Improving Quality of Care is the Most Powerful Means to End Preventable Maternal Deaths

Many would assume that the 45,000 mothers dying in India every year during childbirth is a result of complications that are difficult to manage. It should be rather surprising that these deaths are mostly preventable. In fact, one of the main reasons for losing lives is often due to sub-standard and inconsistent quality of care.

Our entire maternal health care community is aware of this. And yet, improving the quality of maternal health services has been a tough challenge in India, largely due to insufficient tools and incentives for providers to change.

In recent years, considerable efforts to improve the quality of institutional care during the antenatal, delivery and postpartum periods have favored public health care facilities, largely excluding private ones. This has been the case despite the fact that private providers in India account for up to 30% of institutional deliveries in rural areas and up to 52.5% of institutional deliveries in urban areas, and despite evidence suggesting that quality of care is an issue in both sectors. Many such facilities, even those that have been in business for 5 to 10 years and even longer, have been found not to be following recognized, evidence-based quality standards of care in their labor and delivery wards. They do not have the necessary emergency protocols in place to prevent complications.

These challenges persist due to a widespread lack of technical resources, insufficient training and other opportunities for nurses and paramedics to update their skills and knowledge (leading to continued use of outdated, ineffective and sometimes harmful practices); weak incentives for private maternity facilities to invest in quality improvement because efforts typically do not immediately translate into an increased client base; and limited capacity (if not total absence) of systems to measure and monitor the quality of their services.

Greater efforts must be made to bridge the gap between research-supported knowledge and clinical practice. What we need is a large scale streamlined quality improvement initiative, offering a practical and compelling way for private health care facilities to improve their capacities for managing care during labor, delivery and the immediate postpartum period, when risks for life threatening complications are the highestAn intervention which offers all of the above is an important step forward for maternal health in India. Read more here

Investing in the health of mothers in Africa: Social hurdles

Even when maternal health facilities are available, expectant mothers in Africa do not always get timely care. A study by the Africa regional office of the World Health Organization (WHO), Reducing Mortality Rates, reports that sometimes women or birth attendants “fail to recognize danger signals and are not prepared to deal with them.” One answer, argues Dr. Yves Bergevin, senior adviser on reproductive health for the UN Population Fund (UNFPA), is to improve the skills of birth attendants and the knowledge and capacity of women, their families and their communities.

Involving men is important, says Lucy Idoko, UNFPA’s former assistant representative in Nigeria. Most men, she says, do not know the risks of going through labour. “Maternal health is not only a woman’s issue but also a man’s issue, and important to society as a whole.”

Cultural practices can also affect women’s health risks. WHO cites genital mutilation, early marriage and multiple pregnancies. Women who have undergone infibulation, a form of genital mutilation where the external genitalia are stitched, are more likely to suffer from obstructed labour. UNFPA data show that girls who give birth between the ages of 15 and 20 are twice as likely to die in childbirth as those in their twenties, while girls under 15 are more than five times as likely to die.

“Adolescent girls face the highest risk of premature delivery,” says Dr. Grace Kodindo, former chief of maternity at the Ndjamena general hospital in Chad. “Because their bodies are not yet fully mature, they risk obstructed labour. This is why we encourage young women to postpone their first pregnancy.”

Dr. Kodindo argues that both young age and the low status of women in society often leave them with little power to determine if, when and with whom to become pregnant. They also have little choice in the number and timing of their children.

Read more here