Despite being in the twenty-first century, maternal and child mortality remain unacceptably high in much of rural India, with particularly low coverage of ante- and post natal care in forest and forest-fringe areas. According to the SRS 2010-2012 report, the maternal mortality ratio in Chhattisgarh is 269 per 100,000 live births, much higher than the national average of 173. Likewise, the infant mortality rate is 46 per 1,000 live births, as compared to the country mean of 40. Although mortality has reportedly decreased in recent years, poor access to ante natal and post natal care, coupled with the high prevalence of unsafe deliveries, remains a cause for concern and point of intervention for JSS.
While anyone can be at risk for health complications during pregnancy, the danger is particularly high in rural areas where poverty and malnutrition are rampant, women start having children at incredibly young ages, and the number of pregnancies for an individual woman is often in the double digits. On top of the already high risk of health issues that these women face, they live in remote villages that can be hours away from a functioning health centre. With around half of deliveries being conducted at home, if complications arise during delivery, there is little hope of getting the woman to a hospital in time.
The problems we see
Some common issues we see in our pregnant patients include anemia, infections, malaria (falciparum malaria can be highly lethal in pregnant women), pre-eclampsia and eclampsia. In addition, low birth weight infants are common, and traditional practices often discourage mothers from eating, drinking, or breastfeeding their child in the first several days. Such practices only further exasperate the malnutrition of both mother and child.
With continuing high rates of home births, unsafe delivery remains a widespread issue in rural India. Traditional birth attendants (TBA) are often the primary care providers during delivery, yet they are untrained in the importance of hygiene and sanitation and are often disconnected from formal health care facilities in times of emergency. Post-partum hemorrhage is perhaps the most common form of emergency during and immediately after delivery and is a leading killer among women living in remote areas of the world.
Unsafe abortion is another pressing maternal health issue in the region. This is largely due to the double stigma of unwanted pregnancies and abortions. With a lack of access to institutions that provide safe and legal abortion services, illegal abortion is the cause of many maternal deaths.
What we are doing
In 2004, we decided to take action to improve maternal and child health services in the region and started antenatal care (ANC) clinics in six different villages in the Bilaspur district. Our ANC clinics were developed with the following objectives:
1. To identify high-risk pregnancy
2. To ensure early registration of pregnancy
3. To promote institutional delivery
4. To prevent ante, intra and post natal complications
At our ANC clinics, pregnant women are examined to ensure normal development of fetus and continued health of the mother. They are also taught about the importance of nutrition during pregnancy and how to recognize warning signs for pregnancy complications. In addition, we conduct regular dai trainings for traditional birth attendants (TBAS), who are instructed in proper referral as well as in conducting safe deliveries at home. Referral services and emergency transportation have been drastically improved in recent years due to continued advocacy efforts, and there is now a government ambulance based in one of our remote villages for quick access in the case of emergencies.