EHA

However much a mother wants to care for herself, it is impossible if she is poor and oppressed, illiterate and uninformed, anaemic and unhealthy, has 5-6 children, lives in a slum or village, has no clean water, and if she is without support from health services, her society, or the father of her children.

Reliable estimates of maternal mortality in India are not available. WHO estimates show that out of the 529,000 maternal deaths globally each year, 136,000 (25.7%) are contributed by India. This is the highest burden for any single country.

• To decrease maternal and neonatal mortality in the population served by the hospitals and community health projects of EHA
• To decrease the mortality associated with unplanned pregnancies by providing easily accessible family planning services
• To improve the health of adolescent girls and decrease the complications associated with early and too frequent childbearing.
• To upgrade facilities in every EHA hospital for the provision of high quality and affordable care including the use of standard treatment protocols, improved infrastructure and relevant staff training.
• To decrease the three delays that contributes to maternal mortality; delay in instituting adequate and appropriate care at the hospital level.
• To improve the survival of neonates who are low birth weight, premature or compromised during pregnancy by providing modern neonatal care.
• To decrease the morbidity associated with gynaecological problems by early diagnosis in the community and high quality treatment at the hospital.
• To steadily improve record keeping and collect data that will inform future activities.
• To be involved in reproductive health research and criterion based audits that will help to focus on key interventions.

Highlight of year 2009

Every time a woman in India becomes pregnant, her risk of dying is 200 times higher than the risk run by a woman in the developed world. Reliable estimates of maternal mortality in India are not available. WHO estimates show that out of the 529,000 maternal deaths globally each year, 136,000 (25.7%) are contributed by India. This is the highest burden for any single country. The existing health system does not adequately meet the needs of pregnant women, particularly for complications of pregnancy and emergencies.

Whose faces are behind the numbers? What were their stories? What were their dreams? They left behind children and families. They also left behind clues as to why their lives ended so early.

EHA attempts to reduce maternal deaths by tackling critical social and economic factors, such as the low status of women, poor understanding of many families about health care, the cost of such care, access to skilled attendants at birth and transport issues from the villages.

Quality Services
Last year EHA hospitals conducted 17,351 safe deliveries of which 5,135 (29.5%) took place at Duncan Hospital, Raxaul. Hospitals at Satbarwa, Fatehpur, Robertsganj, Chhatarpur and Lakhnadon had a substantial increase in deliveries. Less than half the patients had prenatal checks; the figure varying across regions with Landour having the highest coverage at 53.2% and Satbarwa having the lowest at 18.6%. Therefore majority of the deliveries continue to be emergency cases.  Lalitpur had the lowest C-section rate at 12.4% while the highest was at Madhipura at 50.3%; other hospitals had rates in the 20-40% range. Loss of babies at birth remained low, and the majority of dead babies delivered were those who died before the mother reached the hospital.

Sahyog CHD Project works in four slums in Delhi. Their focus is to empower communities to access Government services that are due to them. There has been considerable progress in helping women receive adequate prenatal care. Community volunteers visit the homes of pregnant women and hold awareness sessions. They encourage women to demand visits by the local auxiliary midwife. This resulted in double the prenatal checks from the previous year.  In one slum, 87% of expectant mothers had prenatal care.  The volunteers also facilitate referral of complicated cases to a city hospital.

Prem Sewa Hospital, Utraula sees about 300 pregnant women daily as out-patients with 1218 safe deliveries conducted last year. To increase prenatal coverage and provide maternity services close to village homes a rural maternity centre was established in Paltondi village. Trained reproductive and child health nurses run the centre making it easier for women to have regular check ups.

Prem Jyoti Community Hospital, Barharwa gives a special charity package to the Malto tribal women. Deliveries are conducted for just Rs.100. This has led to many women coming to the hospital for delivery.

The Reproductive and Child Health Course for nurses has equipped 75 nurses to be middle level practitioners who are the first point of contact for women patients. Two RCH continuing medical education (CMEs) programs were held as refresher courses for the nurses trained in earlier batches with a focus on adolescent health and neonatology. Basic computer skill training was added this year.

Partnerships – Several EHA hospitals are recognized by the government for delivery services under the National Rural Health Mission. Under different schemes hospitals are given funds to subsidize the cost of delivery for women living below the poverty line allowing more women to have safe deliveries in hospital. EHA's community health projects also sensitize communities on maternal and prenatal health issues, including birth preparedness and complication readiness.

Challenges
Social and economic factors like the low status of women in communities, poor nutritional status of mothers,  the poor understanding of families on when to seek care, lack of transport, poor roads and multiple referrals to different health facilities, adds to the complications, and remains as challenges. A lack of blood banks affects transfusion services, a critical need when dealing with largely anaemic rural women.