Stop leaving our mothers to suffer and die

The death of several women following sterilisation in Chhattisgarh this past week and similar incidents periodically reported from other parts of the country present sorry picture of healthcare in India. Safe maternity and child care is a basic medical service to which all women have a right, but we have not been able to ensure it even after sizeable investments made in the past several decades.

Unfortunately, the situation with regard to maternity care is pretty bad even in urban areas and metropolitan cities like Delhi where adequate health infrastructure exists. Delhi has 32 government hospitals and 250 government-run maternity homes, besides over 550 private hospitals and nursing homes.

One would think that with so many hospitals and maternity homes in the capital, we should be having top-class maternity services in place. But this is not the case, as revealed in a recent study of maternity care conducted by Sitaram Bhartia Institute of Science and Research.

The study, “Delhi Delivery Care”, was designed to evaluate quality of maternity care in terms of medical practices as defined in standard guidelines.

The survey covered 1.18 lakh households and was funded by the Indian Council of Medical Research (ICMR). The findings reveal that a substantial section of women are subjected to overuse of investigations and interventions, while certain minimal public health goals are not being met.

Women in private hospitals had a significantly higher number of ultrasounds and caesarean deliveries compared with public hospitals.

While child specialists are attending a good number of deliveries in private facilities, newborn care is not up to the mark.

Babies are routinely shifted to nurseries and there is delayed initiation of breastfeeding. In several facilities, newborns are being given formula feed or animal milk within 48 hours of birth, flouting all standard norms. Family planning advice at discharge was given to only a quarter of mothers in both government and private hospitals. “Although some basic public health objectives are being met, prevalent practices deviate substantially from both a wide range of national and international guidelines”, according to Abhishek Bhartia, one of the co-authors of the study. This is also happening in private institutions where patients or insurance companies pay for care and where infrastructure is not a limiting factor. The high rate of C-section deliveries is particularly disturbing.

In government hospitals, the caesarean rate was 23.7 per cent, while it was as high as 53.8 per cent in private hospitals and 41.4 per cent in nursing homes. This is much above the ten to 15 per cent, which has been set globally as a benchmark by the World Health Organisation (WHO).

Considering that caesarean is a major surgery which should be carried out only when medically required, the high rates seen in Delhi are worrying.

A lot of women are being subjected to an unnecessary surgical procedure which carries certain risk. While we need to invest more to increase access to healthcare, it may still be more problematic if we do so without ensuring quality of care. This is an important message that the Delhi study holds for rest of the country.