By Midhun Mohan – Student Editor

Read this case about a 25-year-old anaemic woman who died from a massive atonic postpartum haemorrhage

How and why did this happen?

The case report states that on a national scale a culmination of three factors are responsible for the state of healthcare in India, especially in regard to the rural poor.

1. Poor handling of healthcare funds
2. Corruption at local and national levels
3. High levels of illiteracy in the poor, that prevent access to available healthcare and leads to a failure of women asserting their healthcare rights

On a local scale, obstetric care provided by local birth attendants with variable levels of training may be fall far below accepted standards.

The report states:

“A 12-h period (one night) was wasted in futile attempts to deliver but also, multiple internal examinations led to development of Gram-negative septicaemia superimposed on existing anaemia, resulting in massive atonic PPH and death”

Could this have been avoided if the woman had been transferred to the hospital sooner?

In 2005, the Indian government started a cash incentive scheme for poor pregnant woman to promote institutional deliveries. The aim was to reduce maternal and neonatal mortality.

Read more about it here: http://nrhm.gov.in/nrhm-components/rmnch-a/maternal-health/janani-suraksha-yojana/background.html

Despite this scheme increasing the number of institutional deliveries the maternal mortality has not decreased. Why? The reasons are likely to be multifactorial.

One study conducted in another rural district in India concluded that the following factors contributed to maternal deaths:

1.     Absence of antenatal care despite high levels of anaemia
2.     Absence of skilled birth attendants
3.     Failure to carry out emergency obstetric care
4.     Referrals that never resulted in treatment

This case report provides a useful insight into the state of obstetric medicine in rural India. Women from deprived nations all over the world suffer from the same sub-standard obstetric care. When a woman dies she leaves behind children who need care.

The statistics released recently by the LifeBox Foundation are staggering. They are as follows:

1. 1,000,000 BABIES. A million children a year could be saved by safer obstetric surgery
2. 5 BILLION IN DANGER. Around the world, billions of women, children, and families lack access to the most basic surgical care
3. 800 WOMEN A DAY. Preventable pregnancy-related causes including unsafe surgery kill hundreds of women daily

Click here to link to learn more about the LifeBox Foundation

What are the causes of maternal mortality worldwide and what has been done to reduce this? What else needs to be done to really improve obstetric care?

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