Maternal Mortality in India

Maternal Mortality in India Soumitri Varadarajan Date March 2010

Problem ✤

20 - 25% of Maternal Deaths on this planet occur in India.

✤

In 38% of the cases the deaths are due to Post-partum Hemorrhage (PPH)

✤

An injection - Misoprostol, Oxytocin, Endometrine - can stop the hemorrhage!

✤

The solution: Drug to be available at the time of Delivery!

✤

(Research Field Trip)

Intervention!

✤

Oxytocin easily available in rural contexts - dairy uses

✤

Improved availability will not change the situation

✤

Who will deliver the injection?

✤

Direct versus Indirect causes

Drug delivery is not the solution!

SEWA Rural ✤

With 75% home delivery, SEWA Rural could reduce MMR by 40% and NMR by 45% in three years with specific interventions at community level backed up by a functional FRU. ✤

Empowering TBAs/ Local women volunteers ensuring satisfactory Birth Preparedness/ Complication readiness

✤

Clean and Safe normal delivery ensuring critical new born care and post natal follow up

✤

Timely identification of any complications during delivery and ensuring prompt referral to SEWA Rural’s functional FRU

✤

Professional provision of basic and comprehensive emergency obstetric care by SEWA Rural FRU

Vajpai, Smita (CHETNA). November 21st 2006. "Building Community Based Mechanisms: Workable Solutions to reduce Maternal Mortality in India Presentation at the Civil Society Window on Maternal Mortality." In Presentation at the Civil Society Window on Maternal Mortality. New Delhi: Planning Commission of India. http://images.wri.org/photo_sewa_print.jpg

Indirect Causes: Risk of PPH ✤

✤

Most maternal deaths occur in women from tribal/dalit communities, poor socio– economic status, living in rural, remote regions.

Women do not have access to complete, continued care from the public health system

✤

Risks, Causes - known/ unknown

✤

Youth Pregnancy/ <15 yrs age

✤

Anemia

✤

History

✤

✤

Physical, socio- cultural and economic barriers affect access to institutional health services

List Causes - and need for risk elimination, or being risk aware and acting accordingly Key slide!!!

On predicting the liklihood of PPH

Maternal Deaths global ✤

Distribution

✤

Spheres of Engagement

✤

Modes of Engagement

✤

Capacity for Intervention

✤

(global project - India focus?)

Maternal Health facts ✤

85% of the women will deliver normally

✤

20-25% deaths occur during pregnancy

✤

10-15% women will develop complications that will need medical intervention

✤

40-50% deaths occur during labour and delivery

✤

25-40% deaths occur after childbirth (more during the first seven days

✤

3-5% women will need surgical interventions (blood, cesarean etc.)

Source: Vajpai, Smita (CHETNA). November 21st 2006. "Building Community Based Mechanisms: Workable Solutions to reduce Maternal Mortality in India Presentation at the Civil Society Window on Maternal Mortality." In Presentation at the Civil Society Window on Maternal Mortality. New Delhi: Planning Commission of India.:

MMR - India

✤

MMR Distribution

✤

Three tier strategy: (in 100s) (in 200-300s) (in 400s)(above 400)

✤

“I think Australia should focus upon Assam” - Aparajita Gogoi

Janani Suraksha Yojana ✤

(Safe Motherhood Programme)

✤

India - MMR MDG target of 100

✤

Funding - Elements of NRHM focussing upon MMR

✤

NRHM Focus upon MMR has Gaps! ✤

Reliance on Accredited Social Health Activist (ASHA)

✤

Data and interventions not always related

✤

Quality of service

NRHM ✤

(National Rural Health Mission)

✤

Well Funded

✤

Proportion of MOHFW:International Funding (92:8)

✤

State level program-proposal development - Three tier strategy: (in 100s) (in 200-300s) (in 400s)(above 400)

✤

Program evaluation reports

✤

(Only 6 countries

Tamil Nadu ✤

Success Story: Model! check this

✤

Change: 300 to 145

✤

Innovations ✤

90% Institutional Delivery

✤

State Health Care service

✤

Verbal Autopsy

✤

Trained personnel

✤

Padmanaban, P., P. S. Raman and D. V. Mavalankar.

2009. "Innovations and challenges in reducing maternal mortality in Tamil Nadu, India." J Health Popul Nutr 27(2):202-219.

What is the project then? ✤

Filling the Gap!

✤

What is the Gap?

✤

What can Australia do?

✤

What can RMIT do?

✤

How can the project be constructed?

✤

What will the project look like?

Safe Motherhood Project 2010-15 A Multidimensional Support Project Consultation Paper

Breakthrough strategies against maternal mortality are grounded not only in best public health practice, but in a constructive framework of accountability and human rights. This is provided for in human rights treaties and commitments made in the Beijing Platform for Action and the Cairo Programme of Action.

Oral Statement at 54th CSW Session ORAL STATEMENT DELIVERED AT THE 54TH SESSION OF THE UN COMMISSION ON THE STATUS OF WOMEN, 1-12 MARCH 2010 This statement is delivered on behalf of Action Canada for Population and Development, Amnesty International, the Center for Economic and Social Rights, the Center for Reproductive Rights, Human Rights Watch, the International Initiative on Maternal Mortality and Human Rights, the International Planned Parenthood Federation, Ipas, and the Women's Global Network for Reproductive Rights.

Project Aims ✤

Helping (Assam) reach Millennium Development Goals

✤

Responding to articulated needs

✤

Supporting agencies in their work

✤

Adding to existing/ongoing efforts in Capacity Development

✤

Collaborating with Universities and NGOs on the ground

✤

Facilitating social innovation enterprises

✤

Providing education opportunities - for key stakeholders

Focus upon Assam ✤

MMR Assam - 490

✤

NGO Assam - The ANT

✤

University Link: IIT Guwahati, University of Guwahati, TISS

✤

Health Secretary (Govt.)

✤

CEDPA-WRA

Strategic Project! ✤

RMIT: Design + Health

✤

International Project

✤

Business Case

✤

Profile in India

✤

Industry Engagement

✤

Government Participation

✤

Institution Development

Discussion with CF/PVC Decisions: Key Drivers - Aus Govt Key Drivers - RMIT University Supported Project

RMIT Project (D+H)?

Decision to be taken To set up a Strategic Project and to resource it! ✤

Home: DSC College/ RMIT

✤

Cost Centre: Independent (How will Government fund it? What will University put in?)

✤

Staffing Plan: Project Manager, Coordination and academic team/ group

✤

Goals: Effective participation to reduce MMR in Assam

✤

International collaboration with own funding (if University)

✤

Risk in Program location (College location)

Project March 2010 ✤

Next Steps:

Ongoing Work - Soumitri Varadarajan in Industrial Design, with GPK/ DRI support College Support - for additional RA

✤

Report ( Field Trip Feb 2010)

✤

Consultation Process

✤

Funding (8K GPK+RA/MW+RA+...)

✤

Projects and Programme Definition

✤

2015 Outcomes and impacts

Disciplines EOI ✤

Design

✤

Midwifery

✤

Management

✤

Computer Science

✤

Art, theatre, music

✤

(Medical)

Connected to RMIT Project

1 Direct Intervention Design, invited projects

Product Service System design ✤

The transport service

✤

The Midwives

✤

The hospital

✤

EmOC Transport

✤

The FRU

✤

The Data service

✤

The blood bank

✤

The Training Course

✤

The village health unit

✤

The Safe Abortion Service

New Enterprises, Social Innovation

2 Indirect Intervention Capacity Development, Training, Research Date

1. Endeavour Project ✤

2011 - 2015 (GC Project - agenda)

✤

125, 000 K/ year - 625, 000 K

✤

Incoming Cohort (15-20/year): Capacity Development in Social Innovation

✤

Outgoing Cohort(6/ year): Field work project in NGO spheres

✤

Documentation: Film, Web, local narratives

✤

Local Women as Focus

2. Health pathway ✤

Special Programme-Pathways inside Industrial Design

✤

Upper Pool Studio: Design Project on infrastructure and services

✤

Year 4 studio: A Service Design Studio (Participle Link)

✤

International Collaborative Studio: Regional or Great Civ focus

✤

University elective on Safe Motherhood

✤

Industry MOU on Health Service Design

3. Research Cluster-Cohort ✤

(students from Assam - capacity development)

✤

Masters by Research - cohort (Bus) model of 15 sponsored students

✤

PhD slots in “Safe Motherhood”

✤

Grad-Dip sponsored cohort in Service Design, Social Innovation, (Nursing), (Public Health Management)

✤

(Masters by Coursework in Health Service Design)

Additional Notes ✤

Many Projects and International agencies

✤

Midwifery Project - SIDA/ Karolinska Institute

✤

Focus upon Assam-NE

✤

Direct Interventions: Data gathering and analysis, Midwifery,

✤

Indirect Interventions: Capacity Development, Technology Development, Resource Development

make direct and indirect interventions into sketches

Safe Motherhood Project 2010-15 A Multidimensional Support Project Development Vision