New Delhi: India saw some success last year when statistics showed that Maternal Mortality Rate (MMR), one of the key public health concerns in the country, dropped by 22 per cent.
From 167 in 2011-2013, India’s MMR fell to 130 in 2014-2016, revealed data.
Experts, however, say a lot more still needs to be done for Indian women to achieve a healthy and safe prenatal and postnatal care and be at par with pregnant women in developed countries.
On National Safe Motherhood Day, ThePrint looks at five major risks involved in pregnancy of women in India and how they can be prevented.
Lack of nutritious diet
Bleeding during pregnancy and delivery (postpartum haemorrhage) is one of the main health risks women face while giving birth. This life threatening condition is linked to malnutrition, both in rural and urban women.
“While there is difference in terms of access to healthcare and awareness between urban and rural women in India, both sections are facing a similar problem which is malnutrition. The women are mostly anaemic due to which they often have excessive bleeding during delivery,” Dr Ranjana Sharma, senior consultant, gynaecology, Indraprastha Apollo Hospitals, told ThePrint.
“In women who lack access to proper healthcare, this condition leads to death. However, in urban areas, women are aware and stick to supplements and regular check-ups,” said Sharma.
To tackle this nutrition situation, the World Health Organisation (WHO) recommends daily iron and folic acid supplementation during pregnancy. In India, the government has formulated a strategy, Anaemia Mukt Bharat, or Intensified National Iron Plus Initiative, for the target group, which includes women in reproductive age.
“Only one in five females follows this advice. Besides causing bleeding, anaemia also leads to fatigue and weakness among women. The only way out for pregnant women is to have a balanced diet,” said Dr Anjana Singh, senior consultant and head of department, gynaecology, Fortis Hospital, Noida.
“A healthy mother is important because she is an incubator for her unborn child. If a woman eats a nutritious diet during pregnancy, then the brain development of the foetus is good. It also ensures there is a reduction in birth defects and the weight of the baby is healthy,” added Singh.
For Indian women, gynaecologists also warn of infections in government facilities and lack of professionalism by health workers at the time of pregnancy.
“Another major risk is sepsis (infection) which accounts for 10 per cent of deaths during delivery due to poor sanitation,” said Singh.
Sharma, who has 40 years of experience as a gynaecologist, underlined the risk of trauma during delivery.
“In the rural belt, the concept of delivery at home is still there. This sometimes leads to complications like infections and similar is the scene in some government facilities where the health workers are not professional enough and end up giving physical trauma to the pregnant woman,” Sharma explained.
“Midwives have basic knowledge of delivering but do not know how to conduct operations.”
Sharma added that due to lack of doctors, the chaos in labour rooms of government hospitals also cause great stress for pregnant women.
The experts stressed that maintaining hygiene during delivery and postpartum care should be made compulsory at all levels.
“Sometimes, the uterus does not contract and keeps on bleeding. In this situation, we need to give the pregnant woman medicine. In government facilities and even hospitals, clean sanitary napkins must be provided in abundance because some women use dirty cloth which causes severe infection,” said Sharma.
Sexual and reproductive rights activists often highlight that a woman should have full authority on her body. In this regard, gynaecological experts point out the importance of timely pregnancy to women.
“The most important advice is to conceive at the right age. It should not be delayed beyond 30 and 35,” recommended Singh, further calling for pre-counselling sessions.
“This will allow the doctor to identify any diseases the baby might have, any genetic defects that the baby might be suffering from. Accordingly, decisions, tests can be taken,” said Singh.
The doctors also noted the rising trend of late pregnancies in Indian women — 20 to 30 per cent women opt for pregnancies after the age of 35 years, said Sharma.
“Additionally, females do not go for antenatal check-ups as a result of which they are unaware of the risk factors. Indian women also develop pre-eclampsia and eclampsia which is related to blood pressure and could be life threatening,” added Sharma.
“Women should at least do three check-ups during pregnancy, including all necessary investigations.”
Postpartum depression, an extremely debilitating mood disorder, is another risk women face after delivery.
“Anxiety, hopelessness, fatigue, anger, frequent mood swings and the constant fear that one will not be a good mother characterise this disorder,” said Singh.
A 2017 study done in collaboration with the WHO — Postpartum depression in India: a systematic review and meta-analysis — explained the mood disorder in considerable detail.
Risk factors for postpartum depression include financial difficulties, domestic violence, past history of psychiatric illness in the mother and marital conflicts, besides sick baby or death of baby at birth.
“In order to deal with postpartum depression one needs to understand that it can be antenatal depression which, if continuing, can be recurrent, lasting two weeks to three months after delivery. There is no set time period for this. The effective methods of treating it include counselling and medication,” said the Fortis expert.
Reducing physical and mental stress and exercise also find a prominent mention in the gynaecologists’ advice to deal with the issue.
Infection in children
To prevent infection in babies immediately after birth, and for safe and healthy motherhood, breastfeeding is another crucial factor.
“Breastfeeding is important because breast milk has antibodies which protect the child, especially the breast milk of the first three days which is called colostrum. Additionally, it is nutrition at the right PH balance, at the right temperature,” said Singh.
“There is enough protein in it, balanced amount of carbohydrates,” she said.
Breast milk is also believed to prevent infection, and is hygienic.
“It allows for lesser chances of gastric infection,” said Singh.
In September last year, New Zealand Prime Minister Jacinda Ardern made history by bringing her baby Neve to the UN General Assembly and breastfeeding her, providing the issue much-required attention worldwide.