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MATERNAL MORTALITY -
High Maternal Mortality: A Social Problem, Not A
Medical Problem
INTRODUCTION: -
India has one of the highest maternal
moralities in the world. The medical names of these conditions
that kill these mothers are 1) Anemia (2) Hemorrhage 3)
Eclampsia 4) Sepsis. Childbirth is a physiological process.
There are hundreds of physiological processes going on in the
body and humans don’t die of a physiology. Childbirth is
probably the only physiology that can kill. Besides, the dying
mother is all very young and in the most productive years of her
life. This makes any one take a note of the problem.
THE MEDICAL ANGLE:-
As written in the previous paragraph, there
are many medical names to which one can attribute the death of a
mother, just as anemia is called as blood replaced by water. The
doctor is in-fact the last person in this entire chain. He
receives the patient when the problem is either very serious or
irreparably damaged. 90% of the current causes of maternal
mortality in India are preventable. But prevention is at the
level of the society. Eclampsia – a state of convulsions is due
to high B.P. in pregnancy. Once eclampsia occurs both, the
mother as well as the fetus are at an instant risk of death. But
this eclampsia can be prevented if B.P. as not allowed to go out
of control. Another cause or medical name for death of a mother
is hemorrhage. Doctors get these mothers in a state of shock
with profuse bleeding and many a times the mother can’t be
saved.
THE SOCIAL ANGLE:-
In the previous section I have written
about different names of condition that kill the mother. I am
specifically using the word medical “names”. But if we closely
look at these conditions, the killers are actually different.
Anemia would not have occurred if she would have taken just two
tablets of iron every day when she was pregnant. The eclamptic
patient would have not died had she taken regular antenatal care
leading to early diagnosis and treatment of the hypertension in
time. Post partum hemorrhage patients would not have died if the
mother could have reached the medical help in time. Sepsis would
not have killed the mother if she had resorted to legal abortion
(MTP) services and healthy and readily available hospital
services for delivery.
Now who is responsible for this? Obviously
the society! Making a women and her family conscious of her
health is a social problem. Doctors can’t do it. Improving a
women’s status in the society is a social problem-doctors can’t
do it. The Government on recommendations of doctors have started
free supply of iron to treat and prevent anemia in pregnant
women. But the society and the pregnant mothers think that
because these tablets are free they are useless and so they
throw them away. Inaccessible roads and inhospitable terrains
prevent the woman of hemorrhage from reaching medical help in
time. A doctor can’t improve the roads and establish effective
communication systems. The Government has to do it. Blood
donation is still a huge problem. At most places the demand is
more than the supply. Relatives refuse to donate blood when they
accompany women in labour or with complications for which blood
is required. What can the doctor do in this? At the most he can
go and donate blood. I have seen countless doctors
(obstetricians) who themselves donate blood for these patients
and then come and operate the patient abandoned by relatives.
Clean delivery environment and safe abortion services are easily
available in this country. But women still prefer to deliver at
home or get aborted through unsafe means. Doctors can’t reach
out to every home for delivery. The population is so large that
it is impossible for a doctor to reach out to every home
delivery. Instead the society can convince the mother to avail
of safe delivery and abortion services.
WHAT IS THE SOLUTION?
Having conclusively accepted that mothers
die due to society and not due to doctors –what is the solution?
The solution is in literacy and improvement of economic
conditions both, together. They are the most powerful ways to
solve this problem. Individually they can’t solve the problem.
Punjab is financially rich and so is Gujarat but maternal
mortality is high. Tamilnadu and Andhra are literate but
financially poor- maternal mortality is high. Kerala, flush with
petrodollars and excellent literacy has the lowest maternal
mortality in the country. Reasons are not for far fetched.
Financial prosperity coupled with education will automatically
save 90% mothers in our country. Doctors can’t do this. It is
not a medical problem. This only society can do it as it is a
social problem.
VISION: -
Improving financial prosperity of the
society by employment generation agriculture and industrial
growth coupled with spread of literacy can easily help India
achieve figures of maternal health comparable with the developed
world.
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