Maternal Health in Gujarat, India: A Case Study

Abstract

Gujarat state of India has come a long way in improving the health indicators since independence, but progress in reducing maternal mortality has been slow and largely unmeasured or documented. This case study identified several challenges for reducing the maternal mortality ratio, including lack of the managerial capacity, shortage of skilled human resources, non-availability of blood in rural areas, and infrastructural and supply bottlenecks. The Gujarat Government has taken several initiatives to improve maternal health services, such as partnership with private obstetricians to provide delivery care to poor women, a relatively-short training of medical officers and nurses to provide emergency obstetric care (EmOC), and an improved emergency transport system. However, several challenges still remain. Recommendations are made for expanding the management capacity for maternal health, operationalization of health facilities, and ensuring EmOC on 24/7 (24 hours a day, seven days a week) basis by posting nurse-midwives and trained medical officers for skilled care, ensuring availability of blood, and improving the registration and auditing of all maternal deaths. However, all these interventions can only take place if there are substantially-increased political will and social awareness.

Global, regional, and national levels of maternal mortality, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015

“…This treatise is supported by the observation that many of the countries or regions that improved more rapidly than would have been expected after 2000 were also the biggest recipients of Development Assistance for Health,39 funds that are often directed toward strengthening health systems, while many of those that have improved more slowly than expected have suffered from epidemics, natural disasters, and armed conflicts that impair the function of health systems and the willingness or ability of women to seek care. Third, within any given region, heterogeneous or slower-than-expected MMR improvements might be related to uneven ramp-up of coverage for specific method of reproductive health care— antenatal care, in-facility delivery, skilled birth attendance, family planning services, EmOC, and post natal care—that are all known to decrease the risk of bad pregnancy outcomes 40,41. Indeed, increasing use of reproductive health services was one of the driving factors behind establishment of the Janani Suraksha Yojana conditional cash transfer programme in India.…”

Improving Maternal Survival in South Asia - What Can We Learn from Case Studies?

“…The percentage of posts unfilled suggests that the two districts in Bangladesh (12) are broadly better staffed than either those of Gujarat (3) or Andhra Pradesh (2); however, the comparison depends on the levels at which numbers of posts have been set. The statistics indicate the extent to which absence of staff is due to failure to recruit or retain rather than failure to sanction the post (usually but not always an indication that the post has been budgeted for).…”

“…The Chiranjeevi programme seeks to enlist the more numerous private-sector care providers to maternal healthcare provision in remote and difficult areas (3), based on an understanding that it will require incentives and adequate finance to do so, and also in Gujarat, the ‘walk-in' recruitment system indicates an openness to finding other ways of doing things. Similarly, in Rajasthan (5) and Tamil Nadu (1), contracted staff who have proved in other settings less able to shift their employment to another location have been a component of the strategies adopted.…”

“…Reliable estimates of MMR are notoriously difficult, and the case studies of Gujarat (3) and India as a whole (7) document widely fluctuating rates, more likely to reflect errors of estimation than fluctuations in deaths themselves. Other case studies would caution against too direct an association between the use of skilled birth attendants (SBAs) and the MMR.…”

“…In Gujarat, the Chiranjeevi Scheme appears to play at least some role in the explanation of the increased uptake of available maternal services (3). In Andhra Pradesh, it is less apparent which of the strategies identified, if any, might explain its better performance in maternal health (2).…”