title: Policy and management constraints on access to and use of life-saving emergency obstetric care in India.
abstract: Maternal mortality is still very high in India and the developing world. India's maternal mortality ratio is about 540 deaths per 100,000 live births. Poverty and lack of resources contribute to this, but the main reasons for such high maternal mortality are policy barriers and management problems that impede access to good-quality emergency obstetric care in rural areas. The government policy does not encourage training general practitioners to provide cesarean sections, even when there are very few specialists available in rural and remote areas. Nurses are also prohibited from providing such basic emergency care procedures as intravenous oxytocics, antibiotics, and anticonvulsants. The doctors, nurses, and other hospital staff in managerial positions are not trained in modern management skills, which contributes to poor-quality services. The situation can be improved by training existing medical staff to provide emergency obstetric services in rural areas and training hospital managers in management skills. International aid organizations and women doctors should lobby for such policy changes, which will help increase access and quality of emergency obstetric care.
authors.affiliation: Indian Institute of Management, Ahmedabad.
authors.forename: Dileep V
authors.initials: DV
authors.lastname: Mavalankar
mesh_terms: D004632:Emergency Medical Services / Q000592:standards*; D005260:Female; D006291:Health Policy; D006297:Health Services Accessibility; D006801:Humans; D007194:India / Q000453:epidemiology; D008428:Maternal Mortality; D013513:Obstetric Surgical Procedures / Q000592:standards*; D010344:Patient Advocacy; D011247:Pregnancy