High stillbirth rate in 9 dists, including Pune

For all its progress, the state is still grappling with basic healthcare issues. A recent report of the state health department has shown high stillbirth (SBR) rates in nine districts of Maharashtra, including Pune, which experts say is a telling indicator of the abysmal healthcare service provided to pregnant women. In fact, the stillbirth rate in these districts not only outnumbers infant deaths but is also alarmingly higher than the national average.

In its report, the state health department has put the stillbirth rate (babies born dead per 1,000 births) in Pune at 17.7 and a distressing 42.9 in Gadchiroli, the highest in the state. The national stillbirth average, as per 2011 census, is 9. Experts attribute the high stillbirth rate to poor antenatal (predelivery) and delivery-care for pregnant women as most stillbirths are preventable.

The report, brought out recently, doesn’t paint a healthy picture for the state in general, putting the state’s stillbirth rate and infant mortality rate (number of infants who die within a year of their birth per 1,000 live births) is 16.8 and 20.4 respectively.

The State Health System Resource Centre (SHSRC), the technical and research wing of the state health department, has noted that while the state focuses on nutrition of pregnant women so as to prevent stillbirths, it fails to monitor it (stillbirths) like it does with infant and child mortality. Currently, the state health department’s strategic interventions are focused on reduction of infant mortality and more particularly on neonatal mortality under the Reproductive Child Health (RCH) programme.

“It is likely that,reporting of stillbirths may not be accurately done at the level of reporting units,as it is not among the key monitoring indicators.The SBR reported by districts such as Latur, Aurangabad and Wardha is likely to be under reported, since it is less than 10,” the SHSRC’s report suggested. In about 19 districts, the SBR reported is higher than 15, which is the upper acceptable level.

Activists note that while there is better awareness for institutional delivery, the state health machinery has failed to beef up service and infrastructure to take care of more women seeking to deliver under medical supervision. “Over a period of time, the rate of institutional deliveries (deliveries taking place in hospital set up) has considerably increased. But, the emergency pregnancy care and quality of pregnancy care has not improved proportionately at rural hospitals,” Abhay Shukla of Jan Swastha Abhiyaan. He noted that many posts of gynaecologists were still vacant at rural hospitals. “So if a pregnant woman has pregnancy induced hypertension or if she slips into prolonged labour, then management of such complicated deliveries has become extremely difficult in rural hospitals,” said Shukla.

The report corroborates Shukla’s point.It underlines that most of the stillbirths were preventable and attributed them to inadequate antenatal care and suboptimal intrapartal care. “The common medical causes contributing the stillbirths are pregnancy induced hypertension, abruptio placenta (separation of the placenta which nourishes the foetus from its attachment to the uterus wall before the baby is delivered),birth asphyxia (occurs when a baby doesn’t receive enough oxygen before,during or just after birth) and preterm labour besides other causes like cord prolapse,congenital malformations,antenatal infection,” the report states.

The SHSRC report revealed stillbirths were almost equal to infant deaths (infant deaths 36,777 and stillbirths 30,126) in the state. Also, state’s stillbirth rate (SBR) of 20.4 was less than its infant mortality rate (IMR). Of 16.8.

“The figures are distressing as most stillbirths are preventable. This only indicates grossly low pre-delivery and delivery care given to pregnant women in these districts.These figures suggest the importance of registration of patients for antenatal care. Consulting a doctor at regular intervals soon after conceiving helps avert the eventuality of stillbirth,” said senior gynaecologist Sanjay Gupte, former president of Federation of Obstetrics and Gynaecolgical Society of India (FOGSI), a national body of gynaecologists.

Health officials said they were acting on the report. “SHSRC has analysed the data on stillbirths and infant deaths in Maharashtra, for the year 2012-13 and made some observations and recommendations. We have asked all health officials from Zilla Parishad and municipal corporations to start implementing them at their level,” said V K Rokde, assistant director (child health), state family welfare bureau.