INFANT MORTALITY RATE

Interventions

p Promotion of institutional deliveries
p Establishment of CEmONC centres
p Establishment of BEmONC centres
p Establishment of 24 hours delivery care services
p Adolescent girls anaemia control programme
p Inroduction of emergency newborn care protocols
p Birth companion scheme
Proposed new interventions
p Formation of state task force for IMR reduction
p Infection control protocols
p Quality audit
p Incident reporting
p One delivery one sterile delivery kit policy
p Use of partographs
p Posting of additional nurses for obstetrics and paediatrics departments in Medical colleges
p Still birth audit
p IMNCI training
p Formation of separate nursing cadre for obstetrics and paediatrics
p BEmONC training
p Skilled birth attendant training
p Anaemia control
p Women link volunteers for every village panchayat


Maternal Mortality Ratio

Maternal Mortality Ratio represents the obstetric risk associated with each pregnancy, It is calculated as the number of maternal deaths during a given year per 1000 live births during the same period, though the measure has traditionally been referred to as a ‘rate’ it is actually a ‘ratio’.


Maternal Death
The death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental cause.

Maternal Mortality Rate
Maternal Mortality Rate measures both the obstetric risk and the frequency with women are exposed to this risk. It is calculated as the number of maternal deaths in a given period per 1000 women of reproductive age (Usually 15 – 49 years).

Direct Obstetric Deaths
Those resulting from obstetric complications of the pregnant state (Pregnancy, Labour and the puerperium), from interventions, omissions or incorrect treatment or from a chain of events resulting from any of the above.




Indirect Obstetric Deaths
Those resulting from previous existing disease or disease that developed during pregnancy and that was not due to direct obstetric causes but was aggravated by the physiological effects of pregnancy.

Life Time Risk of Maternal Death
Life time risk of maternal death in to account both the probability of becoming pregnant and the probability of dying as a result of the pregnancy cumulated across a woman’s reproductive years.

CAUSES OF MMR
p HAEMORRHAGE -38%
p SEPSIS -11%
p ABORTION -8%
p PIH -5%
p OBSTRUCTED LABOUR -5%
p OTHERS -34%
SOURCE-SRS 2003
Effective Interventions to Reduce Maternal Death.
Vision
All women enjoy pregnancy and its outcome with equity, respect, dignity and social justice through better access to quality health services especially during pregnancy, child birth and the post partum.

A. Puerperal Infections

n Delivery by Qualified. (Not less than an ANM/VHN)
n Institutional deliveries.
n Antibiotics for Preterm (before 36 weeks )
n Clean delivery practices
n Rupture of membranes.
n Parenteral antibiotics for sepcis.

n Blood Transfusion & surgical intervention.
n Pregnancy counsellling for recognizing danger signs.
n Family Planning.
EXPECTED REDUCTION IN MMR 11%

B. PIH

p Family Planning
p Early detection and management of cases at HSC/PHC level.
p Antihypertensive drug therapy for mild to moderate.
p Mag sulphate & other anticonvulsants for women with Eclampsia.
p Calcium supplementation during pregnancy for preventing Hypertensive disorders and related problems.
p Pregnancy counselling for recognizing danger signs.
p Blood Transfusion & surgical intervention.
ECXPECTED REDUCTION IN MMR 5%
C. HAEMORRHAGE

p Family Planning.

p Skilled attendant providing active management of III Stage.

p Management of Primary PPH with rectal Mesoprestol.

p Treatment of Primary PPH.

p Blood Transfusion & surgical intervention.

p Promotion of voluntary blood donation.
p EXPECTED REDUCTION IN MMR 32.5%

D. OBSTRUCTED LABOUR
p Family Planning.
p Blood Transfution & surgical intervention.
p Use of Partographs.
EXPECTED REDUCTION IN MMR 5%

E. Complication of abortion

p Family Planning.
p MTP services at PHC level.
p Early registration and pregnancy counselling.
EXPECTED REDUCTION IN MMR 8%





E. Anaemia
p Iron and folate supplementation in pregnancy,
p Treatment for iron deficiency in pregnancy.
p Adolesent Anaemia control.
p Nutrition promotion.
p Blood Transfusion.
p Family Planning.
EXPECTED REDUCTION:20%
G. Others
p Community based MCH services.
p Balanced protein energy supplements in pregnancy.
p Continuity of care given during pregnancy & child birth.
p Pregnancy counselling.

INTERVENTIONS
p Establishment of CEmONC Centres
p 24 hours delivery services with three staff nurses
p Establishment of BEmONC PHCs
p Community Blood Donation camps
p RCH outreach camps
p Birth Companion Scheme
p Operationalising PHC FW operation theatres
p Upgrading of PHCs
p Hiring of Anesthetists and obstetricians