Uttar Pradesh is the most populous state and has some of the worst health and socioeconomic indicators in India. Health indicators are below national averages and include: female literacy at 26%; total fertility at 4.75; infant mortality at 98 deaths/1,000 live births; contraceptive prevalence at 20%; and number of deliveries attended by trained personnel at 18%. The maternal mortality ratio is 737/100,000 live births compared to 407 for India.
CARE-India is implementing both rural and urban projects in Uttar Pradesh to improve reproductive health. Verbal autopsies (VA), community-based assessment tools, were conducted to identity factors associated with 22 maternal deaths. Of the woman who died, 4 had attended school, 7 received antenatal care, 12 delivered with untrained attendants, and only 11 had live births. At the time of VA, only one child was surviving.
The VA identified the following causes of death: hemorrhage(7), severe anemia(4), sepsis(3), eclampsia(3), obstructed labor(1), and jaundice(3). Most were the result of delay in identification of complications by Traditional Birth Attendants(TBAs), delay in decision making by TBAs/family members, delay in transport and delay in receiving treatment.
Community members developed VA video case studies to educate men, women and TBAs on the causes of maternal mortality. As a result of awareness the community established a health fund for emergency transport and treatment and developed materials on pregnancy danger signs to sensitize pregnant women, their families, and community members. The maternal deaths reported have decreased from 17 in 1998 to 6 in 1999.
Learning Objectives: Idenitfy leading causes of maternal mortality in Uttar Pradesh, India. Discuss contributing factors to maternal death. Describe how verbal autopsies used as a community-based intervention tool can improve reproductive health.
Keywords: Maternal Health, Community Participation
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: CARE-India
I have a significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.
Relationship: employment