title: Maternal health in Gujarat, India: a case study.
abstract: Gujarat state of India has come a long way in improving the health indicators since independence, but progress in reducing maternal mortality has been slow and largely unmeasured or documented. This case study identified several challenges for reducing the maternal mortality ratio, including lack of the managerial capacity, shortage of skilled human resources, non-availability of blood in rural areas, and infrastructural and supply bottlenecks. The Gujarat Government has taken several initiatives to improve maternal health services, such as partnership with private obstetricians to provide delivery care to poor women, a relatively-short training of medical officers and nurses to provide emergency obstetric care (EmOC), and an improved emergency transport system. However, several challenges still remain. Recommendations are made for expanding the management capacity for maternal health, operationalization of health facilities, and ensuring EmOC on 24/7 (24 hours a day, seven days a week) basis by posting nurse-midwives and trained medical officers for skilled care, ensuring availability of blood, and improving the registration and auditing of all maternal deaths. However, all these interventions can only take place if there are substantially-increased political will and social awareness.
authors.affiliation: Centre for Management of Health Services, Indian Institute of Management, Vastrapur, Ahmedabad 380015, India. dileep@iimahd.ernet.in
authors.forename: Dileep V
authors.initials: DV
authors.lastname: Mavalankar
authors.forename: Kranti S
authors.initials: KS
authors.lastname: Vora
authors.forename: K V
authors.initials: KV
authors.lastname: Ramani
authors.forename: Parvathy
authors.initials: P
authors.lastname: Raman
authors.forename: Bharati
authors.initials: B
authors.lastname: Sharma
authors.forename: Mudita
authors.initials: M
authors.lastname: Upadhyaya
mesh_terms: D001771:Blood Banks / Q000600:supply & distribution; D004632:Emergency Medical Services / Q000458:organization & administration / Q000592:standards; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D008427:Maternal Health Services / Q000458:organization & administration* / Q000592:standards; D008428:Maternal Mortality / Q000639:trends; D008429:Maternal Welfare; D008880:Midwifery / Q000193:education; D007744:Obstetric Labor Complications / Q000517:prevention & control; D009774:Obstetrics / Q000193:education / Q000458:organization & administration / Q000592:standards*; D011247:Pregnancy; D011634:Public Health