Dr. KANUPRIYA CHATURVEDI

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Maternal Newborn Health
WITH reference to INDIA RAJASTHAN

• Dr. KANUPRIYA CHATURVEDI

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KEY ISSUES

• Maternal Newborn Health Where we stand
• Creating a supporting environment
• Continuum of care across time location
• Risks opportunities
• Strengthening health systems
• The Rate of Progress

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Maternal Newborn Health Where we stand
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Maternal Newborn Health Where we stand

• Global Scenario
• Regional distribution
• Maternal mortality ratio Maternal mortality
  rate
• Direct causes
• Conceptual framework

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Global scenario-Maternal health

• Each year, more than half million women die from
  causes related to pregnancy childbirth
• For every such death there are 20 others who
  suffer pregnancy related illnesses or other
  adverse outcome (obstetric fistula, uterine
  prolapse)
• Around 10 million women annually suffer from
  complications of pregnancy
• On average, each day1500 women die from causes
  related to pregnancy child birth
• 80 of maternal deaths could be avoided by access
  to essential maternity basic health services

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Global Scenario-Neonatal Health

• Nearly 4 million newborns die 40 of under 5
  deaths within 28 days of birth
• Three quarters of neonatal deaths occur during
  first 7 days
• For every newborn death ,20 others suffer birth
  injury, complications of preterm birth or other
  neonatal conditions
• A child born in a least developed country is 14
  times more likely to die within first 28 days of
  life as compared to industrialized country

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The big divide

• The divide between industrialized countries
  developing regions is perhaps greater than on
  any other issue
• Average lifetime risk of maternal death for a
  woman in least developed country is gt300 times
  than in industrialized country
• In developing world a woman has 1 in 76 lifetime
  risk of maternal death as compared to 1 in 8000
  in industrialized countries
• Global MMR stood at 430/lakh live births in
  1990,and at 400/lakh in 2005

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Maternal mortality ratio per 100,000 births
Uttar Pradesh 517
2001-2003
India 301
Kerala 110
Source SRS
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Medical causes of maternal deaths in India
Source SRS
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Medical Causes of Neonatal Deaths-India
Diarrhoea
Asphyxia
Preterm
Tetanus
Other
Congenital
Infection
Source Lawn JE Cousen SN for CHERG (Nov 2006)
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Share of under-five mortality in India
40
Infant deaths within 7 days of birth
Neonatal deaths 50
Infant deaths 76
Infant deaths between 7 days of birth and within
28 days
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Infant deaths between 28 days and within one
year of birth
26
Child deaths between one year and within five
years of birth
24
Source SRS 2007
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Infant Mortality Rates by State
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Infant Mortality Rate-Rajasthan
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Infant Mortality Rate by Demographic
Characteristics
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Childhood Mortality Rates by Sex
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Steady Decline in Infant Mortality Rates India
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Creating a supporting environment
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Creating a supportive environment for women
children

• Millennium development Goals
• Promoting a healthy behavior
• Securing a quality education
• Preventing child marriage
• Ante natal care coverage
• Skilled delivery care coverage

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Promoting a healthy behavior

• Timing of births
• Safe motherhood
• Child development
• Breast feeding
• Nutrition growth
• Immunization
• Diarrhoea

• Coughs, colds more serious illnesses
• Hygiene
• Malaria
• HIV and AIDS
• Injury prevention
• Disasters emergencies

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Quality education a decent living

• Studies show that educated women
• Are more likely to delay marriage
• Ensure that their children are immunized
• Are better informed about nutrition
• Undertake improved birth spacing practices

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Age at marriage-India
Percentage of women aged 20-24 married before age
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Early marriage leads to early childbearing
thereby enhancing maternal health risks
Source NFHS
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Antenatal Coverage -Rajasthan
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Continuum of care across time location Risks
opportunities
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First 28 Days of life

• Specific factors
• Limited access to skilled care providers
• Home births Associated with half of newborn
  deaths
• Inadequate recognition of newborn illnesses
• Insufficient care seeking
• A limited repertoire of interventions for early
  neonatal disorders e.g. birth asphyxia,
  premature births
• A lack of consensus on interventions and delivery
  strategies

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Nutrition among women
Percentage of ever-married women age 15-49 with
any anaemia and Body Mass Index (BMI) below 18.5
kg/m2
High percentage of women with anaemia and low BMI
results in higher risk of low birth weight and
peri-natal deaths
Source NFHS
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Antenatal care
Percentage of ever-married women age 15-49 years
having at least one ante-natal care
There has been a significant increase in
ante-natal care in the last 7 years. Further
increases are seen in the latest DLHS results
Source NFHS
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Women Who Received Antenatal Care
For last births in the past 3 years
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Deliveries at institutions / by skilled birth
attendants
Institutional births have shown significant
improvement in the DLHS results
Source NFHS
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Trends in Institutional Deliveries by State
Percentage point change between NFHS-2 and NFHS-3 States
Remained unchanged (2 states) Arunachal Pradesh, Nagaland
Increased less than 7 percentage point (7 states) Assam, Chhattisgarh, Delhi, Goa, Jharkhand, Tripura, West Bengal
Increased by 7-14 percentage points (10 states) Bihar, Gujarat, Maharashtra, Madhya Pradesh, Meghalaya, Rajasthan, Tamil Nadu, Kerala, Uttar Pradesh , Mizoram
Increased by 15 or more percentage points (10 states) Andhra Pradesh, Haryana, Himachal Pradesh, Jammu Kashmir, Karnataka, Manipur, Orissa, Punjab, Sikkim, Uttaranchal
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Institutional deliveries Rajasthan
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Post natal care for mothers
Percentage of women having at least one postnatal
care within two days of delivery
Only 37 of women received postnatal check-ups
within the recommended period of two days of
delivery
Source NFHS
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Initiation of breastfeeding within an hour
Percentage of children born in the last three
years who started breastfeeding within one hour
of birth
Only one in four children in India are breastfed
within 1 hour of birth
Source NFHS
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Birth weight
Percentage of children with reported birth weight
less than 2.5 kg
Based on reported birth weight data 30 in NFHS
2 and 34 in NFHS 3
Every year at least six million children in India
are born with low birth weight which gives them a
disadvantaged start in life
Source NFHS
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Strengthening health systems
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Proposed action framework

• Central premise .. Essential services for
  mothers, newborns and children are most effective
  when delivered in an integrated package
• at critical points in life cycle,
• in a dynamic health system,
• in an environment supportive of womens rights

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Essential Services for mothers newborn children

• Adequate nutrition
• Improved water sanitation
• Hygiene practices

• Basic health care
• Quality maternal care
• Newborn child health care

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Critical points for service delivery

• Adolescence,
• Pre-pregnancy,
• Pregnancy,
• Birth

• Infancy,
• Childhood
• Post-partum,
• Neonatal

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Supportive environment

• Protection from abuse, exploitation, violence
  discrimination
• Equal participation in home community, social
  political life
• Women empowerment

• Respect for rights of women children
• Quality education
• Decent standard of living
• Greater involvement of men

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The continuum of care across time
location-Risks opportunities

• Across time- Key points
• Adolescence
• Pre pregnancy
• Pregnancy
• Birth
• Post natal
• Neo natal

• Across location- Key points
• Household level
• Community level
• Outreach services
• Outpatient services
• Facility based care

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Key actions

• Enhance nutrition of adolescent girls
• Improve quality of reproductive health services
• Ensure adequacy of antenatal care
• Ensure skilled assistance during pregnancy
  childbirth

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Key actions

• Provide access to quality Basic and Comprehensive
  Emergency Obstetric
• Initiation of breastfeeding within one hour of
  birth
• Newborn care when required
• Expand post-natal care for mothers newborns
• Promote safe water hygiene practices at
  households and in facilities

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Strengthening health systems to improve maternal
newborn health

• Enhancing data collection analysis
• Enhancing human resources, training supervision
• Fostering social mobilization
• Ensuring equitable sustainable financing

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Contd.

• Strengthening infrastructure, transportation,
  logistics ,supplies referral process
• Improving the quality of care
• Global health initiativesStrengthening
  collaberation

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The Rate of Progress
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The Rate of Progress
Countries/ Territories U5MR 2007 Average annual Rate of reduction ( ) 1990-2007 GDP/Capita Annual Growth Rate () 1990-2007 TFR 2007 Average annual Rate of reduction ( ) 1990-2007
India 72 Rank-49 2.9 4.5 2.8 2
S.E.Asia 78 2.8 4.1 3 2.2
Industrialized countries 6 3 1.9 1.7 0.2
Developing countries 74 1.9 4 2.8 1.6
Least developed countries 130 1.9 2.5 4.7 1.3
WORLD 68 1.8 2.4 2.6 1.3
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Comprehensive Programming for Reducing Maternal
Mortality

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What will make it happen

• Building synergy and partnerships
• Generating and sustaining strong political
  leadership for health of women and children
• Mobilizing resources for maternal and newborn
  health
• Empowering families and communities for promoting
  health and accessing healthcare