Inequality in maternal health-care services and safe delivery in eastern India.

Background: The target for Millennium Development Goal 5 (MDG-5) is to reduce the maternal mortality ratio by three quarters between 1990 and 2015. The United Nations 2014 report on MDG-5 concluded that little progress had been made in the South Asian countries, including India, which accounts for 17% of all maternal deaths globally. In resource-poor economies with widespread disparities even within the same country, it is very important to explore inequalities in safe delivery during childbirth by key socioeconomic factors in order to provide insights for future programming and policy actions. Methods: Data from the Indian District Level Household and Facility Survey 3 were analysed to examine inequalities in safe delivery in eastern India. Univariate and multivariate logistic regression models were used. Results: There were substantial inequalities in safe delivery by asset quintile, education of the woman and her husband, area of residence (rural or urban), religion and age at marriage (<18 years or ≥18 years); however, not all inequalities were the same. After adjusting for education levels of both parents, area of residence, religion and mother’s age at marriage, the odds of having a safe delivery were almost eightfold higher for those in the highest asset quintiles compared with those in the lowest quintiles. The odds for a safe pregnancy were three times higher for educated women compared with a base case of no education. The chances of having a safe delivery were twofold higher for women living in urban areas compared with those in rural areas (odds ratio 2.04, 95% confidence interval 1.91–2.17). Conclusion: Addressing inequalities in maternal health should be viewed as a central policy goal together with the achievement of MDG-5 targets. In addition to following the indirect route of improving maternal health via poverty alleviation, direct interventions are needed urgently. Women’s education has a strong potential to improve access for poor pregnant women to safe delivery services and to reduce disparities in maternal health outcomes in resource-poor economies.

Programmed Labor For Optimizing Labor And Delivery.

To evaluate the efficacy of Programmed Labor protocol in providing shorter, safer and a relatively pain free delivery.The study was conducted in Obstetrics & Gynecology deptt of Christian Medical College & Hospital, Ludhiana. 30 primigravidae were included into the study and treated as per protocol. Labor outcome was analyzed in terms of mean rate of cervical dilatation, mean duration of first, second and third stages of labor, average blood loss, mode of delivery, maternal and neonatal morbidity. 50 primigravidae as controls were also included in the study and analyzed for the same parameters. The mean rate of cervical dilatation in the study group was 2.3cm/hr, which was almost double of the control group. There was marked shortening of all the stages of labor. Average blood loss was comparatively less in the study group. 70% of women in the study group had significant pain relief. Majority of women in the study group delivered vaginally. 2 (6.7%) babies born to these mothers had an Apgar Score < 7 but there was no perinatal mortality. Programmed labor protocol can safely lead to shorter labors and significant pain relief without any major increase in maternal or neonatal morbidity.