DEATH FROM C-SECTIONS HIGH IN DEVELOPING COUNTRIES
06, Apr 2019
Prelims level : Science and Technology -Medicine and Pharmaceuticals Mains level : Paper - III Technology, Economic Development, Bio diversity, Environment, Security and Disaster Management
Why is it in News?
- WHO has said deaths from C sections are high in developing countries, and its overuse and underuse are a global concern?
- Maternal deaths following caesarean sections in low and middle-income countries are 100 times higher than in high-income countries, according to a new review published in The Lancet, which has considered 196 studies from 67 low and middle-income countries.
- Study shows that data from 1990 to 2017 show that a quarter of all women died while giving birth in low and middle-income countries had undergone caesarean section.
- Every year, 3 lakh women die during childbirth, 99% of whom are from low and middle- income countries.
What is C-section?
- Caesarean section, also known as C-section, or caesarean delivery, is the use of surgery to deliver babies. A caesarean section is often necessary when a vaginal delivery would put the baby or mother at risk.
Maternal mortality rate:
- MMR is defined as the proportion of maternal deaths per 1,00,000 live births.
- The causes could be related to or aggravated by the pregnancy or its management. Complications during pregnancy and childbirth are a leading cause of death and disability among women of reproductive age.
MMR in India:
- In the 2011-13 period, India’s MMR was 167. As per the recently released data, the MMR during 2014-16 period stands at 130.
- Significant decline (246 to 188) was seen in the so called Empowered Action Group (EAG) states and Assam. EAG states are those states where economic and development indicators are a particular concern. Among the southern states, the decline has been from 93 to 77 and in the other states from 115 to 93.
- National rural health mission: – Janani Suraksh Yojna (JSY) is one of the main strategies or policy shifts under NRHM. It is a conditional cash transfer scheme to motivate pregnant women for institutional deliveries. In better developed states of South India, it is limited to women below poverty line up to first two childbirths.
- But notably, maternal mortality steeply rises in grand multiparous women, delivering a child after third pregnancy onward.
- Web-based Mother and Tracking System tracked every pregnancy in the country since 2010. It sends messages to health workers and expectant mothers about ante-natal checkups, vaccinations etc. For Ceasarean sections, there are First referral units (FRUs)
- FRU (First Referral Unit) is a district or sub-divisional hospital or community health centre which has the facilities in this regard. NRHM also allowed auxiliary nurse midwives (ANMs). The Accredited Social Health Activist (ASHA) attended to women who were not going to hospitals for deliveries. Besides these, the Janani Shishu Suraksha Karyakram (JSSK) was implemented. It entitles all pregnant women delivering in public health institutions to free delivery, including C-sections. Other initiatives include the Pradhan Mantri Surakshit Matritva Abhiyan launched in 2016 for engaging the private sector to voluntarily provide free antenatal services on the 9th day of every month to pregnant women.
- Pradhan Mantri Matru Vandana Yojana under which a cash incentive of ₹5,000 is provided to encourage antenatal check-ups for pregnant women and lactating mothers.
- Maternal mortality varies significantly within and between States. Kerala’s MMR, for instance, was 46 in 2016 compared to Assam’s 237.
Training and monitoring
- The shortage of trained human resources, especially doctors and auxiliary nurse midwives, remains a key challenge to improving maternal health outcomes.
- Human resource compensation packages for personnel working in remote and rural areas need to be made more attractive. Currently, haemorrhage is the leading cause of maternal mortality in the country followed by sepsis and abortion. This points to the need for urgently exploring the possibility of a national blood transfusion service network considering that India has a blood supply deficit of 25 per cent as against the prescribed reserve of 1 per cent of the population, according to the World Health Organisation.
- Strengthening of surveillance and monitoring systems such as the Mother and Child Tracking System and the Health Management Information System as well as the promotion of vital registration is required. Hypertensive disorders are a more important cause in south India and abortion-related deaths are higher in the EAG States and Assam, thereby necessitating the design of customised policy interventions.