1. Tamil Nadu’s initiatives to reduce MMR
POPULATION
India Mn
Tamil Nadu Mn

2. Structure of the presentation
Present status of maternal health in the state
Major achievements over
Issues and concerns-comparison of maternal death data
Planned interventions for each of the focus areas

3. Demographic Profile VITAL EVENTS INDIA TAMILNADU Infant Mortality Rate53
(SRS 2008) 31
Maternal Mortality Ratio
254
(SRS ) 79
(State HMIS )
TFR
2.7
(SRS 2007)
1.6
Institutional Deliveries
40.7
(NFHS 3)
90.4
Maternal Anaemia
57.8
53.3
Mothers who had at least 3 antenatal care visits for their last birth (%)
50.7
97.6

4. Trend in Maternal Mortality Rate-Tamil Nadu
MMR
AMTSL, LSAS training, Hiring of Specialists
Blood storage facility, AN protocol, etc
EMRI
Before RCH
RCH
NRHM
Source DPH & PM
YEAR

5. Maternal Death Cause Analysis 2008-09

6. Improved utilization of PHCs
Positioning 3 staff nurses in each PHC to provide 24x7 delivery care and training to these nurses in SBA skills
Filling vacancies of medical officers and equipping the PHCs to provide BEmONC services.
Using untied funds and Patient Welfare Society funds to improve ambience and user friendliness of PHCs
Building bridges between PHC and community using innovative IEC techniques

7. IMPROVED UTILISATION OF PHCs
Average OP per Day
Average IP per Month
Average Deliveries per Month

8. CONTRIBUTION IN DELIVERIES (%)
Domi.
PVT GH
PHC
HSC
Up to Dec. 8

9. Melakkal PHC, Madurai HUD
NRHM Additionalities
Melakkal PHC, Madurai HUD
Old Building
New Building

10. Privacy assured during the stay at PHC RO , Solar water heater
Baby warmers at PHC
X-Ray Unit in PHC
Communication
Clean and Neat environment

11. Valaikappu Ceremony conducted at PHCs
This programme reduces the gap by building bridges between the PHC and the community.

12. Making Emergency Obstetric Care available
Hiring private anaesthetists and obstetricians to carry out caesarian operations
Total caesarians done in secondary institutions in
Increased to (upto Jan2010)
Training MBBS doctors in short term course in Life Saving Anaesthesia Skills and Emergency Obstetric Care.
So far 177 doctors trained
No of LSCS done by trained anesthetists

13. Making Emergency Obstetric Care available (contd)
Emergency Referral Services (Toll free no 108) introduced
AN mothers transported in Jan
Cases of inter facility transfer

14. Cause for concern! No major change in causes of maternal death!!
Direct Cause
2006(%)
2008(%)
Post partum haemorrhage 30
25.4
Pregnancy induced Hypertension
6.5
Postpartum sepsis
3.5
3.2
Septic abortion
Indirect Cause
Anaemia in pregnancy
5.4
4.5
No major change in causes of maternal death!!

15. Analysis of Maternal death (2006 & 2008) - A comparison
Place of Maternal death
2006(%)
2008(%)
Teaching Hospital 31 39
Transit 22 19
Private Hospital 16 18
Head quarters Hospital 15 7
Home 12
Marginal reduction in transit… increase in teaching hospital…no change in home deaths!

16. Analysis of period of Maternal Death- 2008(%)
Out of 73 % of PN death
Antenatal 22
Intranatal 5
Post natal 73
In spite of 99% institutional deliveries, 35% of the deaths are still within 24 hrs!

17. Haemorrhage-Direct Cause
Interventions
AMTSL training for the whole state-NASG of Pathfinders International also being introduced
Focus on training of all nurses including secondary and tertiary institutions
Ensuring safe blood availability – blood storage centres and logistics of how to use them in resource poor settings

18. PIH-Direct Cause Interventions
Retraining to all VHNs in ante natal care protocols and skills including basic BP measurement
Use of electronic BP apparatus as a validating device
Model blocks to introduce calcium supplementation for antenatal women
Reemphasising the use of magnesium sulphate in management of eclampsia

19. Sepsis-Direct cause Interventions
Post natal care visits- emphasis of danger signs in home based care training
IEC/ BCC messages to new mothers on danger signs and to overcome cultural taboos of leaving home before one week
Ensuring forty eight hour stay in PHCs with clear discharge guidelines to be checked by the medical officer
Hospital side- infection management practices in labour rooms and post natal wards- training programmes to be put in place

20. Obstructed /Prolonged labour (Direct cause)
Interventions
Training on use of partogram
Emphasis on prompt referral
Building district level quality control circles using the obstetricians and nurse trainers to improve delivery skills of nurses
Ensuring availability of emergency services at the CEmONC centres through better networking

21. Anaemia management (Indirect cause)
Interventions
Anaemia management protocol for normal, moderate and severe anaemia cases including mandatory deworming in view of the high worm load
Use of iron sucrose for severe anaemia
Supplementation with Vit C and B-12 in view of the deficiencies in diet
Ensuring proper measurement of haemoglobin levels
IEC strategy for changing diet and lifestyle of women (using slippers..)
Adolescent Anaemia Control programme - long term effect on haemoglobin and ferritin levels

22. Other initiatives Interventions
Pregnancy cohort monitoring- focus on women at risk
Verbal community death autopsy conducted by the district collector
Continued focus on reduction of higher order births- strong IUD campaign for those women unwilling to accept sterilization
Policy for safe abortion and ensuring availability of MVA services at least at the block level.

23. Thank you