Causes and prevention of maternal deaths India State:  State Date:  Day, Month, Year
What is a maternal death? <ul><li>The death of a woman: </li></ul><ul><li>while pregnant or within 42 days of termination ...
Maternal Mortality Ratio (MMR)  <ul><li>The number of maternal deaths per 100,000 live births. </li></ul><ul><li>In India,...
How many  maternal deaths take place? <ul><li>In the world – more than one death every minute:  530,000 deaths/yr </li></u...
When do  maternal deaths occur?
Biological causes of  maternal deaths
There are several cultural and social factors that also contribute to maternal deaths Factors contributing to  maternal de...
What are some common practices and beliefs underlying maternal deaths?  <ul><li>Too early and too many pregnancies </li></...
What are some common social factors contributing to the “ three delays ”?  <ul><li>Low social status of women </li></ul><u...
The first delay <ul><li>Delay in decision making  –  </li></ul><ul><li>Delay in recognizing the need for health care </li>...
The second delay <ul><li>Delay in reaching the appropriate health facility   </li></ul><ul><li>Arranging money for transpo...
The third delay <ul><li>Delay in receiving health care at the facility </li></ul><ul><li>Inadequate resources at the facil...
<ul><li>Which of these delays do you think contributes most to maternal deaths in  District(s) ? </li></ul>
Preventing maternal deaths  <ul><li>All pregnant woman are at risk for life-threatening labour and delivery complications ...
Preventing maternal deaths  <ul><li>Individual birth preparedness </li></ul><ul><ul><li>All pregnant women have a “birth p...
MAPEDIR plans for  State  (below is an example – modify according to State plans) <ul><li>Block meetings to sensitize Panc...
MAPEDIR plans for  State  (below is an example – modify according to State plans) <ul><li>Train state-level trainers </li>...
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Mapedir trainer slides session1.2 mm causes&prevention_01_july07_pp95-2003

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Mapedir trainer slides session1.2 mm causes&prevention_01_july07_pp95-2003

  1. 1. Causes and prevention of maternal deaths India State: State Date: Day, Month, Year
  2. 2. What is a maternal death? <ul><li>The death of a woman: </li></ul><ul><li>while pregnant or within 42 days of termination of pregnancy </li></ul><ul><li>irrespective of the duration or site of pregnancy </li></ul><ul><li>from any cause related to or aggravated by the pregnancy or its management </li></ul><ul><li>but not from accidental or incidental causes </li></ul>
  3. 3. Maternal Mortality Ratio (MMR) <ul><li>The number of maternal deaths per 100,000 live births. </li></ul><ul><li>In India, the MMR is estimated at the national and State levels by the Sample Registration System (SRS) </li></ul><ul><li>District and sub-district levels are unknown due to incomplete reporting of deaths </li></ul>
  4. 4. How many maternal deaths take place? <ul><li>In the world – more than one death every minute: 530,000 deaths/yr </li></ul><ul><li>In India – about one death every 6-7 minutes: about 78,000 deaths/yr </li></ul><ul><li>About 15% of all maternal deaths in the world are in India </li></ul><ul><li>In State – #,### deaths/yr </li></ul><ul><ul><li>Average block -- ## deaths/month </li></ul></ul>
  5. 5. When do maternal deaths occur?
  6. 6. Biological causes of maternal deaths
  7. 7. There are several cultural and social factors that also contribute to maternal deaths Factors contributing to maternal death
  8. 8. What are some common practices and beliefs underlying maternal deaths? <ul><li>Too early and too many pregnancies </li></ul><ul><ul><li>Inadequate birth spacing </li></ul></ul><ul><ul><li>Son preference contributes to this </li></ul></ul><ul><li>Delivery in unclean </li></ul><ul><ul><li>Due to belief that labor process is dirty </li></ul></ul><ul><li>Unskilled birth attendant </li></ul><ul><ul><li>Because its never caused a problem </li></ul></ul><ul><li>Inadequate food while pregnant–due to belief that more food leads to: </li></ul><ul><ul><li>Larger baby: difficult delivery for mother </li></ul></ul><ul><ul><li>Larger baby: will get squashed </li></ul></ul>
  9. 9. What are some common social factors contributing to the “ three delays ”? <ul><li>Low social status of women </li></ul><ul><ul><li>Last to eat, receive health care, etc. </li></ul></ul><ul><li>Lack of knowledge of danger signs </li></ul><ul><li>Preference for traditional health care </li></ul><ul><li>Lack of economic resources for care </li></ul><ul><li>Not knowing where to go for care of severe illness </li></ul><ul><li>Hospital provides inadequate care </li></ul>
  10. 10. The first delay <ul><li>Delay in decision making – </li></ul><ul><li>Delay in recognizing the need for health care </li></ul><ul><ul><li>Lack of knowledge of danger signs </li></ul></ul><ul><li>Delay in deciding to seek formal care </li></ul><ul><ul><li>Women’s low social status </li></ul></ul><ul><ul><li>Lack of economic resources </li></ul></ul><ul><ul><li>Preference for traditional care </li></ul></ul><ul><ul><li>Other responsibilities, etc. </li></ul></ul>
  11. 11. The second delay <ul><li>Delay in reaching the appropriate health facility </li></ul><ul><li>Arranging money for transportation and health care </li></ul><ul><li>Locating the transport </li></ul><ul><li>Knowing where to go </li></ul><ul><li>Distance to the appropriate facility </li></ul><ul><li>Infrastructure for transporting the patient – bad or no roads, etc. </li></ul>
  12. 12. The third delay <ul><li>Delay in receiving health care at the facility </li></ul><ul><li>Inadequate resources at the facility </li></ul><ul><ul><li>Health personnel, supplies, equipment </li></ul></ul><ul><li>Inappropriate treatment and referrals </li></ul>
  13. 13. <ul><li>Which of these delays do you think contributes most to maternal deaths in District(s) ? </li></ul>
  14. 14. Preventing maternal deaths <ul><li>All pregnant woman are at risk for life-threatening labour and delivery complications </li></ul><ul><ul><li>It is not possible to accurately predict which women will have a complication </li></ul></ul><ul><ul><li>Therefore, all women require skilled birth attendance (ideally in a health facility) and referral and access to emergency obstetric care when needed </li></ul></ul>
  15. 15. Preventing maternal deaths <ul><li>Individual birth preparedness </li></ul><ul><ul><li>All pregnant women have a “birth plan” </li></ul></ul><ul><ul><li>Includes “complication readiness” </li></ul></ul><ul><li>Community birth preparedness </li></ul><ul><ul><li>Communities take responsibility and action to prevent maternal deaths </li></ul></ul><ul><ul><li>Maternal death inquiries identify local causes of death and suggest effective action plans </li></ul></ul>
  16. 16. MAPEDIR plans for State (below is an example – modify according to State plans) <ul><li>Block meetings to sensitize Panchayat secretaries </li></ul><ul><li>VHC and SHG meetings to sensitize the community regarding causes of maternal deaths, birth preparedness, and the need for maternal death inquiries </li></ul><ul><li>Identify and interview every family with a suspected maternal death </li></ul><ul><li>Analyze and share the information with the community and health officials </li></ul><ul><li>Help the community take effective action and advocate for improved services </li></ul>
  17. 17. MAPEDIR plans for State (below is an example – modify according to State plans) <ul><li>Train state-level trainers </li></ul><ul><li>Trainers train 3-4 staff at each block (interviewer, recorder, supervisor) </li></ul><ul><li>Community death notifiers </li></ul><ul><li>? Health facility inquiries ? </li></ul>

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