Are we really making motherhood safe? A study of provision of iron supplements and emergency obstetric care in rural Maharashtra.
BACKGROUND
The Government of India launched the National Rural Health Mission (NRHM) in 2005 to improve healthcare delivery and strengthen the public health system. Prevention and management of anaemia during pregnancy and access to quality emergency obstetric care services are important factors in reducing maternal mortality, which is a priority goal in the NRHM. We studied the ground realities specific to the availability of maternity services in the public health system of Maharashtra.


METHODS
The study was done in the rural areas of Ahmednagar district in Maharashtra in 2006. Data regarding the number and place of deliveries, and details regarding iron supplements received and used were collected from 14 primary health centres selected by a stratified random method. Data regarding the number of caesarean section operations conducted in 3 selected rural hospitals and the availability of iron supplements at the district headquarters were also obtained. Three questionnaires were used in the format prescribed under the Right to Information Act of the Government of India, 2005.


RESULTS
No iron supplement was available during the entire year in 21% of primary health centres. Iron supplements were available for 1-4 months, 5-8 months and 9-11 months, in 4, 3 and 4 primary health centres, respectively. The district headquarters did not receive supplies of iron supplements during the year from higher authorities. No caesarean sections were done in any of the selected rural hospitals during 2006. The proportion of deliveries that took place in primary health centres and subcentres, at home, and at private healthcare facilities was 1:1.5:5.


CONCLUSIONS
Essential supplies such as iron supplements are in short supply and emergency obstetric care services are nonexistent in the public health system in our study area. The NRHM needs to address the ground realities to make motherhood safe.
Chaturvedi
Sarika
S
Foundation for Research in Community Health, At/p Relegan Siddhi, Taluka Parner, Ahmednagar, Maharashtra, India. sarika_bharat@rediffmail.com
Ranadive
Bharat
B
D000293:Adolescent; D000328:Adult; D036861:Delivery, Obstetric; D019587:Dietary Supplements; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility; D006304:Health Status; D006306:Health Surveys; D006801:Humans; D007194:India; D058085:Iron Compounds / Q000627:therapeutic use*; D008427:Maternal Health Services / Q000706:statistics & numerical data*; D008429:Maternal Welfare; D011247:Pregnancy; D011634:Public Health; D012424:Rural Population; D012449:Safety; D011795:Surveys and Questionnaires
D058085:Iron Compounds