MAPEDIR: new tool to reduce Maternal Mortality

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New Delhi, Oct 7: Described as the 'national shame' the high rate of maternal mortality could now be reduced by using a powerful new tool 'MAPEDIR' that analyses the underlying medical and social reasons behind such deaths and is utilised by health experts, policymakers and communities to prevent them.

India has the highest number of maternal mortality in the world with an estimated 80,000 pregnant women or new mothers dying each year often from preventable causes including haemorrhage, eclampsia, sepsis and anaemia, it was learnt.

As many as 301 women die annually for every 100,000 live births while in some states maternal mortality ratio is even higher at 379 in Madhya Pradesh, 371 in Bihar and 358 in Orissa.

The stories of millions of these women who die in India during pregnancy, delivery or from post-partum complications largely remain untold as many of these deaths happen in the anonymity of their homes or on the way to seek help at a medical facility thereby remaining unrecorded.

The Maternal and Perinatal Death Inquiry and Response (MAPEDIR) has been launched with the technical support of UNICEF in select districts of Rajasthan, Madhya Pradesh, West Bengal, Jharkhand, Orissa and Bihar providing an ongoing, systematic collection of data to reconstruct and analyse the cases of 1,600 women -- the highest number of audited maternal deaths in the world.

MAPEDIR empowers communities by demystifying maternal mortality.

The accumulated evidence can help communities understand the root causes behind these deaths so they can take effective, local action and advocate for improved services to prevent future deaths. In addition, MAPEDIR informs health officials about the challenges local women face in accessing reproductive health care.

''The tragic reality is that too often maternal deaths are not visible. They don't leave any trace behind, and their deaths are not accounted for,'' said Chris Hirabayashi, UNICEF India Deputy Director of Programmes, here today at a meeting bringing together health officials from all six states.

For India to achieve the Millennium Development Goal of reducing maternal mortality by three quarters by 2015, social and economic factors like the low status of women in communities, the poor understanding of families on when to seek care, a lack of transport, poor roads, the cost of seeking care, multiple referrals to different health facilities and a delay in life-saving measures in rural areas need to be addressed, Mr Hirabayashi added.

Medical records only capture part of the story, documenting the biological causes of death. This new knowledge identifies the other crucial factors that contribute to mothers dying so that solutions can be identified by communities and health systems. ''Unless we know the main reasons for maternal deaths we cannot take effective measures to tackle them. The traditional system did not deal with the issues adequately. Now using MAPEDIR, we can know if the deaths are due to delays in decision making at household level or lack of transport or delay at the facility or a cumulative of all three,'' said Dr S P Yadav, Director of Medical and Health Services in Rajasthan.

A team of state government health and nutrition officials and NGO members, headed by a member of the local village council or Panchayati Raj Institution, conducts interviews with surviving family members at community-level.

Technical support is being provided by UNICEF with funding from the United Kingdom's Department of International Development (DFID).

MAPEDIR supports the development of effective local, community-implemented interventions while increasing the urgency among policymakers to tackle the causes of maternal mortality. For instance, West Bengal has instituted a policy of free maternity beds and a voucher-based referral transport system. Another innovation in Orissa is the setting up of blood banks and blood storage units in eight Navajyoti districts.

It facilitates community-health system partnerships as an obstetric helpline and referral transport system has been set up in Dholpur, Rajasthan. In Madhya Pradesh, a referral transport system has been instituted linking remote villages to a health sub-centre providing 24x7 safe delivery can in Guna.

''The MAPEDIR data is an empowering tool that builds community awareness on rights and participation in women's health issues. It builds awareness to take local action and generate demand for health services that will save women's lives and ultimately their newborns,'' said Dr Henry Kalter, an associate at John Hopkins Bloomberg School of Public Health, who helped guide the process.

MAPEDIR follows a six step process, which are sensitising communities on maternal and perinatal health issues, including birth preparedness and complication readiness.

Reporting and investigating maternal deaths and interviewing all families with a maternal death to determine the biological and social causes; analysing and interpreting the data; Sharing the finding with communities to develop appropriate, high-impact, local interventions; Monitoring the interventions with ongoing maternal death inquires and developing new evidence-based interventions as needed.


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