Dr. Saroj Naithani
Hon'ble CMO
Haridwar, Uttarakhand.
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Maternal Health
In India, one woman dies every five minutes and every year, more than half a million women die as the result of complications of pregnancy and childbirth. Over 80% of all maternal deaths are due to abortion, hypertensive disorders, haemorrhage, obstructed labour and infections. For the most part, the interventions needed to prevent such deaths are well conceived. What is lacking, however, is the ability to implement them in resource - constrained settings. There is a need for better information about the incidence, determinants, long-term consequences and prevention/management of hypertensive disorders of pregnancy, intrauterine growth retardation that account for a large proportion of morbidity and mortality. There is a need to evaluate the determinants of the attitude and practices of women in seeking, health care during pregnancy and childbirth as well as to identify and implement effective approaches for overcoming barriers to use of health care services. Maternal care has been a priority with the state health department, but gains in maternal survival have not been as much as expected. Problems of access, availability and utilization of the health services are further compounded by the difficult terrains and cultural practices in many parts of the state. In addition, the status of women in the state, reflected in low levels of literacy and limited autonomy further limit the care available to thems.

Utilization of maternal health services in Haridwar district is low and majority of women depend on public health facilities for services. Women who had not utilized ANC services mentioned that they did not feel the need to avail ANC services. Though women were aware of pregnancy seeking care was negligible and those who sought visited a private doctor. Deliveries in Haridwar mainly take place at home that are attended by untrained persons and place of delivery are a matter of concern. Emergency obstetric facility is limited in the district and available only at the district hospital while basic obstetric care in four facilities. Women hardly seek postnatal services and ANM rarely visit them for postnatal services. On the whole, awareness about the various services and social customs and traditional practices of the community govern/impede utilization of either availing ANC or Postnatal/post delivery services.

Objectives
  • To reduce Maternal Mortality Ratio..
  • To increase the Early ANC registration.
  • To ensure 3 or more than 3 ANCs to all the expectant mothers and special attention to high risk pregnancies
  • To decrease the incidence and progress of anaemia in pregnant and lactating women.
  • Provide adequate opportunities for safe deliveries and to increase institutional deliveries.
  • To improve the coverage of post partum care.
  • To increase access to Emergency Obstetric Care for complicated deliveries through strengthening of FRUs.
  • To increase access to early and safe abortion services
  • To ensure the Maternal Death audit of all Maternal Deaths.
  • To ensure JSSK entitlements in all Govt. institutions deliveries.

Schemes/Initiatives

Janani Surakha Yojana (JSY)
Janani Suraksha Yojana (JSY) is a safe motherhood intervention under the National Rural Health Mission (NRHM) being implemented with the objective of reducing maternal and neo-natal mortality by promoting institutional delivery among the poor pregnant women. The Scheme has contributed immensely in increasing the Institutional deliveries among the BPL, ST and SC population. The progress of Scheme has been remarkable since inception and is expected to achieve good results in the years to come.

Janani Shishu Suraksha Karaykaram ( JSSK)
Janani –Shishu Suraksha Karyakram is a step further in ensuring better facilities for women and child health services. State ensures that benefits under JSSK would reach every needy pregnant woman coming to government institutional facility. The new initiative of JSSK would provide completely free and cashless services to pregnant women including normal deliveries and caesarean operations and sick new born (up to 30 days after birth) in Government health institutions in both rural and urban areas. The new JSSK initiative is estimated to benefit more than one crore pregnant women & newborns who access public health institutions every year in both urban & rural areas.The Free Entitlements under JSSK would include: Free and Cashless Delivery, Free C-Section, Free treatment of sick-new-born up to one year, Exemption from User Charges, Free Drugs and Consumables, Free Diagnostics, Free Diet during stay in the health institutions – 3 days in case of normal delivery and 7 days in case of caesarean section, Free Provision of Blood, Free Transport from Home to Health Institutions, Free Transport between facilities in case of referral as also Drop Back from Institutions to home after 48hrs stay. Free Entitlements for Sick newborns till 30 days after birth similarly include Free treatment, Free drugs and consumables, Free diagnostics, Free provision of blood, Exemption from user charges, Free Transport from Home to Health Institutions, Free Transport between facilities in case of referral and Free drop Back from Institutions to home. .

Maternal Death Review (MDR)

Maternal Mortality Situation :

Maternal death is a death of a woman during pregnancy, delivery and within 42 days of child- birth, irrespective of the site of pregnancy or the duration of pregnancy. Studies have revealed that 75% of the deaths are preventable and interventions to deal with maternal deaths can also reduce the infant deaths. A systematic fact finding mission is therefore required to analyze every maternal death. This is to determine the cause of maternal death which maybe a direct obstetric cause, indirect or a socioeconomic cause. This will assist in adopting corrective and preventive measures in the future. Hence there is a need to adopt a maternal death audit for early reporting, investigating and taking action in all the maternal deaths. Most of the maternal deaths can be averted even where resources are limited but, in order to do so, the right kind of information is needed in order to base actions. Knowing the statistics on the levels of maternal mortality is not enough - information is needed on the causes and circumstances that have led to maternal deaths so as to initiate corrective measures to avert such deaths Moving in accordance with instruction and GO (which clearly defines the procedure of this Maternal Death Audit at the facility level.)”