India can reduce maternal deaths

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July 09, 2018

For thousands of families across the developing world pregnancy does not end as a happy birth to be celebrated, but instead as a huge tragedy for the entire family. A mother and wife and daughter is lost, and even if the baby survives, she runs very high risks in the first months of a motherless life. Many families even fall apart, or ‘disintegrate’, after a mother dies and surviving older children also do poorly. Globally about 830 women die every day from these complications, with over a 120 of them in India alone.

Despite all the attendant risks, evolution has ensured that mothers are enormously resilient and with good healthcare it has been possible to bring their death rates down to all but zero. However, this has required health systems to be designed so that mothers are able to give birth in good mother-newborn friendly birthing facilities which are close to well-equipped hospitals so that they are able to balance the dangers of over-medicalization with the need for good emergency care. Using such approaches, countries such as Thailand and Turkey have brought death rates of mothers down to below 0.02% which, while still high, is ten times lower than what other low and middle-income countries, including India, have been able to achieve. In health systems, such as India’s which, for a variety of reasons, do not have such a design, a sharp reduction is nevertheless possible using relatively simple methods that are now available, even in poorly-equipped and relatively isolated facilities.

In many parts of the world, including in India, profuse and uncontrolled bleeding after birth accounts for more than half of all maternal deaths. Massaging the womb, and timely, i.e., within 60 seconds of birth, administration of easily available low-cost drugs such as oxytocin can have a dramatic impact on this bleeding. While 5–10 percent of all birthing women will bleed ‘more than normal’ after birth, they can be taken care of with these methods. However, about 2–4 birthing women out of every thousand will have very severe and continued bleeding that, if untreated, will lead to their demise. Such severe bleeding mostly takes everyone by surprise, there are rarely any warning signals or risk factors. Now we know better how to effectively deal with this catastrophe using three additional methods.

Research has shown that a simple condom, tied on to the tip of a plastic tube or syringe commonly available in health facilities, when inserted into the womb of the bleeding woman and there filled with water through the tube, can save the lives of 97% of women in shock from bleeding. The water-filled ‘balloon tamponade’ presses on the walls of the uterus acting as a plug or a ‘tampon’ to stop the bleeding. The entire disposable kit, costs less than Rs.200, and with basic training even a primary health care provider can apply this method at a health center.

An additional method that is now available is a simple and cheap drug called tranexamic acid (TXA) which promotes rapid clotting of blood in cases of severe trauma by ensuring that fibrin, a fibrous protein which, along with platelets, forms a clot, does not quickly break down. The use of this medicine alone reduces mortality by 30%.

Another technology, a non-pneumatic (elastic and not air-pressure based) anti-shock garment (NASG) originally developed by NASA as an antigravity suit to keep astronauts from blacking out by applying pressure on the abdomen and legs and pushing blood back towards their vital organs, has now been validated for use amongst women experiencing severe bleeding. The cost of such a garment is only about Rs.3,000 and since it can be washed, the per-use cost is even lower at under Rs.30. This garment, which is almost as effective as the ‘balloon tamponade’, can be used by staff after just a few hours of training.

These three simple methods have been thoroughly validated for wide-spread use and what is now urgently needed is to have them quickly be adopted at health-centers where babies are being delivered. Using a combination of these methods, India and many other countries, in the next 5 years can substantially reduce maternal deaths due to bleeding after birth, even as they continue to work towards building better health systems.

<em markup--p-em"="">The article was originally published in <em markup--p-em"="">Hindustan Times <em markup--p-em"="">on June 28, 2018

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