PUNE, Maharashtra – Despite achieving a high rate of 96% institutional deliveries, stillbirths continue to be a persistent challenge in Maharashtra. A recent study, conducted across three blocks in the Pune district, highlights that the critical issue is no longer the accessibility of healthcare but the quality of care provided during maternal and neonatal periods. Researchers are urging for a formal endorsement and scaling up of successful interventions identified in the study to address this ongoing concern across the state.
Quality of Care Identified as Key Obstacle
The study, led by Dr. Rutuja Patil from the Community Health Research Unit (CHRU) at KEM Hospital Research Centre, Pune, has brought to light instances where preventable stillbirths occurred due to lapses in the quality of maternal care. The findings suggest that while women are accessing health facilities for delivery, the care they receive within these institutions is falling short of optimal standards. This gap in quality is contributing to adverse pregnancy outcomes, including stillbirths, a devastating outcome for families.
Information available with The Chenab Times indicates that the research focused on identifying specific shortcomings in the delivery of maternal healthcare services. The study points towards a need for enhanced training, better oversight, and improved protocols within healthcare facilities to ensure that every pregnancy culminates in a healthy outcome. The evidence generated by the study, named SHRiSTI, is now positioned to inform state-level policy and practice.
Case Studies Illustrate Critical Lapses
The study’s findings are underscored by poignant case studies that illustrate the critical lapses in care. In one instance, a 30-year-old woman from Junnar in Pune district experienced complications during her ninth month of pregnancy, including reduced fetal movements and abdominal pain. Upon reaching a rural hospital, the attending doctor was unavailable, and a nurse’s assessment and subsequent departure without updating the family delayed crucial medical attention. By the time the doctor arrived, the woman’s labor pains had subsided, and although a nurse and ward boy conducted the delivery, the baby was stillborn. The woman expressed a belief that timely medical intervention could have saved her child’s life.
Another case involved a 41-year-old woman with chronic hypertension in Bhor, Pune district, who developed a fever and decreased fetal movements during her final month of pregnancy. Despite being reassured by a doctor at a public health facility that the fetus was normal, her condition worsened, leading to intrauterine death confirmed at a private hospital. This case highlights a lack of counselling regarding her high-risk pregnancy status, further emphasizing the quality-of-care deficit.
Broader Context of Maternal Healthcare in India
India, as a nation, has made significant strides in increasing institutional deliveries, a key strategy to reduce maternal and infant mortality. National Family Health Survey (NFHS-5) data indicates that while institutional deliveries have risen, stillbirth rates remain a concern. Studies have indicated that stillbirths are influenced by various maternal factors, including anemia, pregnancy-induced hypertension, prematurity, and intrauterine growth restriction (IUGR). In some regions, stillbirth rates are higher among urban mothers compared to rural mothers, challenging the assumption that greater access to facilities inherently leads to better outcomes.
While Maharashtra is considered a relatively better-performing state in terms of maternal health indicators compared to some northern and central Indian states, the SHRiSTI study suggests that systemic issues related to the quality of care persist. Previous research on maternal and newborn health in Maharashtra has noted the importance of quality improvement initiatives, such as in-service training and the implementation of programs like LaQshya, which aims to enhance intrapartum care. However, the study on private sector healthcare facilities in Maharashtra, Jharkhand, and Uttar Pradesh, observed that the overall quality of maternity care in these facilities was poor, particularly in managing complications, with a significant proportion of nursing staff being underqualified.
The challenge of stillbirths is complex, interwoven with factors such as the availability of skilled healthcare professionals, adherence to clinical standards, and the effective management of high-risk pregnancies. Reports from districts like Nandurbar in Maharashtra have highlighted severe infrastructural deficits and staff vacancies in women’s hospitals, leading to a heavy toll of stillbirths and infant deaths, indicating that even with widespread access, the availability of quality care remains a critical determinant of outcomes.
Call for Action and Scalability
The findings of the SHRiSTI study are expected to be presented at upcoming research forums, bringing further attention to the critical need for quality improvement in maternal healthcare across Maharashtra. The researchers have emphasized that the evidence gathered from the Pune study provides a clear pathway for the state government to endorse and implement effective interventions. The ultimate goal is to translate these localized successes into broader public health strategies that can significantly reduce the burden of stillbirths throughout Maharashtra.
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