An investigation of maternal deaths following public protests in a tribal district of Madhya Pradesh, central India

• Published in: Reproductive health matters 2012-06, Vol.20 (39), p.11-20
• Main Authors: Sri B, Subha, N, Sarojini, Khanna, Renu
• Format: Article
• Language: English
• Subjects: Accountability; Cash; Cesarean section; Community health; Death; FEATURE; Female; Females; Health care delivery; Health Care Services; Health Services Needs and Demand - economics; Health Services Needs and Demand - organization & administration; health systems; Humans; India; India - epidemiology; Internal Medicine; Low Income Groups; Maternal Health Services - economics; Maternal Health Services - organization & administration; Maternal Mortality - trends; maternal mortality and morbidity; Maternity benefits; Medical referrals; Medical treatment; Midwifery; Morbidity; Mortality Rates; Mothers; Nurses; Obstetric Labor Complications - mortality; Obstetrics; Obstetrics and Gynecology; Poverty; Pregnancy; Pregnancy Complications - mortality; Protest movements; Quality of Health Care; Reproductive health; reproductive health policy and programmes; Treatment Programs; Tribes; Vulnerable Populations; Womens health
• ISSN: 0968-8080; 1460-9576
• DOI: 10.1016/S0968-8080(12)39599-2

Since 2005, the Government of India has initiated several interventions to address the issue of maternal mortality, including efforts to improve maternity services and train community health workers, and to give cash incentives to poor women if they deliver in a health facility. Following local protests against a high number of maternal deaths in 2010 in Barwani district in Madhya Pradesh, central India, we undertook a fact-finding visit in January 2011 to investigate the 27 maternal deaths reported in the district from April to November 2010. We found an absence of antenatal care despite high levels of anaemia, absence of skilled birth attendants, failure to carry out emergency obstetric care in obvious cases of need, and referrals that never resulted in treatment. We present two case histories as examples. We took our findings to district and state health officials and called for proven means of preventing maternal deaths to be implemented. We question the policy of giving cash to pregnant women to deliver in poor quality facilities without first ensuring quality of care and strengthening the facilities to cope with the increased patient loads. We documented lack of accountability, discrimination against and negligence of poor women, particularly tribal women, and a close link between poverty and maternal death. Depuis 2005, le Gouvernement indien applique plusieurs interventions en matière de mortalité maternelle, notamment pour améliorer les services de maternité, former les agents de santé communautaires et verser une allocation aux femmes pauvres si elles accouchent dans un centre de santé. Après des manifestations locales contre le nombre élevé de décès maternels en 2010 dans le district Barwani au Madhya Pradesh, en Inde centrale, nous avons mené une mission d'enquête en janvier 2011 sur les 27 décès maternels signalés dans le district d'avril à novembre 2010. Nous avons constaté une absence de soins prénatals, en dépit de niveaux élevés d'anémie, un manque d'accoucheurs qualifiés, l'incapacité à dispenser des soins obstétricaux d'urgence dans des cas évidents de besoin et des aiguillages de patientes n'ayant jamais abouti à un traitement. Nous présentons deux cas à titre d'exemple. Nous avons transmis nos conclusions aux autorités de santé du district et de l'État, et demandé l'application de mesures éprouvées de prévention des décès maternels. Nous remettons en question la politique d'encouragement financier pour inciter les femmes à accoucher da