Monitoring and Evaluation

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MATERNAL MORTALITY
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MMR remains high in the developing world India
has the highest number of maternal deaths in the
world (136,000 per annum) and accounts for 26
of all maternal deaths
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• The baseline data period only covers 36 weeks.
• Maternal mortality is a relatively rare event.
• To have a more accurate picture of the current
  situation regarding maternal mortality in this
  population 60 weeks of data have been analysed.

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Definitions

• Maternal death - Death of a woman while pregnant
  or within 42 days of termination of pregnancy,
  irrespective of the duration and site of
  pregnancy, from any cause related to or
  aggravated by the pregnancy or its management,
  but not from accidental or incidental causes.
• Maternal mortality rate Maternal deaths per
  100,000 live births.
• Pregnancy related death - The death of a woman
  while pregnant or within 42 days of termination
  of pregnancy, irrespective of the cause of death.
• Late maternal death - The death of a woman from
  direct or indirect obstetric causes more than 42
  days but less than one year after the termination
  of pregnancy.

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Maternal Outcome
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Cause of death
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Timing of maternal death
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Place of death

• 55 died at home
• 37 died in hospital
• 8 died in transit (3 to 5 from facility)

Place of death of Suru Lohar in Kuida, West
Singhbhum
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Three delay model
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Delays prior to maternal deaths . . .
1. Delay in seeking care 2. Delay in reaching
care 3. Delay in receiving care
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1. Delay in Seeking Care
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2. Delay in Reaching Care
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3. Delay Receiving Care
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Neonatal outcome for maternal and late maternal
deaths
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Balema

• Balemas labour pains started at around
  midnight on 31st January 2006. Her husband wanted
  to call the dai, but Balema would not allow it,
  saying that they should wait until the pains had
  increased. At 430am the pain increased and the
  dai was called, who arrived at 6am. She delivered
  the baby without any problems, but the placenta
  did not come out. The private nurse was called
  who gave her two injections, but when the
  placenta did not deliver she asked them to take
  her to the hospital. It took until 1130 am
  before they were able to arrange transport and
  transferred her to hospital. One woman was
  already undergoing a caesarean section so no one
  was able to assist Balema. She was eventually
  examined by the doctor at 245pm. He said she
  needed oxygen and medicines but he could not give
  her any because the tube was cracked and there
  were no medicines in the hospital. The relatives
  tried to buy medicines from outside but all of
  the medical shops were closed. She was put on an
  intravenous drip but she died at 4pm on 1st
  February.

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Suryamani

• Suryamani went into labour at around 10pm on
  27th May 2005. She had still not delivered by 7am
  the following day, so a local private nurse was
  called. The nurse gave her two injections to
  induce labour and told her to wait until 12noon.
  When she had still not delivered, she was
  referred to the village doctor at around 4pm.
  He gave her intravenous fluid and two more
  injections to induce labour and asked her to wait
  half an hour. At 7pm 28th May she delivered a
  stillborn baby boy. After the placenta had come
  out she tried to get up from the bed but she fell
  down and started bleeding profusely. She was
  given an oxytocic injection to try to stop the
  bleeding but when the bleeding did not stop, she
  was referred to a private qualified doctor. The
  doctor refused to see her as she had been
  referred by a village doctor. She was taken to a
  nursing home where she was told that she had lost
  a lot of blood and she would need five units of
  blood. The nursing home did not have a blood bank
  so she was referred to the medical college
  hospital. Suryamani reached the hospital at
  around midnight on 28th May but she was
  pronounced dead on arrival.

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Conclusion
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Key Findings
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First
Maternal death rates are extremely high in this
largely tribal population.
Husband and children of Suru Lohar who died in
Kuida, West Singhbhum
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Second
Most maternal deaths in this population occur at
home (55) rather than at a facility (37).
Place of death of Mecho Tubid Dharamsai, West
Singhbhum
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Third
The findings contradict the widely held belief
that two-thirds of maternal deaths occur around
the intra- partum period.
Husband and child of Basanti Munda, Gajapur,
Keonjhar
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Fourth
Verbal autopsies highlighted serious delays in
seeking or receiving care for all maternal deaths.
Husband, mother-in-law and 2 daughters of Moko
Rautiya, who died in Tendrauli, West Singhbhum
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Fifth
Sarkudar village, Keonjhar, Orissa
Our study suggests a poor outcome for infants
whose mothers suffer a maternal death, especially
for girls.
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Thank You