DRAFT: This module has unpublished changes.

Maternal health in Uttar-Pradesh, India is the worst in India. India has an average maternal mortality ratio of 407 per 100, 000 live births at the national level; Uttar-Pradesh has the highest reported maternal mortality ratio at 440 per 100, 000 live births. The causes of this extreme mortality rate in Uttar-Pradesh have been identified as: 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. As seen in the video, "In Silence" even if women do get to a local hospital to deliver their babies, their chances of having a successful birth do not necessarily improve; resources are extremely limited: no surgeons, no blood-supply, limited medicines.

 

Is there actually any benefit of delivering in a clinic so deprived as the ones in Uttar-Pradesh? To me it seems like the added risks of getting to the clinic, and exposure to pathogens in a hospital environment do not outweigh the benefits of delivering here.

 

Surprisingly, the factors, which contribute to maternal deaths in Uttar-Pradesh, are not much different than any other state in India, but the continuous neglect and unchangeable beliefs, behaviors and attitudes of the people here have made maternal mortality invincible. What are the underlying causes for this neglect of maternal mortality?

 

The underlying issues, which are at the root of the reasons for which care is so poor in developing countries, have to do mostly with economics and education. 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.

 

In Senegal when I was working in the maternal department of the local hospital, I noted that the women who came to seek contraceptive were all married. I wondered what the single women were doing for birth control. Although, the Islamic culture disapproved of extramarital sex, I knew that it was still happening. For example, there was an unmarried woman in St. Louis who had a daughter out of wedlock and was shunned by the entire community. They have hardly enough to eat in order to survive, and I am sure that they are malnourished; the girl did not go to school. I worry that one day her daughter will repeat her mother's actions, and have sex for money or food, and end up pregnant with little to no access to birth control. Due to growing up in extreme poverty, and being extremely malnourished, she is put at a high risk of dying before, during or after her pregnancy. I project that the future for this young girl is not bright.

 

How could her chances of not being a victim of maternal mortality be improved?

Can solely increasing the availability of antenatal care or maternal services decrease the maternal mortality rate? Or, should these deeply embedded sociocultural issues be the targets of improving maternal health?

DRAFT: This module has unpublished changes.