REGIONAL WORKSHOP ON SKILLED BIRTH ATTENDANTS IN SOUTH AND WEST ASIA HELD IN ISLAMABAD, PAKISTAN

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REGIONAL WORKSHOP ON SKILLED BIRTH ATTENDANTS
IN SOUTH AND WEST ASIAHELD IN ISLAMABAD,
PAKISTAN

• Situational Analysis INDIA
• April, 2004

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National Population Policy

• High MMR and IMR
• Wide variation between states

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Availability of Skilled Attendants (Nurses
including Auxillary Nurses)
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Skilled Attendants ( Physicians)

• Graduate Doctors 176 Medical Colleges, nearly
  20,000 turn out each year
• Midwifery skills covered during training
• 90 percent in private sector, high concentration
  in urban areas.
• Post Grads on Obst/Gynae More than 18,000
  members of FOGSI (Federation of Obst/Gynae
  society of India).
• Availability of Anesthesia specialists a major
  constraint for C section.

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Concerns

• Bulk of Deliveries at home by untrained or semi
  skilled persons.
• - Around 34 at Public/Private Institution
• Of the remaining 2/3 rd , more than 50
  conducted by TBA
• Wide inter-state variation
• Kerala(96.4), Tamil Nadu(76), AP(56.0),
  Rajasthan(26.3), Bihar(13.3), UP(17.9)
• Disparities in Rural/Urban
• In Rajasthan only 30 births attended by
  Health Professional in contrast to 72 of
  births In Tamil Nadu

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Rural/Urban Disparity

• Births attended by HP

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Concerns

• Interstate as well inter-district Gap in the
  manpower infrastructure at PHC
• Sub-optimal functioning of th delivery services
  and poor referral services
• Access to and utilization of services poorest in
  some northern states
• Heavy work load of women and agrarian life style
• Socio-economic and cultural practices
• Pervasive gender inequality

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CONSTRAINTS

• Training of TBAs
• TBAs, ANMs and staff nurses ill-equipped with
  midwifery skills
• In some states, MOs at PHC level provide Em. Ob.
  Care.
• Weak referral System due to weak community
  participation

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Major Causes of Maternal Mortality

• Cause

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Felt Need

• Body of evidence available in India indicating
  the interventions which are effective in reducing
  maternal deaths
• At what level
• By whom
• Revisions of curriculum of ANMs to provide safe
  deliveries, stabilize a mother or neonate in case
  of emergencies before referral
• New Courses on Nurse Midwife is being envisaged.

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Steps Initiated

• Based on the evaluation of competence of the
  existing professional manpower, competence-based
  training of ANMs, LHVs, Nurses and MO to improve
  skill for emergency Obs. Care are going on
  currently, under the overall RCH Programme.

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Community based Midwife

• Felt need for a community based SBA to increase
  access of rural poor women to high quality and
  equitable maternity care
• Need for developing a cadre of Community based
  Midwife which will be cutting age in reducing
  Maternal Mortality.
• Proposes to start a pilot in a few districts in
  weak performing states shortly.

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THANK YOU