The term “ high risk pregnancy ” (HRP) is used to describe a pregnancy in which “a mother or her foetus or both are at higher risk of developing complications during the pregnancy or the child birth than in a normal pregnancy.” In India, nearly 30% pregnancies are classified as a HRP, which are “responsible for 75% of perinatal morbidity and mortality.” Even though Bihar has consistently improved in lowering its rate of maternal mortality, it still falls behind the national average and the 2030 Millennium Development Goal of up to 70 deaths per 1,00,000 live births.
Jamui District in Bihar has observed high incidence rates of maternal mortality. This is largely due to the prevalence of anaemia in nearly 60% of the women in the district. Aspirational District Fellows Meenakshi Basnal and Mohd. Sameer, in assisting the District Administration, sought to identify policy and structural gaps contributing to these mortality rates, and also identify an intervention to prevent the same.
Identifying an Intervention:
To identify an intervention, the ADFs assessed the existing processes. Prior to the intervention, data was collected and compiled on a Block level. This data was relayed to the district administration in data points, without the profiles constituting the data. This process resulted in several of the following gaps.
First, the District administration only had access to the numerical value of women who missed their Antenatal Care (ANC) provided at VHSND, but it did not provide information on who these women were. Thus, preventing adequate targeting by the district administration to ensure provision of ANCs.
Second, this paucity of data prevented the tracking of HRP women. Further, the month-long time taken in gathering and compiling Block level data prevented access to real-time data by the district administration.
Third, there was a lack of coordination between the district health department and ICDS department. This was primarily due to an absence of a formalised platform to deliberate concerns between them.
Fourth, it was found that there was a lopsided focus on Routine Immunisations at VHSNDs, compared to ANCs. This was primarily due to the absence of data allowing specific and targeted interventions in ANC.
Process of Intervention:
The district administration implemented a four step plan to execute the intervention.
First, coordination meetings with all stakeholders (ICDS and Health departments) were held in order to define and specify clear roles and responsibilities.
Second, a Google Sheet was designed to collect real time data of HRP women with all relevant details. This data was collected by ANMs, relayed to the Block level officials. This information was uploaded on a spreadsheet which was viewable on a real-time basis.
Third, a call centre was set up to follow up on HRP women based on the spreadsheet. This ensured adequate monitoring of their condition and any subsequent complications. These women were also provided with information on the right type of nutrition for the duration of their pregnancy.
Fourth, based on this real-time updated list, regular home visits were made by Lady Supervisor (LS) and ASHA Workers to check up on HRP women. Their observations were relayed to the Block officials who updated the spreadsheet.
This was a low cost-high impact intervention. The regular district funds were used to establish the call centre and train a few district officials in updating the spreadsheets regularly.
Impact of the Intervention:
Given the intervention’s recent implementation, it will take time to assess the long-term impact. However, the short-term impact assessment has shown encouraging results.
Nearly 600 HRP women were identified through this intervention, from which 18 extremely HRP women’s lives were saved based on real time data tracking and timely medical assistance. Haemoglobin levels, Antenatal care, diet, immunization of these women were given special attention to reduce incidences of maternal mortality.
Going ahead, to make this a sustainable intervention and build on it, the District Administration is considering deploying a mobile application for ease of access to information on HRP women.
This small intervention which merely identified women with HRP had a magnified impact, positively affecting the lives of numerous women in the district. It has taken the district a step ahead in reducing high MMR.