Service helps reduce risk at birth

Bhutanese consider children a blessing, but the beginning of life and the survival of the mother at birth have never been easy.

"The mother's life has always been at risk during the delivery of the baby, especially for my mother's generation," said an anxious young man waiting for the delivery of his first-born at the National Referral Hospital in the capital Thimphu.

The feeling is understandable in a country where maternal mortality rate (MMR) is high. Although improvement in the primary health care system has reduced the MMR from 770 per 100,000 live births in 1984 to 255 in 2000, the figure is still (one of the highest in South and East Asia) very high.

The difficult terrain, low literacy and lack of emergency obstetric care for people living in remote areas have all added to the high MMR.

Many maternal deaths result from complications. A study of 31 health centres in 2000 revealed that the most common complication was obstructed/prolonged labour (13.9 per cent), followed by infection and fits (eclampsia) (13.1 per cent), haemorrhage (13 per cent), and natural causes of abortion (5.4 per cent). Other complications included urinary tract Infection, anaemia and abnormal presentation.

It was previously thought that, if women took care of themselves before and during pregnancy, they would be able to detect any possible obstetrical complications.

"If such complications could be predicted, they could then seek health care and potentially prevent complications during pregnancy, " said Dr. Dechen, a gynaecologist at the Thimphu Hospital. "But this is not the case."

"Most obstetric complications cannot be predicted or prevented. But they can be successfully treated." Hence the idea for emergency obstetric care services.

A project has been started to ensure that women experiencing obstetric complications receive timely and appropriate emergency care. The "Women's Right to Life and Health Project" -- initiated by UNICEF and Columbia University -- works towards establishing and strengthening emergency obstetric care (EMOC) services in district hospitals.

EMOC services is planned to be set up in 14 centres throughout the country. Four of them will provide comprehensive services, including more sophisticated procedures such as Caesarian operations, while the others will have basic equipment and services.

Basic emergency obstetric care services are planned to cater to a population of 60,000 within two to three hours walk from the villages. Each comprehensive EMOC centre plans to support four to five districts, all within three to five hours driving distance.

Providing EMOC services is just one aspect of the project which also tries to make such facilities are "women friendly". The project will also develop human resources and promotes decentralized management.

Just as important is the need to make sure community leaders and the communities themselves understand the need for emergency care and to recognize the signs of women at risk for complications.

This would ensure that women at risk are rushed to the nearest EMOC centre for emergency care and treatment.