Nearly half of the maternal deaths in Rajasthan take place due to the delay by family members in deciding where they should take the pregnant woman for delivery, a social review has revealed.

The social review was conducted from September 2014 till July 2017, Dr Tarun Choudhary, project director, maternal health, said. A total of 760 maternal deaths were reported during the period. Of these 45% were due to the indecisiveness of family members on whether to call a midwife; take the pregnant woman to a quack; or get the delivery done at home with the help of elderly women.

Choudhary said this indecisiveness stems from social or personal beliefs. “These (760) maternal deaths were those that took place either at home or on the way to hospital. The major reason of these maternal deaths was lack of awareness about the service availability,” he said.

Of the 760 deaths, 12% were due to delay in transportation and 8% due to delay in treatment, Choudhary said.

According to Sample Registration System 2013, the maternal mortality rate (MMR) in Rajasthan is 244.

After a maternal death is reported, a social review is carried out at anganwadi centre on mother and child nutrition (MCHN) day that is organised every Thursday. The anganwadi worker, family members of the deceased, a teacher, panch and doctor from primary health centre review the reasons behind the death. The issues discussed include whether the pregnant woman had gone for ante natal care, was administered tetanus injection and given iron folic acid tablets, and whether she had got proper transport facility to the hospital.

Choudhary said some progress has been made in bringing down the maternal mortality by creating awareness about the service availability. He said the pregnant woman and her family are encouraged to go for institutional delivery. They are informed about the available ambulances and taxis to reach the nearest delivery point. Regular check-ups under Pradhan Mantri Surakshit Matratva Abhiyan is organised on 9th of every month across the state. Similarly, Surakshit Matratva Diwas is organised every alternate Friday at community health centres and Prasuti Niyojan Diwas is held on last Thursday of every month at the sub centre. Kushal Mangal Karyakram is also organised to identify high risk pregnancies.

Choudhary claimed that with awareness, the institutional delivery has gone up to 84% as per National Family Health Survey-4 (2015-16).

He said compared 55% deaths due to delay in taking decisions in 13 months, from September 2014 to September 2015, the figure came down to 33% in the 13-month period of October 2015 to October 2016. Similarly, deaths due to delay in transportation came down to 8% from 15% during the same review period.

Contacted, National Health Mission chief Naveen Jain said, “Rajasthan is the only state in the country that had introduced social review of maternal deaths to know the reasons and plug in the gaps. This was started in September 2014.”

He said this idea of ‘social review/audit’ was taken from Mahatma Gandhi National Rural Employment Guarantee Scheme (MGNREGS). Based on the findings, many gaps have been plugged.