Maternal Death in India: Whose responsibility it is ?

 With Sustainable development goals targets to reduce maternal mortality below 70/ lakh live births by 2030, India has to bring its focus on to reduce maternal mortality. India is contributing 1/8th of the maternal deaths across the world and this indicate there is a need for extensive mechanism to combat maternal deaths. 

But are we in the direction of reducing maternal deaths or just trying to ensure that no death occurs at our facility, during our duty hours, or just by referring any serious case to some other facility so that the patient dies during transit or in other facility so that we wont be blamed for that death or we dont have to review that maternal death. Well that's a big question mark on our system. 

I am here by just sharing my experience of working in the field. I was having my regular rural posting at a Community Health Centre in Meerut. It was a day of PMMSY where a gynaecologist from the medical college visit the centre and look for high risk pregnancies. 

We noticed that a lot of females were high risk pregnancies with anemia, pre-eclampsia, multipara being the common causes. To my curiosity I asked the Nurse who deals with deliveries at the CHC about the health of mothers in the community (approx 1.8 lakh population), why so many are high risk females. She told that nothing happens if we cant treat them here we use to refer them to medical college. I was satisfied by her answer. But then I thought that its not necessary that all women will go to medical college and some pregnancies are also un-diagnosed high risk pregnancies. What all facilities do they have at CHC for them. 

I again asked her about such cases, she again said if we come to know we refer them to higher center. When inquired about the maternal deaths at CHC and review meetings for maternal deaths in the CHC, she said "Jab kisi ki death CHC pe hoti hi nai to kaisi review meeting". I was literally surprised that a community health center covering over 1.8 lakh population and providing delivery facilities to population has not recorded a single maternal death. 

I contacted the medical officer incharge of the CHC, and asked about the same. He said its true we never reported any maternal death. When asked the reason for it he said "kaun pachde mein pade, let the things go smoothly". 

When inquired about the reason and what they do if one came with severe bleeding or any other complication and dies on reaching CHC. They said that if one patient came in serious condition and they have feeling that the patient wont survive they refer them immediately to higher center. Even when the patient expires in the Community health Center they refer them to higher center without reporting the condition of the patient as dead so that they don't have to show in their records. They don't bother to review the death of mother and not even claim that the death occurred in their premises. 

The worst part is most of the deaths occurs during transit (including those where the dead bodies are referred to higher centers) are not being claimed by the higher centers as well. 

If we have a system of maternal death review in order to reduce the maternal mortality its necessary for the facilities to claim the death and find the cause of death but due to fear of relatives and keeping their records clean such patients who are either dead or partially dead are referred to and fro from secondary level to tertiary level and vice versa. 

The condition of Indian system is so pathetic that we try to save our selves beside looking for patients and to some extent its true also, as we are not being provided any security that if patients relative get on us what can we do, secondly the system of reviewing is so complicated that no one want to claim the death in order to do a lot of paper work and other activities. 

Its just sharing my experience on maternal deaths in India, how in human we are regarding death of mothers in the country and beside that claiming that we can reduce maternal mortality and will be front runner for SDG, 2030.