Improved access to safe blood must be prioritized as a core component of comprehensive efforts to prevent maternal deaths in Uttar Pradesh, India.

Abstract

Background: Postpartum hemorrhage is responsible for 39% of maternal deaths in India. Provision of blood transfusion is one of the key components of functional First Referral Units (FRU) meant for providing Comprehensive Emergency Obstetric Care (CEmONC). However, in the absence of functional FRUs, there is hardly any facility available which can provide safe blood transfusion to a haemorrhagic woman in Uttar Pradesh (UP). Aims & Objectives: The objective of this study was to argue for improving access and availability of safe blood transfusion for women, who are haemorrhagic and/ or severely anaemic, on priority basis, to prevent maternal deaths. Materials and Methods: Community based maternal death review and facility review was conducted in district Unnao, UP, and information gathered on maternal deaths. Out of the 57 maternal deaths analyzed, 37 were due to hemorrhage and severe anaemia. Pearson correlation test was performed between maternal mortality ratio (MMR) and number of estimated pregnancies per blood bank, for five key states including UP. Results: Out of 57 maternal deaths, 37 maternal deaths were due to hemorrhage (39%) and severe anaemia (26%). Out of 15 facilities assessed; only the district hospital (6.7%) had a blood bank and transfusion facility and the rest 14 (93.3%) of the facilities had no provision for blood transfusion, blood storage unit (BSU) or dedicated staffs to handle any emergency. A significant correlation was observed between the MMR and number of pregnancies per blood bank (r = 0.970, p=0.006). Conclusion: Given the role of blood transfusion in multiple obstetric emergencies, provision of blood bank /BSU at the FRUs, district hospitals, sub-divisional hospital (SDH) or community health center (CHC) needs to be given high level of priority to avert preventable maternal deaths in UP.