Maternal mortality rate in India Recent RCH Schemes of Government of India Causes of MMR in INDIA Preventive stratergies

1. MATERNAL
MORTALITY:
LOOKING BACK AND
MOVING FORWARD
Dr. Sathiyalatha Sarathi
Vice Principal,
Sree Balaji College of Nursing

2. INRODUCTION
• Paradise lies under the feet of the
mother – Holy Quran (Islam)’
From this we can judge women’s
respect and importance in our life
and society.
• They play their roles with great
responsibilities in upbringing of a
health solid society. A good solid
society is a good harbinger of
development
• The survival and wellbeing is not
only important in their own right
but also key to solve larger-
broader social, economical and
developmental challenges.

3. BACKGROUND
Each year in India, roughly 28 million women experience
pregnancy and 26 million have a live birth. Of these, an
estimated 67,000 maternal deaths and one million newborn
deaths occur each year.
In addition, millions more women and newborns suffer
pregnancy and birth related ill-health.
Thus, pregnancy-related mortality and morbidity continues to
have a huge impact on the lives of Indian women and their
newborns.

4. Historical Horror of
childbirth
• Local Dias
• Unhygienic place
• Lack of care for poor women
during childbirth

5. MMR
• According to WHO maternal
mortality defined as the death of
a woman while pregnant or
within 42 days of termination of
pregnancy

6. Total no of female deaths due to complications of pregnancy, childbirth or within
42 days of delivery from puerperal causes in an area during a giver year
MMR =
x 1000 (or) 100,000
Total no.of live births in the same area and year
MMR ratio

7. Maternal Mortality Rate -
worldwide
• Maternal mortality is unacceptably high. About
295 000 women died during and following
pregnancy and childbirth in 2017. The vast
majority of these deaths (94%) occurred in low-
resource settings, and most could have been
prevented.
• Sub-Saharan Africa and Southern Asia accounted
for approximately 86% (254 000) of the estimated
global maternal deaths in 2017.
• Sub-Saharan Africa alone accounted for roughly
two-thirds (196 000) of maternal deaths, while
Southern Asia accounted for nearly one-fifth
(58 000).

8. and 2017, Southern Asia
• At the same time, between 2000
achieved the greatest overall
reduction in MMR: a decline of
nearly 60% (from an MMR of 384
down to 157).
• Despite its very high MMR in
2017, sub-Saharan Africa as a
sub-region also achieved a
substantial reduction in MMR of
nearly 40% since 2000.
• Additionally, four other sub-
regions roughly halved their
MMRs during this period: Central
Asia, Eastern Asia, Europe and
Northern Africa.
• Overall, the maternal mortality
ratio (MMR) in less-developed
countries declined by just under
50%.
GLOBAL DECLINE IN MATERNAL
MORTALITY RATE

9. MMR- Key facts
Every day in 2017,
approximately 810 women
died from preventable
causes related to pregnancy
and childbirth.
Between 2000 and 2017,
the maternal mortality ratio
(MMR, number of maternal
deaths per 100,000 live
births) dropped by about
38% worldwide.
94% of all maternal deaths
occur in low and lower
middle-income countries.
Young adolescents (ages 10-
14) face a higher risk of
complications and death as
a result of pregnancy than
other women.
Skilled care before, during
and after childbirth can
save the lives of women
and newborns.

10. Where do maternal deaths
occur?
• The high number of maternal deaths in some
areas of the world reflects inequalities in access
to quality health services and highlights the gap
between rich and poor.
• The MMR in low income countries in 2017 is
462 per 100 000 live births versus 11 per
100 000 live births in high income countries.
• 99% of all maternal deaths occur in the developing
countries
• Sub Saharan Africa and Southern Asian countries
account for most maternal deaths.

11. Causes of MMR
worldwide
• Severe bleeding (25%)
• Infection (15%)
• Eclampsia (12%)
• Obstructed labour (8%)
• Unsafe abortion (13%)
• Other direct causes (8%)
• Indirect causes (20%)
• Indirect causes including anemia,
malaria, heart diseases.
• Other direct causes including ectopic
pregnancy, embolism, anesthesia
related.
Causes of MMR worldwide
20%
25%
8%
13%
15%
8% 12%
Severe bleeding
Obstructed labour
Indirect causes
Infection
Unsafe abortion
Eclampsia
Other direct causes

12. Causes of
MMR IN India
• Haemorrhage (38%)
• Sepsis (11%)
• Hypertensive disorders (5%)
• Obstructed Labour (5%)
• Abortion (8%)
• Other conditions (34%)
Causes of MMR in India
5%
5%
11%
38%
Haemorrhage
Obstructed labour
Sepsis
Unsafe Abortion
Hypertensive disorders
Other Conditions

13. WHY DO WOMEN DIE
?
75% OF MMR is caused by
• Haemorrhage
• PIH
• Puerperal sepsis
• Uterine rupture
• Anemia
• Infection
• Non- Medical abortion
• Cardiac Arrest
• Poor Management of delivery
• Cardiac Arrest

14. RISK FACTORS OF PPH
Postpartum
haemorrhage
ATONY OF UTERUS
Multiparity
Age over 35 years with stretched
uterus

15. • Severe Bleeding : After birth can kill a
healthy women within hours if she is
unattended. Injecting Oxytocics immediately
after childbirth effectively reduces the risk of
• Plasma expanders(Plasma Protein) -
Treatment of circulatory Shock
Referral to an equipped facility must be
available to woman with PPH
Management
of PPH
bleeding.

16. • NASG – Non-Pneumatic
antishock Garment
• It stabilizes a women in shock
and hemorrhage.
• This can save a woman’s life
Postpartum Hemorrhage

17. Puerperal infection- Infection of the Genital
Tract following childbirth
Risk factors
Prolonged labour
Multiple Vaginal Examinations
PPH
Pre-existing STDS
Vaginal lacerations
Unhygienic practices during labour
Retained Placenta
Obstetrical Manoeuvres
Prolonged retention of dead fetus
Lows-socio economic status
Poverty
Anaemia
Diabetes

18. Puerperal Infection
• In India, 11% of the Maternal deaths occurs due to puerperal infection.
• It can be prevented by Maintaining hygiene and hand washing and following
strict aseptic techniques
• Reducing the frequent PV examination and judicious use of antibiotics in
mothers showing signs of infection (REEDA Scale can be used to assess the
signs of infection)

19. Previous
prolonged labour
or stillbirth
Very young age
Height below
145cms
RISK FACTORS:
Obstructed labour
Previous LSCS
Abnormal
Presentation
Abnormal labour
progression

20. • Gender bias in the allocation of meager food
supplies results in poor health, rendering a
woman’s pelvis too small, which causes
obstructed labour.
Social Factor

21. Management of
Obstructed
Labour
• Monitoring Partograph
during labour for early
identification of any
deviation from normal
progress.
• Delivery of those woman
with obstructed labour must
be in facility offering trained
doctors and well-equipped
operating rooms.

22. Administering drugs such as magnesium sulfate for pre- eclampsia can lower a
woman’s risk of developing eclampsia.
Pre- Eclampsia
Pre-Eclampsia should be detected and appropriately managed before the onset
of convulsions ( eclampsia) and other life- threating complications.

23. Unsafe Abortion
• The WHO estimates that almost half
a million woman in developing
countries die in pregnancy and
childbirth every year.
• Unsafe abortion is responsible for
100-400/100,000 deaths which
accounts for 25-50% of all maternal
deaths.
• Whereas in safe abortion the
maternal deaths are estimated
6/200,000.

24. •Safe, legal services for terminating unwanted pregnancies be offered as
an integral part of national primary health care systems.
Also, enormous costs to the health care system for treating
abortion complications.
shock and secondary sterility.
haemorrhage,
pelvic infection,
incomple abortion,
Even when woman survive the procedure,there are
numerous possible physical complicatiions includes
Complications
of Abortion

25. • Mismanagement during
labour by
• Previous LSCS-VBAC
• Myomectomy
• Uterine Perforation ( D&C,
Forceps delivery)
• Oxytocin drugs
Rupture of uterus

26. • Obstetric causes include hemorrhage, eclampsia and amniotic fluid
embolism.
• Non- obstetric causes are sepsis, pulmonary embolism, preexisting
cardiovascular diseases and stroke.
• Iatrogenic causes includes anesthetic complications during delivery or
testing.
Why do pregnant women suffer from cardiac
Arrest?

27. Obstetric CPR
• When a woman is found to be unresponsive and not breathing
properly:
• Call for help
• One person should immediately start high-quality CPR at a
rate of 30 compressions to 2 breaths
• One person should manage her airway(provide ventilation
with bag-valve mask and intubation)
• And someone should apply manual left uterine displacement
to help ensure proper blood flow to the heart. ( push the
women’s uterus towards left side)

28. • Addressing inequalities in
access to and quality of
reproductive, maternal, and
newborn health care services;
• Ensuring universal health
coverage for comprehensive
reproductive, maternal, and
newborn health care;
• Addressing all causes of
maternal mortality, reproductive
and maternal morbidities, and
related disabilities;
• Strengthening health systems
to collect high quality data in
order to respond to the needs
and priorities of women and
girls.
WHO response- MMR

29. The sustainable goal
development goals-MMR
• In the context of the Sustainable Development Goals
(SDG), countries have united behind a new target to
accelerate the decline of maternal mortality by 2030.
• SDG 3 includes an ambitious target:
• “reducing the global MMR to less than 70 per 100 000
births, with no country having a maternal mortality rate
of more than twice the global average”.

30. • Prenatal care include nutritional
supplements and obstetrical
examination
• Targeting woman suffering from
toxemia, bleeding and infections
• Local ambulances with life support
equipment and maternity waiting
houses.
• Referral centers should be capable of
providing sterile conditions and blood
transfusions
• Referrals by trained birth attendants
Effective Strategies for Reducing Maternal
Mortality in India

31. Role of community nurse
in reducing MMR in India
• To improve quality of MCH care at the rural community level (which
includes proper history taking, palpation,blood pressure and fetal heart
screening, risk factor screening and referral)
• To improve the quality of care at the primary health care level
(emergency care and proper referral).
• Attention should be directed to delivery practices and facilities, which
accounts for most of the Maternal mortality.( Clean and well- equipped
labour room).
• High-risk risk mothers should be housed in Maternity waiting homes
located near Hospitals.
• To give attention to care during labour and delivery, which is the most
critical period of complications

32. Key Strategies for accelerating the
pace of decline in MMR
Capacity
Building
Training ASHs
& ANMs
MCTs Tracking
National Iron
plus Initiative
Dakshata
Guidelines
Janani Surekha
Yojana (JSV)
RMNCH +
Approach
MCH Wings

33. • The main of RCH programme is to reduce the
maternal morbidity & mortality and promote
adolescent Health.
Components of RCH
• Essential Obstetrical Care
• Emergency Obstetrical Care
• Strengthening infrastructure
• Capacity Building
• Improving referral system
• Innovative Schemes
THE RCH Programme

34. Essential
Obstetrical
Care
Promotion of Institutional Deliveries
50% of the PHCs and CHCs made operational as
24hours delivery centres.
Skilled attendance at birth
Policy decisions to permit health workers to use
drugs in emergency situations to reduce maternal
mortality.

35. Operationalisation of FRUs to provide:
• 24 hours delivery services
• Emergency Obstetric Care
• Safe abortion services
• Emergency care of the sick child
• Treatment of RTI and STI
• Blood Storage facility
• Essential Laboratory Services
• Referral transport system
Emergency Obstetrical Care

36. Recent MCH Schemes

37. • RMNCH+A approach has been launched in 2013 and it essentially looks to address the major
causes of mortality among women and children as well as delay in accessing and utilizing health
care and and services.
• The RMNCH+A approach has been developed to provide an understanding of continuum care
to ensure equal focus on various life strategies’
• MATERNAL HEALTH – INTERVENTIONS
• Use MCTS
• High risk pregnancies
• Review maternal and Infant deaths
• Identify low institutional delivery areas and incentivize ANMs for domiciliary care services.
RMNCH+A approach

38. Janani Surekhsa
Yojana (JSV)
• The Yojana, launched on 12th April 2005. Janani
Suraksha Yojana (JSY) is a safe motherhood
intervention under National Health Mission
(NHM), being implemented with the objective
To reduce maternal and neonatal mortality by
promoting institutional delivery among the poor
pregnant women.
To promote institutional deliveries
• JSY is a 100% centrally sponsored scheme which
integrates cash assistance with delivery and post-
delivery care.
• The Yojana has identified Accredited Social
Health Activist (ASHA).
• They are the effective link between the
Government and pregnant woman

39. • The scheme focuses on identifying poor
pregnant women in low performing
states(LPS)- Utterpradesh, Uttaranchal, Bihar,
Jharkhand, Madhya Pradesh, Chhattishgarh,
Assam, Rajasthan, Orissa and Jammu and
Kashmir.
• Tracking each Pregnancy: Each beneficiary
registered under the Yojana should have a JSV
card and along with MCH Card. ASHA/AWW/
under the supervision of ANM and MO, should
mandatorily prepare the micro-birth plan. This
will effectively help in monitoring Ante-natal
Check-ups and the post delivery care.
Important features of JSV

40. Pradhan Mantri Surakhit Matritva
Abhiyan(PMSMA)
• The Pradhan Mantri Surakshit Matritva Abhiyan(PMSMA) has been
launched by the Ministry of Health & Family Welfare (MoHFW) in
June, 2016.
• Rational for the program:
• Data indicates that Maternal Mortality Ratio (MMR) in India was
very high in the year 1990 with 556 women dying during
childbirth per hundred thousand live births as compared to the
global MMR of 385/lakh live births.
• As per RGI- SRS (2011-13), MMR of India has now declined to
167/lakh live births against a global MMR of 216/lakh live births
(2015).
• India has registered an overall decline in MMR of 70% between
1990 and 2015 in comparison to a global decline of 44%.

41. • Antenatal checkup services would be provided by
OBGY specialists / Radiologist/physicians with
support from private sector doctors to supplement
the efforts of the government sector.
• A minimum package of antenatal care services
(including investigations and drugs) would be
provided to the beneficiaries on the 9th day of every
month at identified public health facilities (PHCs/
CHCs, DHs/ urban health facilities etc) in both urban
and rural areas.
• Using the principles of a single window system, it is
envisaged that a minimum package of investigations
(including one ultrasound during the 2nd trimester of
pregnancy) and medicines such as IFA supplements,
calcium supplements etc would be provided to all
pregnant women attending the PMSMA clinics.
Key Features
of PMSMA

42. • While the target would reach out to all pregnant women
special efforts would be made to reach out to women
who have not registered for ANC (left out/missed ANC)
and also those who have registered but not availed ANC
services (dropout) as well as High Risk pregnant women.
• OBGY specialists/ Radiologist/physicians from private
sector would be encouraged to provide voluntary services
at public health facilities where government sector
practitioners are not available or inadequate.
• Pregnant women would be given Mother and Child
Protection Cards and safe motherhood booklets.
PMSMA- MCH Cards

43. PMSMA- Stickers for Normal/
High risk Pregnancy
• One of the critical components of the Abhiyan is identification
and follow up of high risk pregnancies. A sticker indicating the
condition and risk factor of the pregnant women would be
added onto MCP card for each visit:
• Green Sticker- for women with no risk factor detected
• Red Sticker – for women with high risk pregnancy
• A National Portal for PMSMA and a Mobile application have
been developed to facilitate the engagement of private/
voluntary sector.
• ‘IPledgeFor9’ Achievers Awards have been devised to celebrate
individual and team achievements and acknowledge voluntary
contributions for PMSMA in states and districts across India.

44. Rashtriya Kishor Swasthya
Karyakram (RKSK)
The Ministry of Health and Family welfare
launched Rashtriya Kishor Swasthya
Karyakram (RKSK) on Jan 2014 for
adolescents, in the age group of 10-19 years.
• The target of the programme is
• Improve their Nutrition
• Improve sexual and Reproductive Health
• Enhance Mental Health
• Prevent injuries and violence
• Prevent substance abuse

45. Newer Initiatives (Saathiya Resource kit)
• Shri C.K Mishra, Secretary, Health and family welfare
launched the SAATHIYA Resource Kit including Saathiya Salah
Mobile App for adolescents.
• As part of the Rashtriya Kishor Swasthya Karyakaram (RKSK)
program, one of the key interventions underthe programme
is introduction of the Peer Educators(Saathiyas) who act as a
catalyst for generating demand for the adolescent health
issues to their peer groups.
• The peer educators will also play short films at their group
meetings. The games and the activity books will bring about
discussion and resolove around adolescent queries.

46. • Screening and care for Sexually
Transmitted Infections (STIs) and
Reproductive Tract Infections (RTIs) are
being provided at health facilities as they
constitute an important public health
problem in India.
• A policy decision has been taken for
universal testing of HIV and syphilis in
pregnant women.
• As per HMIS report for FY 2017-18, till
December 2017, over 32 lakh pregnant
women are screened for
• syphilis and approximately 1.06 crore
pregnant women have been screened for
HIV.
Screening
for STDs &
RTIs

47. Training ASHAs & ANMs
• “Prevention of Post-Partum Hemorrhage (PPH) through
Community based advance distribution
of Misoprostol” by ASHAs/ANMs has been launched for
high home delivery districts.
• Operational Guidelines and Reference Manual have been
disseminated to the States.
• However, during the counselling sessions with the pregnant
women conducted by ASHAs and ANMs, emphasis is laid
on the need to register for ANC and delivery at institutions.

48. • Monthly Village Health and Nutrition Days (VHNDs)
is an outreach activity at Anganwadi centers for
provision of maternal and child care including
nutrition in convergence with the ICDS.
• Village Health and Nutrition Days proposed to
organized once in a month at each Anganwadi Centre.
• ANM, Anganwadi Worker and ASHA will ensure
their presence on Saturday (as per schedule) and will
coordinate to make this activity at village level as an
effective intervention.
Village Health and
Nutrition Days (VHNDs)

49. National Iron+ Initiative-
Prevention and control of anemia
The National Iron plus Initiative
(NIPI) is an attempt to look at the Iron
Deficiency Anaemia comprehensively
across all life stages including
adolescents and women in reproductive
age group, pregnant and lactating
mothers.
Pregnant & Lactating women 100mg
elemental iron & 500mcg of folic acid 1
tablet daily for 180 days, starting after
the first trimester, at 14 - 16 weeks of
gestation.
To be repeated for 180 days post -
partum ANC/ANM/ASHA Inclusion in
MCP Card Women in reproductive age
group( 100mg elemental iron)

50. Maternal Health Kit
• Maternal Health Tool Kit has been developed as a ready
reckoner/handbook for programme managers to plan,
implement and monitor services at health facilities.
• It focuses on the Delivery Points, which includes setting up
adequate physical infrastructure, ensuring
• logistics & supplies and recording/reporting & monitoring
systems with the objective of providing good quality
comprehensive RMNCH services.

51. Delivery Points
• More than 50 deliveries per month is conducted in health care
center which is considered as delivery point.
• More than 20,000 ‘Delivery Points’ have been identified across
the country based on performance.
• Delivery Points will ensure assured services 24x7 hours of Mother
and child care like, ANC, intrapartum, postnatal, Newborn and
child care including family planning services.
• 24x7 PHCs and FRUs Doctors and staff Nurses will be trained for
PPIUCD (Postpartum Intrauterine contraceptive Devices)

52. Capacity building
• Capacity building involves training of MBBS doctors in
Anaesthesia (Life Saving Anesthesia
Skills - LSAS) and Emergency Obstetric Care including C-
section (EmOC) skills to overcome
Skilled Birth Attendants (SBA).
• Training of SNs/ANMs/LHVs for improving quality of care
during delivery and childbirth.
• About 1800 doctors have been trained in Emergency Obstetric
Care including C-sections and 2200 doctors in LSAS. Over
1,17,000 SNs/LHVs/ANMs have been trained as SBAs as per
State reports.

53. Skill Labs
• Setting up of Skill Labs has been done with earmarked skill stations for
different training programmes to strengthen the quality of capacity
building of different cadres of service providers in the States.
• Guidelines and training modules of skill labs have been disseminated
to the States.
• Five National Skills labs are now operational for conducting training of
trainers.
• Skill labs have been established at different states such as Gujarat,
Hayana, Maharashtra, MP, West Bengal, Odisha, Tamil Nadu and
Karnataka.
• 1900 health personnel have been trained at the skill labs till date

54. Pre-Service Education-
Nursing Midwifery cadre
Five National Nodal Centre (NNC) are established for Pre-Service
Education for strengthening Nursing Midwifery Cadre
• College of Nursing, Vadodara;
• Kasturba Nursing College, Sewagram, Wardha;
• Regional College of Nursing, Guwahati;
• College of Nursing, Kanpur; and
• College of Nursing MMC, Chennai have been strengthened
Achieving above 70% of performance standards, around 43% of the
targeted ANM & GNM Nursing institutions in the high focus States
have fully equipped mini-skill labs.
85% of these institutions have library and around 89%have IT labs.
Capacity building of 700 nursing faculties in the country through
customized 6 Week Training has been conducted and 6 days training of
250 nursing faculties also have been conducted at National Skills lab
“Daksh”.

55. • Mother and Child Tracking System
(MCTS) is an initiative of Health &
Family Welfare to leverage
information technology for ensuring
delivery of full spectrum of health
care and immunization services to
pregnant women and children up to
the age of 5 years.
• This Web Enabled Mother and Child
Tracking System (MCTS) is being
implemented to register and track
every pregnant woman, neonate,
infant and child by name for quality
ANC, INC, PNC, FP, Immunisation
services.
• It facilitâtes and monitors service
delivery and also establishes a two
way communication between the
service providers and bénéficiaires
Mother and child Tracking
system (MCTS)

56. Maternal Death Review (MDR)
• The process of Maternal Death Review (MDR) has been
institutionalized across the country to identify not just the medical
causes, but also some ofthe socio-economic, cultural determinants.
• As well as the gaps in the system which contribute to the delays
causing such deaths.
• The objective of MDS is corrective action to be taken at
appropriate levels and improving the quality of obstetric care.
• The states are being monitored closely on the progress made in the
implementation of MDR.
• According to the state Reports, 33% of the estimated maternal
deaths have been reported in 2016-17. Out of these, 72.5% deaths
have been reviewed by the District MDR Committees.

57. High Priority Districts (HPDs)
Further to sharpen the focus on the low performing districts, 184hehe
High Priority Districts (HPDs) have been identified.
• The High priority Districts are identified by poor health indicators.
These includes;HH
• 17 districts – Madhya Pradesh
• 19 Districts- utter Pradesh
• 10 Districts- Rajasthan
• 09 Districts- Bihar
• 08 Districts- Gujarat
• 05 Distrits- Haryana, Manipur, Chattishgarg, Punjab and West
Bengal
• 04 Districts- Meghala and Mizoram
• 03 Districts- Kerala and Uttarakhand
• 01 District- Pondicherry, Sikkim and Tripura
• These districts would receive 30% higher per capita funding, have
relaxed norms, enhanced monitoring and focused supportive
supervision and are encouraged to adopt innovative approaches to
address their peculiar health challenges.

58. Maternal and Child Health Wings (MCH Wings)
Govt of India approved the setting up of a 100-bed model Maternal and
Child Health (MCH) wing for providing emergency obstetrical care and
newborn care.
This wing, located close to the registration OPD of the hospital will ensure
that pregnant women and newborn get high quality care
Over 550 dedicated Maternal and Child Health Wings (MCH Wings) with
more than 32,000 additional beds have been sanctioned.

59. Obstetric HDU & ICU
• HDU is an area for Management of high-risk pregnancies
requiring vigilant monitoring and interventions by specially
trained teams
• Obstetric HDU is a part of maternity wing and located near
the labour room and operation theatre, for easy and prompt
shifting of the patient whenever required.
• It is recommended that all pregnancies with complications be
managed in obstetric HDU
• It is an intermediate care unit between labour room and ICU.
• All District Hospitals should have an Obstetric HDU and ICU
to treat Emergency Obstetric Care (EmOC).

60. Dakshata guidelines (New
guidelines)
• Dakshata guidelines for strengthening intra-partum care.
• The main objectives of Dakshata are
• 1. To strengthen the competency of providers of the labour
room.
• 2. To implement evidence based clinical practices.
• 3. To improve the essential supplies and commodities in
labour room
• 4. To improve recording, reporting and utilization of data
• 5. Implementation of MNH Tool Kit at the delivery points

61. Checklist 1: Before Birth-Safe
Childbirth Checklist ( SCC)
• Explain to call for help if there is:
• Bleeding
• Severe abdominal pain
• Difficulty in breathing
• Severe headache or blurred vision
• Urge to push
• Can’t empty bladder every 2 hours
• NO OXYTOCIN/ other uterotonics for
unnecessary induction/augmentation of labour
• Encouraged a birth companion to be present
during labour,at birth and till discharge- Yes/ No

62. Checklist 2: Just Before and During Birth
(or C- Section)
• AMTSL- Ini. Oxytocin 10 units IM given withih ine minute of birth of the baby?
• A. Yes
• B. No
• Breast feeding initiated in first half-an-hour of birth of the baby?
• A.Yes
• B.No
• (AMTSL- Active Management of Third stage of Labour)

63. Checklist 3: Soon after Birth (within 1 hour)
• Started breastfeeding. Explain colostrum feeding is important for the
baby- Yes/No
• Started skin to skin contact (if mother and baby well) and KMC in pre-
term and low-birth weight babies – Yes/No
• Explain the danger signs and confirm mother/ companion will call for
help if danger signs present.

64. Checklist 4: Before Discharge
• Danger Signs:
Mother has any of:
• Excessive bleeding
• Severe abdominal pain
• Severe headache or visual disturbances
• Breathing difficulties
• Fever or chills
• Difficulty emptying bladder
• Foul smelling vaginal discharge

65. • Postpartum care programs should
function as centers for family
• A National blood transfusion
network should be examined as a
feasible plan.
• All Government vehicles should be
at the disposal of emergency
situations.
• Medical students in Departments
of OBG should spend 66% of their
training time in Obstetrics and
practical skills in childbirth and
newborn care,
• Regional centers for research and
evaluation should be established
by the council on Medical
Research.
• The right to safe motherhood
should be ensured.
activities.
MMR- Preventable?
Preventive strategies

66. Role of Maternity nurse/ OBG
Faculty in reducing MMR
• Antenatal care with risk referral
• Health education about Maternal Health Schemes
• Encorage small family norms among postnatal mothers
• Create awareness about family planning methods
• Practice labour room protocols
• Emphasis legal, medical abortion
• No augmentation of labour unnesscerily
• Faculty should incorporate WHO/ Govt of India guidelines while
demonstrating midwifery procedures to UG/PG-OBG students.

67. • Institutional deliveries in
India have risen sharply
from 47% in 2007-08 to
over 78.9% in 2015-16
(NFHS4)
• while Safe delivery has
simultaneously climbed
from 52.7% to 83.2% in
the same period.
RISING INDIA

68. MMR IN INDIA- A STEEP
DECLINE IN MMR
• Maternal Mortality Ratio (MMR) in India was
exceptionally high in 1990 with 556 women dying
during child birth per hundred thousand live births.
Approximately, 1.38 lakh women were dying every
year on account of complications related to
pregnancy and childbirth.
• The global MMR at the time was much lower at 385.
There has, however, been an accelerated decline in
MMR in India. MMR in the country has declined to
167 (2011-13) against a global MMR of 216 (2015).
• The maternal mortality ratio (MMR) between 2016
and 2018 dripped to 113 in India, almost 100 deaths
lesser than in 2007- 2008 period.

69. The main factors for that prevent
woman seeking care during
pregnancy and childbirth
• poverty
• distance to facilities
• lack of information
• inadequate and poor-quality
services
• cultural beliefs and practices.
• To improve maternal health,
barriers that limit access to
quality maternal health
services must be identified and
addressed at both health
system and societal levels.

70. SOCIO- CULTURAL FACTORS
• Malnutrition
• Poverty
• Overwork
• Lack of primary health care
• Low economic status
• Early marriages and childbearing
• Underfeeding and dietary practices during
pregnancy
• Neglect care to girls and women
• Prepubertal marriage
• Double standards of sexual ethics resulting in
clandestine abortion
Determinants
of MMR
inIndia

71. Woman
Empowerment
• MAHILA MANDALA :
• This is a NGO Organization work for
women and children who need nutrition,
education, family welfare and women
employment.
• To create awareness among women of
rural village even to empower them, train
them educate them and help them to
become economically self- independent.
.

72. Swabhiman program by smile foundation
• Swabhigan, an initiative of smile foundation aims to
bring pride and dignity for our girl.
• Swabhigan is not anti- men, but it encourages women
to defend themselves and protect from violence and
advocates men to be a part of bringing due dignity for
our girl child.

73. Positive Rising
• India has world’s largest number of professionally qualified
women.
• India has the largest population of working women in the world
• India has more doctors, surgeons, scientists, professors than the
United States.
• Indian women today are also singers, painters' beauty queens and
actors.

74. • These women have done so
much than just the few
things I listed off for each
individual.
• As you can see, India has
become a long way, but
there is still work to be done.
• By the efforts of these
women, and many more,
hopefully men women in
India can live in a society of
equal power without the
stigmas from the history in
India.
The women of India

75. • Trends in maternal mortality: 2000 to 2017: estimates by WHO, UNICEF, UNFPA, World Bank Group
and the United Nations Population Division. Geneva: World Health Organization; 2019.
• (2) Ganchimeg T, Ota E, Morisaki N, et al. Pregnancy and childbirth outcomes among adolescent
mothers: a World Health Organization multicountry study. BJOG 2014;121 Suppl 1:40–8.
• (3) Althabe F, Moore JL, Gibbons L, et al. Adverse maternal and perinatal outcomes in adolescent
pregnancies: The Global Network’s Maternal Newborn Health Registry study. Reprod Health 2015;12
Suppl 2:S8.
• (4) Say L, Chou D, Gemmill A, Tunçalp Ö, Moller AB, Daniels JD, et al. Global Causes of Maternal
Death: A WHO Systematic Analysis. Lancet Global Health. 2014;2(6): e323-e333.
• (5) World Health Organization and United Nations Children’s Fund. WHO/UNICEF joint database on
SDG 3.1.2 Skilled Attendance at Birth. Available at: https://unstats.un.org/sdgs/indicators/database/
• (6) Strategies towards ending preventable maternal mortality (EPMM).Geneva: World Health
Organization; 2015.
References

76. Conclusion
• Woman are the basic unit of our society. They play their roles
with great responsibilities in upbringing of a healthy solid society.
A good solid society is a good harbinger of development.
• The survival and wellbeing of mothers is not only important in
their own right but also key to solving larger-broder, social,
economical and developmental challenges.
• Massive and strategic investments have been made under the
National Health Mission for improvement of Maternal health, by
Health and Family welfare, Govt of India; must be reach to the
grassroot level. So that, we can reach the concept of attaining
the THEME of the conference on “EACH MOTHER COUNTS – TO
IMPROVE MATERNAL HEALTH.