia. This effort is supported by health sub-centres in the form of provision of essential medicines and supplements, such as iron and calcium tablets. Importance of good nutrition for expectant mothers, and later for breast feeding mothers is emphasised time and again. Essential medicines for protection from malaria are also provided at the proper time (once every week after 3 months of pregnancy), along with a mosquito net.
Dr. Suhas Kadam, co-ordinator of Community Medicine says, “There are many prevailing beliefs in the area which are contrary to medical advice. For example, the insistence on immediate bathing of the newborn is not advisable as the newborn needs warmth. Sometimes, women do not feed the newborn baby for three or four days, while feeding should start immediately. Counselling at ANC centres helps to dispel such superstitions.
JSS made a significant effort to understand the causes of maternal death by undertaking a detailed survey of 55 maternal deaths. Direct and indirect, all types of factors which contributed to the tragedy were considered and discussed. Direct causes are those related to the pregnancy and delivery processes – hemorrhage, sepsis, hypertensive disorders of pregnancy, obstructed labour, abortion. Indirect causes include HIV, TB, malaria, hepatitis, anaemia, heart conditions etc. which are not caused by pregnancy, but become more risky because of the woman’s pregnant status. A significant aspect of this study was that social causes also got due recognition along with clinical causes.
On the basis of such studies the JSS has listed details of better obstetric technology, improved hospital technology, better transport facilities, and overall improvement in comprehensive health care which are needed to reduce maternal mortality. What is more, this research reveals that overall correction of inequalities at all levels, including gender and rural-urban inequalities are needed to ensure that mothers in particular, and women in general, from the poorest families in our remote villages, get proper health care.
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Bharat Dogra
The writer is a Delhi-based freelance journalist who writes on social concerns.[/column]