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UNICEF unveils new tool to combat maternal mortality in India

© UNICEF/India/2006/Khemka
Bindu Modi of Purulia, West Bengal, suffered from high blood pressure and anaemia while she was pregnant. Her condition resulted in a complicated delivery of twins.

By Roopa Bakshi

NEW DELHI, INDIA, 6 April 2006 – In this country where a woman dies in childbirth every five minutes, UNICEF is unveiling a new method to save mothers’ lives: the Maternal and Perinatal Death Inquiries method, or MAPEDI.

Developed and implemented with Johns Hopkins University in the United States, MAPEDI uses what is called the ‘verbal autopsy method’ to gain insight from people in communities who have firsthand experience with the tragedy of maternal mortality.

Equipped with a detailed MAPEDI questionnaire, UNICEF India volunteers have begun conducting one-on-one interviews with family members and health care workers in six high-risk districts. The data collected at these interviews will be analyzed and presented to local communities for review. The new tool is being used in collaboration with the Government of India as part of the National Reproductive and Child Health Programme, which is supported by the World Bank and seeks to significantly reduce maternal mortality rates.

Confidentiality leads to answers

Common factors leading to death during pregnancy include anaemia, obstructed labour and unsafe abortion. But underlying causes exist as well – causes more difficult to document, including the low social status of women, lack of awareness or sheer distance from quality health care in rural areas. And many health care centres in India still suffer from limitations such as inadequate birthing facilities and inoperable ambulances.

With its vast population and a rate of 540 maternal deaths per 100,000 live births, India accounts for more than 20 per cent of global maternal and child deaths – most of which could be prevented with access to the right kind of information. Speaking directly to the community will make it easier to identify not only the biological factors that contribute to maternal and perinatal death, but the elusive social ones as well.

Taking care to keep the MAPEDI interviews non-threatening is of the utmost importance.

© UNICEF/India/2006/Khemka
Alpana Mahato with her newborn infant, who was delivered at home by a trained birth assistant in Purulia, West Bengal.

"Ensuring confidentiality when sharing the findings of the death inquiries with and outside the community leads to openness in reporting, which provides a more complete picture of the precise sequence of events leading to death,” states Project Officer for Safe Motherhood and Women's Health, Dr. Khynn Win Win Soe. “The approach seeks to identify community factors, and gaps and failures in the health care system, only in view of taking positive action toward improvement – never to provide the basis for legal action, punishment or blame."

A grassroots approach

Significant underreporting of deaths, because either the underlying cause was never determined or the relevant information was not recorded, makes it difficult to evaluate why maternal mortality rates in India are so high. So during MAPEDI interviews, UNICEF volunteers encourage community members and health care workers to help others by thoroughly documenting and reporting all deaths.

This grassroots approach also aims to embolden women to assess the quality of their obstetric care. The findings will allow communities, local governments and non-governmental organizations to take definitive action against the documented factors contributing to maternal mortality.

India’s national Department of Health and Family Welfare has already stressed the need for skilled birth attendants and adequately equipped hospitals. Despite this guidance, India continues to lose women to preventable maternal death. If the reasons behind many of these deaths remain unknown and unreported, it will difficult to make significant improvement. The goal of MAPEDI is provide the missing information and lower these numbers by raising awareness.

The UN Millennium Development Goals call for reducing maternal mortality by three-quarters by 2015. As India works toward helping the world meet this goal, MAPEDI data will provide concrete evidence that maternal mortality should be a national health priority.

Kyria Abrahams contributed to this story from New York.



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