Skilled midwives can cut maternal deaths
Reported May 26, 2009
Ahmedabad: Maternal health has rarely got the attention of the government, but, fortunately since 1990, government has come up with different programmes such as Child Survival and Safe Motherhood programme (additional budget $300 million) in 1992; and Reproductive and Child Health-I (additional budget $250 million) in 1997. However, these programmes also lacked strategic focus on critical interventions to reduce maternal mortality. The much talked National Rural Health Mission (NRHM), launched in 2005, has focused on producing health volunteers at village level, fancily called, Accredited Social Health Activities (ASHA).
The health ministry believes that the neglect of the maternal health and non-development of fully qualified well-trained midwives will be compensated by minimally trained village women called ASHA. On the other hand, to improve services for women in delivery, government has been promoting deliveries in hospitals and health centres by paying money to women who deliver in government institutions.
The old wine of ‘incentives’ which were used in family planning programme is in the new bottle of Janani Suraksha Yojana. The development partners have invented a new name for these payments — they are now called ‘demand side financing’ or ‘conditional cash transfers’. Unfortunately, not adequate and effective steps are taken to improve the public health institutions where women are coming for deliveries. Kanti is just one example of how poor quality care can not help prevent deaths of mothers.
Even today the government does not systematically monitor how many PHCs and community health centres are providing good quality delivery services and emergency obstetric care (EmOC) on 24 hours seven days in a week. One of the reasons for this lack of monitoring is that our public health departments are ridiculously thin at the top.
We have only three technical officers for maternal health at the national level and almost no state in India has a director at state level only focusing on maternal health. Such thinly staffed health departments can not plan, implement and monitor maternal health program in a country of 1 billion with 26 million births per year.
According to National Family Health Survey (2006), only 52% of women receive three antenatal contacts and 42% receive any postnatal care in India. With more than 60% of births as domiciliary deliveries, India needs skilled birth attendance by well-trained and accountable midwives at community level to reduce maternal mortality rate.
Relying on traditional birth attendants (TBAs), which India has done for years, will not work to save mothers. Sweden stared to train midwives 300 years ago and it passed a law not to employ TBAs about 150 years ago. Sri Lanka made policy to ensure deliveries by public health midwives about 50 years go and hence both these countries have very low maternal mortality rate. In India, on the other hand, we de-facto abolish the whole cadre of midwives which existed before independence and till 1960s. And that is why we still have a high maternal mortality rate.
Therefore, to reduce maternal mortality rapidly, we need skilled birth attendance by midwives back up by emergency care by obstetricians and referral services. To convert the goals of maternal health into reality in India, we require a comprehensive maternal health services within efficient public health systems. Maternal health should be seen in the framework of women’s health and welfare. The increased political priority, managerial capacity, and resource allocation will determine seriousness of our efforts and future of maternal health in India.
Source : Centre for Management of Health Services, Indian Institute of Management, Ahmedabad.