Social Obstetrics, aim, classification of maternal death,MMR,JSSK,MDG goals,NSSK,RBSK,RKSK,WIFS programme,

1. SOCIAL OBSTETRICS

2. MATERNAL MORTALITY
 Maternal death not only reflects the quality of medical care but also a reflection of
social structure and presence or absence of related facilities in a given set up. So, it
is taken as an indicator of social responsibility in improving the care for pregnant
mothers.
 DEFINITION:
 Maternal death is defined as ‘the death of a woman while pregnant or within 42
days of termination of pregnancy, irrespective of the duration and site of
pregnancy, from any cause related to or aggravated by the pregnancy or its
management, but not from accidental or incidental causes.’
 In India, it is mandatory to have the birth and death registered within a specified
period.

3. CLASSIFICATION OF MATERNAL DEATH
1.DIRECT MATERNAL DEATH:
Maternal death resulting from obstetric complications of the pregnancy state(
pregnancy, labour, puerperium),from interventions, omissions, or incorrect treatment , or
from a chain of events resulting from any of the above.
2.INDIRECT MATERNAL DEATH:
Maternal deaths resulting from previous existing disease or disease that developed
during pregnancy and it was not due to direct obstetric causes but was aggravated by the
physiological effects of pregnancy.
3.NON-OBSTETRICAL maternal deaths results from incidental causes like accident, assault,
suicide, snake bite, burns and so on.
4.Late maternal death is one which results from either direct or indirect obstetric causes,
more than 42 days but less than 1 year ,after termination of pregnancy.

4. MATERNAL MORTALITY RATE
 It is defined as the number of maternal deaths in a given period per 100,000
women of reproductive age (15 to 49 years of age) during the same time period.
 MATERNAL MORTALITY RATIO:
 It refers to the number of maternal deaths during a given time period per 1,00,000
live births. This is the most commonly used measure of maternal mortality .MMR is
used as a measure of quality of healthcare system.

5. MILLENIUM DEVELOPMENT GOALS (MDG)
 MDG 5 relates to maternal health
 The goal is to improve maternal health
 The targets are :
 Reduce the maternal mortality ratio by three quarters , between 1990 and 2015.
 Achieve universal access to reproductive health by 2015.
 WHO estimates show that out of all maternal deaths globally each year,17% are in
India. This is highest burden for any single country.
 India accounts for 20% of world maternal deaths, with a woman dying every 5
minutes.

6. Factors Influencing Maternal Mortality
Age and Parity:
It increases with age and parity.
Socioeconomic status:
low SES leads to malnutrition , anaemia, infection.
Efficient antenatal and intranatal care
Place of delivery and presence of skilled birth attendant
Availability of blood transfusion and transport services.

7. Direct Obstetric Causes:
 About 80% of maternal deaths are due to direct causes. They are
1. Hemorrhage - PPH (25%), APH
Incidence is decreasing nowadays because of AMTSL
2.Hypertension-12%
Mainly preeclampsia and eclampsia
Preventive measure : Magnesium sulphate regimen, antihypertensives.
3.Puerperal Sepsis -15%
Preventive measure: proper hand washing techniques, use of separate linen and
slippers for labour room ,restricting the number of vaginal examinations to minimum,
meticulously following five cleans of delivery.

8. Contd…
4.Unsafe abortion -13%
Preventive measure : safe abortion services ,MTP act.
5.obstructed labour-8%
Other direct causes -8%
INDIRECT CAUSES OF MATERNAL MORTALITY -20%
They are
Anaemia
Heart disease
Infective hepatitis
Malnutrition
Tuberculosis

9. Efforts to reduce maternal mortality:
 Providing good antenatal care
 Early diagnosis and management of complications
 Promoting institutional delivery / by trained birth attendant

10. Initiatives of Govt .of India
 ESSENTIAL OBSTETRIC CARE:
 The components include treatment of anaemia, institutional/ safe delivery services
and postnatal care.
 QUALITY ANTENATAL CARE:
 It includes a minimum of four antenatal visits including early registration-
registration before 12 weeks of gestation.
 Along with this physical and abdominal examination ,during these visits HB
estimation and urine investigation should be done.
 The mother is also given 2 doses of TT /Td and 100 IFA tablets for 100 days.

11.  SKILLED ATTENDANCE AT BIRTH
 Every birth should be attended by skill birth attendant .
 According to WHO , a skilled attendant is an accredited health professional such as midwife ,
nurse or doctor –who has been educated and trained to proficiency in the skills needed to manage
normal ( uncomplicated pregnancies , childbirth and immediate postnatal period and in the
identification , management or referral of complications in women and newborns.
 POSTNATAL CARE :
 Every birth should be in a healthcare facility with a skilled birth attendant.
 All delivered mothers are advised to stay in facility for 48 hours after normal delivery.
 Subsequently , home visits on 3rd ,7 th and 42 nd postnatal day for identification and management
of complications that occur during postnatal period.

12. General Measures to improve Obstetric Care
1. Setting up of blood storage facilities at FRU.
2. Village health and Nutrition day
3. Delivery points
4. Web enabled mother and child tracking system
5. Maternal death review
6. Joint MCP card
7. Tracking of severe anaemia during pregnancy and childbirth by PHCs

13. Programmes of Govt. of India.
 JANANI SURAKSHA YOJANA
 It is a flagship programme under the National Rural Heath Mission which aims to
reduce maternal and infant mortality by focusing on institutional deliveries.
 An amount of Rs.700 is paid to resident rural mothers.
 Rs.600 is paid to resident urban mothers who deliver at accredited institutions.
 Rs.500 is entitled to those mothers who deliver at home.
 Irrespective of age and parity, all BPL/SC/ST mothers delivering at public health
centres and at accredited private institutions are eligible to receive this benefit.

14. JANANI SHISHU SURAKSHA
KARYAKRAM(JSSK)
 Government of India launched this JSSK on June 1,2011.
 The following are the free entitlements for pregnant women under this programme.
 free and cashless delivery
 free cesarean delivery
 free drugs and consumables
 free diagnostics
 free diet during stay in healthcare institution
 free provision of blood
 exemption from user charges
 free transport from home to health care facility
 free transport between the facilities in case of referral
 free drop from institution to home after a 48 hour stay

15.  The following are the free entitlements for sick newborns till 30 days after birth.
This is now expanded to cover sick infants.
 free treatment
 free drugs and consumables
 free diagnostics
 free provision of blood
 exemption from user charges
 free transport from home to healthcare institutions
 free transport between the facilities in case of referral
 free drop from the institution to home.

16. NAVJAAT SHISHU SURAKSHA KARYAKRAM
(NSSK)
 India’s infant mortality is nearly 21% of global burden of infant deaths.
 Neonatal mortality accounts for 2/3 of all infant mortality.
 Birth asphyxia and serious infections account for nearly 50 % of all neonatal deaths.
 By keeping this in mind ,Government of India developed a programme on Basic
Newborn Care and Resusitation to address these causes in a large way.
 This programme trains all health professionals in basic newborn care and simple
resuscitation techniques, so that we can reduce neonatal mortality as well as infant
mortality.

17. RASHTRIYA BAL SWASTHYA KARYAKRAM
 It is a new initiative aimed at early identification and early intervention for children
from birth to 18 years to cover the 4 “D”
 1.Defects of birth
 2.Deficiencies
 3.Diseases
 4.Developmental defects including disability.
 First level screening is to be done at all delivery points through existing medical
officers, SN and ANM.
 After 48 hours till 6 weeks , the screening of newborns will be done by Village
Health Nurses.

18. Contd…
 Outreach screening will be done by dedicated mobile block level teams from
6weeks to 6 years at anganwadi centres and from six years to 18 years at school.
 Once the child has been screened and referred from any of these points of
identification , the necessary treatment or intervention is delivered at zero cost to
the family.

19. RASHTRIYA KISHOR SWASTHYA
KARYAKRAM (RKSK)
 It was launched on January 7, 2014.
 The Ministry of Health and Family Welfare has launched a health programme for
adolescents, in the age group of 10 to 19 years ,which would target their nutrition,
reproductive health and it also deals with issues like substance abuse.
 OBJECTIVES :
 improve nutrition
 improve sexual and reproductive health
 enhance mental health
 prevent injuries and violence
 prevent substance misuse

20. Contd…
 PRINCIPLES:
 Adolescent participation and leadership
 Equity and inclusion
 Gender equity
 Strategic partnerships with other sectors and stakeholders.
 This programme enables all adolescents in India to realise their full potential by
making informed and responsible decisions related to their health and well being.

21. Weekly Iron and Folic Acid (WIFS) programme
 In India , adolescent anaemia is a long standing pubic health problem.
 Due to accelerated growth, poor dietary intake and high worm infestation , the
risk of iron deficiency is high in adolescents. Especially in girls due to menstruation,
adolescent pregnancy and conception.
 Ministry of health and Family Welfare has launched this WIFS programme of
supplementing weekly 100mg elemental iron and 500 ug of folic acid for school
going adolescent boys and girls and for also out of school adolescent girls.
 This programme ensures administration of supervised weekly IFA supplementation
and biannual deworming.

22. THANK YOU