Maternal Morbidities

Definition The World Health Organization (1992) defined maternal morbidity as morbidity among women who have been pregnant (regardless of site or duration of the pregnancy) from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes. Morbidity can be physical or Psychological and result from direct or indirect causes.

Maternal morbidity Up to 15% of all women suffered a life-threatening morbidity associated with delivery and 1 of 11 women with severe maternal morbidity died. Severe postpartum anaemia is reported to contribute to late maternal deaths (Rajasthan study) These do not include morbidity from unsafe-abortions, which may contribute to another 10-15% of morbidity Postpartum psychosis and depression are among the most neglected morbidities. Many women live with disabilities for life

Maternal health and sexual and reproductive health: Intimate interlinkages The two are intimately interconnected Sexual and reproductive health problems compromise maternal health and pregnancy outcome, and these in turn may further compromise sexual and reproductive health Problems cumulative over the woman’s life time

Case study-1 I got married at 21 yrs, after 1 ½ yrs my first child was born. Delivery became complicated. Bag of waters burst but the baby was not born. I was rushed to the government health centre and stayed three days. They could not do anything. Then they said, the baby is dead we cannot do anything. From there I was taken to district hospital. There they operated (appears to be episiotomy) and took the baby out. It was a boy. For three days ‘glucose’ was given. There were stitches. Doctor gave prescription for a lot of medicines. The wound did not heal, the tear had not joined. So the doctor asked me to stay till the wound healed. 33 days it took.

Case study-1-contd. After three years was my second pregnancy. This time I went regularly for check-up. But since I had such a bad time in the hospital the first time, I wanted to stay at home for this delivery. This was a girl, she is well. After that, I have had 4 miscarriages. But I have not gone to the hospital to check-up. I am fed-up, I do not believe that it will help. I have lost my first-born son, and so many others before they are even formed. Only one daughter remains.

Case study-2 ‘I had my first child when I was less than 12. I did not know anything. During my third pregnancy, I went to a doctor and took some tablets for abortion. For three days I suffered badly, after that I aborted. I have had two daughters after that. When I became pregnant again, I went on my own and had an abortion and the operation. Nobody helped me after the operation.

Case study-2-contd. After that, I have to urinate every five minutes, and urine keeps leaking. I have been having white discharge for many days now. As long as I take medicines it becomes all right, after that it starts again. They now say that my condition (urine leaking) is because of the operation, but that is not true, I don’t think that’s the reason.’ (Dalit woman 28 years old, no schooling, former wage worker, now unable to do farm work)

Case study-3 I come from a big joint family. Had to do all the work by myself and grind Ragi and paddy manually soon after delivery. One day, after lifting up a pot of water to my head (within two weeks of delivery) I felt something give way. Since then I have had the uterus slip down when I squat. My husband gets angry because I find sex uncomfortable and am reluctant. These days I am not even able to go for work regularly. I often get (urinary) infection and white discharge, can’t do much about it in my situation.

Most of these deaths and disability are avoidable Unlike rare or newly emerging health problems and conditions, we have the benefit of more than a century of accumulated knowledge about the causes of maternal deaths and disability and what needs to be done to avert them. Maternal morbidities are several times the consequence of poor quality of care received We have some of the best brains and talents among doctors in the world. Can we not do better?

Recommendations (Hardee 2012) Expand focus of safe motherhood to include morbidity Improve data on incidence and prevalence of maternal morbidities Increase access to Reproductive Health care (facility based and community based) Address antecedents to poor maternal health through a life cycle approach