Journey to Death: Are Health Systems Failing Mothers?

BACKGROUND: Annually, about 44,000 maternal deaths occur in India, which is 20% of the global burden. Despite persistent efforts, India failed to meet the fifth millennium development goal by 2015. Lack of reliable data on maternal mortality demands utilization of tools for counting maternal deaths which is vital to implement preventative actions. OBJECTIVES: Our study aims to determine health system-related issues of maternal mortality using the WHO validated tool – Maternal Death Review and demonstrates usefulness of maternal death surveillance and review as a monitoring tool. METHODS: Fourteen maternal deaths were evaluated through community based and facility-based audits from July 2013 to June 2014 in three districts of Gujarat. Pathways to death were traced through Global Positioning System (GPS). Factors contributing to the three delays were analyzed. RESULTS: Type III delay, that is, delay in receiving adequate care was frequently observed in our review including weak referral linkages, lack of blood banking services, inadequate surgical facilities. and staff shortages. Mothers succumbed, not because they did not seek treatment or reach facilities in time but because facilities were incapable of providing appropriate medical care. CONCLUSION: Scaling up of maternal death audits and subsequent use of these findings will help to reduce maternal mortality in India. As we continue to push for institutional deliveries, we need to reevaluate if our health system is prepared to manage an increasing number of facility births and obstetric complications.