It is an established fact that access to quality and timely health services is important for improved maternal health outcomes. Antenatal and postnatal health checkups are healthcare services that can significantly impact maternal mortality, said Rakhal Gaitonde, a public health expert and professor at Sree Chitra Tirunal Institute for Medical Sciences and Technology in Thiruvananthapuram.
“Adequate ante-natal check ups can help in screening pregnant women for certain risk factors that lead to the possibility of dying from childbirth. Similarly, postnatal care and examination of the woman’s health in the first two days after delivery can help identify conditions that could put her at risk of death,” said Gaitonde.
India has a poor record of antenatal and postnatal care – only 30% of pregnant women can access all recommended types of antenatal care and only 81% of deliveries are followed by a health check for the mother within two days of delivery, as per the latest round of National Family Health Survey.
The percentage of women who had four or more antenatal checks was relatively higher among general caste groups (64%), followed by Scheduled Tribes (58%), and Other Backward Classes (57%). This was lowest among women from the Scheduled Castes (55%).
The percentage of women who did not undergo any postnatal checks was uniform across groups – Scheduled Castes (17%), Scheduled Tribes (16%), Other Backward Classes (15%), and Others (16%), as per NFHS – 5 data.
A look at the data on antenatal and postnatal health checks from the NFHS shows a strong correlation between access to health services and maternal mortality.
Most states and union territories that have poor access to antenatal care also record over 100 maternal deaths per 100,000 live births. Here are some of the poor performing states with the percentage of women who can access antenatal care: Nagaland (5%), Bihar (8%), Uttar Pradesh (11%), Arunachal Pradesh (14%),Tripura (15%), Rajasthan (22%), Meghalaya (26%), Assam (27%), Chhattisgarh (30%), Uttarakhand (31%), Madhya Pradesh (32%), Punjab (34%), Sikkim (35%), Mizoram (37%), Himachal Pradesh (45%), Manipur (46%), West Bengal (48%), Odisha (50%), and Delhi (57%).
Poor mortality rates are also reported by states and union territories where a relatively higher percentage of pregnant women can access antenatal care – the Andaman and Nicobar islands (66%), and the Lakshadweep (75%) for instance.
Most of these states and union territories – except Haryana and Lakshadweep – also have a relatively bad record of postnatal health checks for mothers within the first two days after delivery. The northeastern states do much worse than the rest of India.
The registration and monitoring programme for pregnant women often shifts the burden of accessing and availing health services on the women in need of those services, argues Gaitonde in his research paper published in 2012.
“The healthcare system pushes pregnant women to get four or more antenatal checkups during their pregnancy, without realising that the health facility may not be well-equipped or be located at a far off distance without adequate public transport. The government puts an emphasis on consumption of services while disregarding the (women’s) ability to access those services owing to patriarchal norms and other logistical reasons,” Gaitonde told BehanBox.
Among the reasons cited by men for the child’s mother not receiving antenatal care, 28% respondents cited high cost, while 15% cited that they did not allow or consider it important, and 13% cited that the family did not allow or consider it important, as per NFHS – 5 data.
While the launch and implementation of the community healthcare workers under the Accredited Social Health Activist (ASHA) mission in 2006 increased access to healthcare services, it also allowed authorities to shirk their responsibility and pin the blame for maternal deaths on the ASHA or the Auxiliary Nurse Midwives (ANM), added Gaitonde.