Maternal Mortality in Uttar-Pradesh, India

GWMCHstudents

India has seen a fall in maternal mortality rate (MMR) by 59 percent between 1990 and 2008, but the huge rural urban divide in these rates are overlooked making it home to the highest number of women dying during childbirth across the world. One such state is Uttar-Pradesh, a highly populous state with more than170 million people which continues to have highest reported maternal mortality ratio at 440 per 100, 000 live births and which still remains above the national average. Even within a state, the access to and utilization of maternal health care varies based on region rural or urban, caste, religion, income, and education. Research has identified four important reasons for the continuing high maternal mortality rate in Uttar Pradesh: barriers to emergency care, poor referral practices, gaps in continuity of care, and improper demands for payment as a condition for delivery of healthcare services.

More than half a million women and girls die every year globally because of pregnancy, childbirth, and unsafe abortions. Most of these deaths are preventable. Over 99 percent of maternal deaths take place in developing countries which account for 86 percent of world’s births. Well over three-quarters of these deaths occur in South Asia: in India, Bangladesh and Pakistan. There are more maternal deaths in India in one day than are in all the developed countries in one month combined. The country has seen a fall in maternal mortality rate (MMR) by 59 percent between 1990 and 2008, but the huge rural urban divide in these rates are overlooked making it home to the highest number of women dying during childbirth across the world. Though blueprints for safe motherhood programs, National Rural Health Mission (NRHM) to improve public health systems and reduce maternal mortality in particular exists, the equipment and technical competence to provide services is weak at the present moment. The decline, however, is small in relation to the scope of the problem, and camouflages disparities.

 

Like This Story?

Your $10 tax-deductible contribution helps support our research, reporting, and analysis.

Donate Now

Please see this video:

http://www.youtube.com/watch?v=U1bBYfC8Mf4

 

India has an average maternal mortality ratio of 407 per 100, 000 live births at the national level. At the state-level these rates are under-estimated; in fact there are certain states that reach up to 745 maternal deaths per 100,000 live births. The discrepancies not just end here, in a majority of northern states the rural and urban rates differ significantly. One such state is Uttar-Pradesh, a highly populous state with more than170 million people which continues to have highest reported maternal mortality ratio at 440 per 100, 000 live births and which still remains above the national average. Even within a state, the access to and utilization of maternal health care varies based on region rural or urban, caste, religion, income, and education. Research has identified four important reasons for the continuing high maternal mortality rate in Uttar-Pradesh: barriers to emergency care, poor referral practices, gaps in continuity of care, and improper demands for payment as a condition for delivery of healthcare services. While accountability in such a context is already a dry or abstract, the issue literally can be a matter of someone’s life and death.

 

Factors contributing to maternal deaths in Uttar-Pradesh were not much different than any other state but the prolonged neglect and irrevocable beliefs, behaviors and attitudes of the people here have made maternal mortality invincible. Beliefs such as early marriage, illiteracy, women’s poor control over access to and use of contraceptives, husbands or mothers-in-law dictating women’s care-seeking behavior, overall poor health including poor nutrition, poverty, lack of health education and awareness, domestic violence, and poor access to quality health care, including obstetric services are deeply embedded in this community. Less than half of the pregnant women in Uttar-Pradesh seek any antenatal care, even where the care is sought, it usually tends to be in the second trimester with the sole purpose to confirm pregnancy. These observations are not a surprise in the context where women’s health care utilization is in general low and pregnancy is not considered an event requiring any special medical attention.

 

When the reasons are further explored, many factors that perpetuate the condition become exposed. There is no record system in place, the system fails to gather the necessary information at the district level on where, when, and why deaths and injuries are occurring. More than 90percent of pregnant women deliver at home attended by Dai’s or untrained professionals. In cases of emergency, a mid-wife is approached but health worker trained in midwifery can do very little to save the life of a pregnant woman unless she is supported by a functioning health system including an adequate supply of drugs for obstetric first aid, emergency obstetric care. The case is referred to an obstetrician and gynecologist in events of complications such as hemorrhage, obstructed labor, and hypertensive disorders. Unfortunately there are no referral systems, transportation, blood storage or support in place. Uttar-Pradesh has 583 fewer community health centers than Indian public health standards require. Less than a third of existing community health centers have an obstetrician or gynecologist and about 45 percent do not have funds to operate even the one ambulance they have. The issue of maternal mortality has many facets here and needs a multipronged approach.

 

The available information on maternal mortality in rural India is inadequate and scanty. In order to improve the maternal health outcomes in states such as Uttar-Pradesh the policy makers need to leverage a wide spectrum of resources, both public and private to address the health needs of the population in need with appropriate means to deliver them. Reductions in maternal mortalitywould require interventions to improve service delivery, as well as community mobilzation.Time is the key, the availability of the emergency facilities and most important, human resource when required can prevent needless anguish. A strategic plan that considers identifying the roots of the problem, counting true numbers, improved technical skills and equipment, increase utilization of health care, provision of emergency health care resources and all the aspects of health system offers a best opportunity for achieving improved health outcomes for women and children in resource-constrained settings in rural areas. The government should collaborate and co-operate and make efficient use of the opportunities available. The need of the time is weigh the available options and stabilize up a weak health infrastructure to minimize a disaster, as the road ahead is uncertain, but definitely not short.   

 

 

By-Priya Mishra 

MPH Candidate,
Maternal and Child Health Department,
School of Public Health and Health Sciences,
George Washington University.

News Sexual Health

Average Penis Is Less Than Six Inches Long, Study Finds

Martha Kempner

Don't believe the hype. A new study finds the average penis is only 5.6 inches when erect.

A new study published in the Journal of Sexual Medicine has found that most men are not endowed like Dirk Diggler from Boogie Nights. In fact, most men have a penis that measures less than six inches long when erect.

The study, led by Indiana University researcher Debby Herbenick, surveyed 1,661 men, each of whom was asked to measure both the length and girth of his penis when erect. Men were also asked to tell the researchers how they attained the erection.

The largest penis in the survey measured in at 10.2 inches, while the smallest was 1.6 inches. Most men fell firmly in between, with the average penis measuring 5.6 inches in length and 4.8 inches in girth. The researchers found that characteristics such as race or sexual orientation were not good predictors of penis size.

However, men who reported attaining their erection through oral sex were on average larger than men who were alone when they became erect. Herbenick told LiveScience, “We don’t know if that means that when men have oral sex that it’s more arousing and they get a bigger erection, or means that men who have bigger penises could be getting more oral sex in the first place.”

Like This Story?

Your $10 tax-deductible contribution helps support our research, reporting, and analysis.

Donate Now

The data was collected as part of an earlier study comparing men’s use of a standard-sized condoms to the use of condoms specifically sized to fit their erect penis. Herbenick explained the results of that study to Rewire, saying, “We found that both standard and fitted condoms were comfortable for most men, and that some men on either end of the size continuum preferred condoms fitted to the size of their erect penis. Currently, ‘fitted’ condoms are no longer on the U.S. market. However, there’s a wider-than-ever range of condoms that are safe, effective, and pleasurable and that are available for men and their partners to choose from.”

News Sexual Health

Teen Birth Rate Hits Lowest Point Since 1946

Martha Kempner

Today, the Centers for Disease Control and Prevention (CDC) released the latest teen birth rates which found that fewer babies were born to teen mothers in 2010 than in any year since 1946. 

The positive news just keeps coming. In February we reported on the latest teen pregnancy rates which were the lowest in nearly 40 years and showed a 42 percent decrease from their peak in 1990. Today, the Centers for Disease Control and Prevention (CDC) released the latest teen birth rates which found that fewer babies were born to teen mothers in 2010 than in any year since 1946. In 2010 there were 367,752 babies born to teens compared to 409,802 in 2009.

The 2010 birth rates was 34.3 births per 1,000 young women ages 15 to 19 which represents a nine percent drop from just the year before and a 44 percent drop since 1991 when birth rates were at their highest (61.8 per 1,000 young women). The CDC’s report calculated that if that high rate had continued, there would have been about 3.4 million additional births to teenagers between 1992 and 2010.

The teen birth rate dropped across all racial and ethnic groups but still varies widely by race; Hispanics have the highest teenage birth rates at 55.7 births per 1,000 teens in the age group, followed by black teens at 51.5 per 1,000. Asian teens have the lowest teenage birth rate with 10.9 per 1,000.

In addition, teen birth rates fell since 2007 in all states except Montana, North Dakota, and West Virginia.  Still, birth rates vary widely among different groups of states; Mississippi has the highest teen birth rate at 55 per 1,000 girls 15 to 19 years of age, New Mexico’s rate is 53, and Arkansas is 52.5.  New Hampshire has the lowest birth rate at about 16 per 1,000 women with Massachusetts and Vermont following right behind.

Like This Story?

Your $10 tax-deductible contribution helps support our research, reporting, and analysis.

Donate Now

Though this study does not explain why the teen birth rate has dropped so significantly, previous research suggests that a combination of less teen sexual activity, more contraceptive use, and use of more effective contraceptive methods is responsible for this positive trend.

Of course, the United States still has a long way to go if we want to catch up with other industrialized nations which have far lower teen birth rates. Lithuania, for example, has a rate of 16 births per 1,000 young women 15 to 19 and Canada has only 14 births per 1,000.