Community-based Maternal Death Reviews (MDR): Developing, validating and using a verbal autopsy tool to measure the disparities in maternal health care in India
Despite the large RCH program aimed at “reproductive health”, the maternal health indicators in India and its most populous state Uttar Pradesh (UP) have lagged behind. One of the key outcome indicators depicting disparities in healthcare is maternal mortality ratio. But MMR gives very little information in terms of speicifc causes of disparities in maternal healthcare. In India and in UP specifically a large number of maternal deaths remain unaccounted and unanalyzed, decreasing the urgency to act.
METHODS:
We conducted maternal death reviews in selected rural pockets of Lucknow district of UP to identify and establish systemic gaps creating disparities in maternal healthcare. We used a standardized maternal death notification format and verbal autopsy tool. Community-based confidential inquiries of maternal deaths were conducted:
- Using pretested structured questionnaires for death notification, verbal autopsy
- Through a team of well-trained investigators (qualified medical and paramedical staff)
- Compiled using a MS-Access based tool and
- Analyzed using appropriate statistical methods.
RESULTS:
The MDR data was collected from 152 cases (115 natal-postnatal and 37 antenatal and abortion related). Based on the analysis, following direct correlates of maternal mortality were identified:
- Between the educational status of pregnant woman and her chances of dying during childbirth - almost 58% of pregnant women who died were illiterate, while literacy rate in community was 65%.
- Between birth preparedness and odds of maternal death. 53% of deaths were among women whose family had not preplanned
- Between the time taken to reach appropriate health care facility and chances of maternal mortality.
CONCLUSIONS:
Each case of maternal mortality is interplay of community and health system capacities and information. The disparities in healthcare can be reduced through more informed community and affirmative action by health system towards managing obstetric emergencies, in socio-economically disadvantaged communities.