CHAPTER-i

INTRODUCTION

INTRODUCTION
Health is considered to be fundamental right and a social goal the world over. It is essential for the satisfaction of basic human needs which improves the quality of life. According to WHO Health is a state of complete physical mental and social well being and not merely the absence of disease or infirmity. Health is an important component of the quality of life in India. There are three tiers institutional health care system like Central, State and District. District health care system consists of PHC (Primary Health Centre), CHC (Community Health Centre), and Sub -Centre. The crux of health care is beyond the medical intervention which addresses the social, cultural and infrastructural constraints while providing quality health services to all their citizens. The principal focus is on the care for the health of mother and the child. Women represent almost half of the total population. Women build homes that constitute the societies. Health of society depends on the health of its mother and the child. Survival of the mother causes the child to survive and helps the society to prosper. But material mortality is an indicator of gender disparity i.e. inequality between men and women. This clearly indicates the status of women in our society. Women are biologically vulnerable in their peak reproductive years. Nearly 600000 women all over the world between the ages of 15 and 49 die every year as a result of complications arising from pregnancy and child birth. The tragedy is that the women die not from disease but during the normal, life enhancing process of procreation. Most of the deaths could be avoided if preventive measures were taken as to make

available the adequate health care. Maternal mortality is not merely a health hazard but is a social disadvantage as well. Human rights as concern is derive from very existence of human beings. The philosophy behind is carries human values which universal in character. The existence of these rights is either evidence by the natural activities of human being or while observe in breach. One of such human rights which is otherwise is internal truth right is human procreation. The human society which is divided into two species together perpetuates good creation through procreation. The above mention human species man and women both can the burden be getting children. But it is the women who discharge all responsibility which regard to birth of a child. She requires being capable enough to carry out this maternal responsibility. It is burden beauty of the society to enable her to delivery to child to safety essentially this performance of maternal beauty with safety is a right women in our society. Speaking the other way this natural phenomenal of safe delivery can be included in the category of human right, which is non-violable. As much as it is the duty of the women to give birth to a child so much so it is the right of the women to protect her life against all avoidable reason of death at the time of child birth. Therefore it requires maintaining the human condition so that maternal death does not happen it may not be out of place to maintain that the women delivering a child has also the natural human right to live. So along with child birth safety of the lifes of mother and child is equally important for human society. Human rights carry values which is universal in character. It is intended to protect the lives of men and women equally. As the responsibility of procreation is heavier with the women proper care should be

taken to protect their lives for the safe continuity of the reproductive system and the social health of the nation. This in fact constitutes the human right of the expectant mother to safe delivery and safe mother hood. For this, state is liable to create conducive conditions as to play effective role in upholding not only the human right but safely maintaining the process of procreation.

GIOBAL CONTEXT
According to statistics, every minute in the world, 380 women become pregnant; 190 face unplanned or unwanted pregnancy; 110 experience a pregnancy-related complication; 40 have an unsafe abortion; and one woman dies from a pregnancy-related cause. Social and cultural practices, which themselves are responsible for the poor health conditions of most women, are also among the important causes of maternal mortality. Early marriage and pregnancy, when the reproductive organs are not yet properly developed; high fertility rate leading to recurrent pregnancies; and unwanted pregnancies, when the fetus is aborted crudely most often at home, all leave most women vulnerable. Only one out of six women between the ages of 17 and 35 receives prenatal care while more than half of them are anemic. Hardly 20 per cent of mothers receive all the required components of prenatal care. Of all the social indicators, maternal mortality accounts for the largest gap between rich and poor nations. Over 90 per cent of maternal deaths occur in Asia and sub-Saharan Africa, with the latter accounting for 50 per cent of the fatalities.

Lifetime risk of death from pregnancy: Region Sub-Saharan Africa South Asia West Asia and North Africa Latin America & the Caribbean East Asia/Pacific Industrialized countries Risk 1 in 13 1 in 54 1 in 55 1 in 157 1 in 283 1 in 4,085

The maternal mortality ratio or MMR (the number of deaths per 100,000 live births) is a measure of the risk of death once a woman becomes pregnant. While the global MMR is 400, in some Asian countries MMR is as high as 850. For instance, it is 830 in Nepal, 650 in Laos PDR, 600 in Bangladesh, 590 in Cambodia, 470 in Indonesia and 440 in India. But it is as low as 95 in Vietnam, 60 in China and Sri Lanka, 44 in Thailand, 35 in North Korea, 20 in Fiji and in South Korea, 15 in New Zealand, 12 in Japan, nine in Singapore and six in Australia.

The lifetime risk of maternal death is one in 16 in Africa (one in 12 in subSaharan Africa), one in 65 in Asia, one in 130 in Latin America, as against one in 400 in northern Europe. Even more worrisome is the fact that for

every woman who dies, at least 30 suffer injuries and often permanent disability. It is estimated that one in four women in the developing world suffers from acute or chronic conditions owing to pregnancy. For every women who dies in the developed world, 99 die in the developing world. Moreover, a womans lifetime risk of dying from pregnancy related complications in developing countries is 40 times higher than that of her developed country counterpart. Maternal mortality, according to the world health organization (WHO), is the death of a woman while pregnant or within 42 days of termination (by delivery, miscarriage or abortion) of pregnancy, irrespective of the duration of the pregnancy, from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes. The country with the highest number of maternal deaths is India, followed by Nigeria (37,000), Pakistan (26,000) and the Democratic Republic of Congo and Ethiopia (24,000 each). Thirteen countries account for 67 per cent of all maternal deaths worldwide. I do not believe for one minute that if men were dying in their prime in these numbers, so little would be done, observed James Wolfensohn, World Bank President, speaking on safe motherhood and maternal mortality on World Health Day, April 7 in 1998. Twenty-five per cent of maternal deaths occur during pregnancy; 50 per cent within 24 hours of childbirth; 20 per cent within seven days of delivery; and 5 per cent from two to six weeks of childbirth It is however, difficult to predict which women will develop a life-threatening complication during pregnancy. But three

important ways by which maternal deaths can be controlled are: (a) by promoting family planning that is, every pregnancy should be a wanted one; (b) skilled attendance at birth all pregnant women must have access to skilled medical care; and essential obstetric care all pregnant women must be able to reach a manned and equipped healthcare facility if complications arise.

INDIAN CONTEXT:In this context when we analyze the Indian situation our safety is quite dismal. A look at the statistic of maternal death seems to be invaluable loss due to various reasons. It does not execute the rate of child morality being concomitant to it. 407 women die each year out of 1 lakh live birth in India. The pregnant women die in due to reason ranging from poverty and illiteracy to lack of affordable but quality health facilities. These disadvantages are compounded further for the vast majority of women who experience gender based discrimination and have little autonomy concerning decision making. Approximately half (45%) of the female population of the country is illiterate. A majority of working women is employed in the informal sector, with insecure jobs and low wages. More than 40 percent of the women did not have access to money, and almost 50% were not involved in decision making in matter related to their own health care. Maternal mortality ratio in selected states State MMR Uttar Pradesh Andhra Pradesh 154 Assam 388 West Bengal

440 141

Rajasthan Madhya Pradesh Bihar Orissa

388 335 312 303

Punjab Gujarat Haryana Maharashtra

192 160 186 130

ORISSA CONTEXT
One Women dies every minute everyday of pregnancyrelated complications Worldwide i.e. almost 600,000 women each year. One woman dies from pregnancy and childbirth related complications every seven minutes in India which amounts to 70,000 women every year. At least 29 women die during delivery or delivery related complications everyday in Orissa, yet the state is not yet ready to tackle the challenges of Safe Motherhood.

Safe motherhood though is a new terminology for many in the state, yet its importance is high because Orissa being one of the backward states considering its maternal mortality ratio (MMR), it has not kept pace with the country. As per NHFS 2002 Indias MMR was 401 whereas Orissa was well ahead at 368.

At least 60%, and by a very optimistic view around 80%, of Maternal deaths are preventable, more so when it is mandated that a women does not die between the day she conceives till 42 days after the child is delivered. That the state is not able to protect precious lives of women in these crucial 300 odd days even after being a signatory to Universal Declaration of Human Rights which guarantees - Motherhood and childhood are entitled to special care and assistance.

MATERNAL HEALTH PROGRAMME:

Promotion of maternal and child health has been one of the most important objectives of the Family Welfare Programme in India. The current Reproductive and Child Health Programme (RCH) was launched in October 1997. The RCH Programme incorporates the components covered under the Child Survival and Safe Motherhood Programme and includes an additional component relating to reproductive tract infection and sexually transmitted infections. Yet, over a 100,000 women in India continue to die of pregnancy related causes every year. The Maternal Mortality Ratio in India is 407 per 100,000 live births (SRS, RGI 1998). The major causes of these deaths have been identified as hemorrhage (both ante and post partum), toxemia (Hypertension during pregnancy), anemia, obstructed labor, puerperal sepsis (infections after delivery) and unsafe abortion. Maternal Mortality is a cause of great concern. However, reliable estimates of maternal mortality are not available. Any intervention to check it will only be effective if we know reasonably accurate data on maternal mortality.

Interventions :
Reduction of maternal mortality is an important goal. The health programme aims at reducing maternal mortality to less than 100 by the 2010. The major interventions include: Essential Obstetric Care: The RCH Programme aims at providing at least 3 antenatal check ups during which weight and blood pressure check, abdominal examination, immunization against tetanus, iron and folic acid prophylaxis as well as anemia management are provided to the pregnant women

Emergency Obstetric Care: 1. Complications associated with pregnancies are not always predictable Therefore, emergency obstetric care is an important intervention to prevent maternal morbidity and mortality.

2.

Under the RCH Programme FRUs are also being strengthened through supply of drugs in the form of emergency obstetric drug kits and skilled manpower on contractual and hiring basis. 24-Hours Delivery Services at PHCs/CHCs: To promote institutional deliveries, provision has been

made under the current RCH programme to give additional honorarium to the staff to encourage round the clock delivery services at PHCs and CHCs. This is to ensure that at least one medical officer, nurse, and cleaner is available beyond normal working hours. Referral Transport: Time is an important factor for obstetric emergencies. Women who undergo deliveries at home and develop complications often find it difficult to be transported to a referral unit. Safe Abortion Services: Abortion is a significant medical and social problem worldwide. It is estimated that half the abortions taking place around the world every year are performed outside authorized health services and or by unauthorized often unskilled providers and most take place in the developing world. The Medical Termination of Pregnancy Act, 1971 : The Medical Termination of Pregnancy Act, 1971 has been under implementation since 1972. Over the years, the number of centre

where pregnancy can be terminated has increased and at present there are 11025 recognized MTP clinics in the country. However, considering the fact that a large number of unsafe abortions still take place providing for more facilities for MTP services has been taken into consideration under the ongoing reproductive and Child Health Programme.

New Initiatives:
1. Training of MBBS doctors in Anesthetic skills for Emergence Obstetric care at FRUs. To alleviate shortage of specialist manpower Government of India launched. Training of MBBS doctors for gaining Anesthetic Skills in Emergency Obstetric Care at FRUs. 2. Obstetric Management Skills: Government of India is also considering introducing training of MBBS doctors in Obstetric Management Skills. Federation of Obstetric and Gynecological Society of India has prepared the training for 16 weeks in all obstetric management skills including Caesarian section operation and is at present under consideration. 3. Setting up of Blood Storage Centers (BSC) at FRUs: Timely treatment for complications associated with pregnancy is sometimes hampered due to non-availability of Blood Transfusion services at FRUs to facilitate establishment of Blood Storage Centers at such FRUs the Drugs and Cosmetics Act have been amended and guidelines for these Blood Storage Centers (BSCs), have been prepared and

disseminated to the States. Initial funding and equipment will be provided by Government of India under RCH-II. 4. Developing a cadre of Community Level Skilled Birth Attendant: Presently the health care system is not in a position to provide all pregnant women, services of a trained health functionary at the time of delivery. A community Level Skilled Birth Attendant is a person who will be trained in Midwifery to provide maternal care at the community level. She will be selected from the community where she will set up her practice after completion of her training of one year in midwifery. 5. Janani Suraksha Yojna: The scheme is a modification of National Maternity Benefit Scheme, referral transport etc. and is at present under consideration. Objectives: Reduction in MMR & IMR Encouraging Small Family Norms Provision for Caesarean Section Encouraging Pregnant Women to Undergo Tubectomy/Laparoscopy Trained TBA to be Effective Link between Field Level Health Functionary & the BPL Woman. Payment of Incentive to Dai/ASHA. Fund to be released through State SCOVAS/State Department of Family Welfare. Benefit to be disbursed by ANM through recoupable imprest.

6.

According Social Health Activist (ASHA): Government of India has recently announced a

National Rural Health Mission (NRHM) with a clear goal of addressing the health needs of rural population especially vulnerable sections of the society. Such community level link workers may be called as Accredited Social Health Activists (ASHAs). ASHA will act as a link among beneficiary at village level, Anganwadi Worker and ANM. The scheme is under consideration.

7.

Vende Matram Scheme: The scheme is continuing under Public Private

Partnership with the involvement of Federation of Obstetric and Gynecological Society of India and Private Clinics. The aim of the scheme is to reduce the maternal mortality and morbidity of the pregnant and expectant

mothers by involving and utilizing the vast resources of specialists/trained work force available in the private sector. 8. Operationalisation of Primary Health Facilities under Reproductive The focus of the programme will be to reduce the Maternal & Child Mortality & Morbidity with emphasis on rural health care.

and Child Health Programme (RCH-2nd Phase):

CHAPTER-ii
STATEMENT OF THE PROBLEM &PROFILE OF THE STUDY ARE

STATEMENT OF THE PROBLEM:A maternal death is the death of women while pregnant or within 42 days of termination of pregnancy regardless of the site or duration of pregnancy, from any cause related to or aggravated by the pregnancy or its

management. Maternal death is subdivided into direct or indirect obstetric deaths. Direct obstetric deaths result from obstetric complications of pregnancy, labour, or the post partum period. They are usually due to one of five major causes hemorrhages, sepsis, eclampsia, obstructed labour, and complications of unsafe abortion as well as interventions, omissions, incorrect treatment or events resulting from any of these. Indirect obstetric deaths result form diseases arising during pregnancy which are aggravated by the physiological effects of pregnancy examples of such diseases include malaria, anemia, HIV/AIDS. While a biological complication is defined as a cause of death in fact most maternal deaths result from a chain of events that include many, social, cultural factors. Some of these can be prevented before a woman becomes pregnant, such as by ensuring that she is well nourished and not suffering from anemia. Social and cultural factors like low level of education, poverty, lack of participation in decision making. As a result not recognizing or understanding of the importance of maternal complications. So using traditional home care by in formal providers for maternal complications another category of deterring factors like, lack of transportation poor roads, long distances to the centers of health facilities. Where the women can receive appropriate care.

CAUSES OF MATERNAL DEATH:Around 80% of all maternal deaths are the direct result of complications arising during pregnancy delivery or the puerperium.

 Hemorrhages especially post partum hemorrhages is unpredictable, sudden on set but more dangerous when a women is anemic. Globally some 25% of all maternal death is due to hemorrhages. Sepsis, which is often a consequence of poor hygiene during delivery or of untreated sexually transmitted disease (STDs). It accounts for some 15% of maternal deaths. Hypertensive disorders of pregnancy particularly eclampsia, are the causes of approximately 12% of all maternal deaths. Prolonged or obstructed labour accounts for about 8% of maternal deaths. Complications of unsafe abortions are responsible for substantial proportion (13%) of maternal deal Approximately 20% maternal deaths are due to pre existing conditions that are exacerbated by pregnancy or it mis-management

SAFE MOTHER HOOD IS A HUMAN RIGHTS ISSUE:-

The death of women during pregnancy or child birth is not only a health issue but also a matter of social injustice. The universal declaration of human rights by the United Nations in 1948 State that apart from treating all human beings as equal has given special treatment to motherhood and childhood which are entitled to special care and assistance. Womens reproductive rights include the right to liberty and security of persons, an absolute right to physical integrity and the freedom to decide on matters of sexuality and the partners, family health care professionals, and religious groups and the state etc.

RELEVANCE OF HUMAN RIGHTS TO THE SAFE MOTHER HOOD ARE:

Rights relating to life, liberty and security of the person, which require governments to ensure both access to appropriate health care during pregnancy and child-birth and womens right to decide whether when and how often to bear children. Government must therefore address factors concerning areas such as the economic, legal, and social and health that deny women these fundamental rights. Rights relating to the foundation of families and of family life, which require governments to provide access to such health services and related facilities which women need to establish family and enjoy life with in it. Rights relating to health care and benefits of scientific progress including information on health and education which require governments to provide access to good sexual and reproductive health care with appropriate referral system. The measures needed to ensure safe motherhood can be provided through primary health care facilities irrespective of countrys level of economic development central to these rights is information on a range of reproductive health issues, including family planning abortion sex education including sex determination of the fetus.

Rights relating to equality and non discrimination, which require governments to provide access to services such as education and health care without discrimination on grounds such as sex, marital status, age and socioeconomic position. Discriminatory policies include womens requirement of to obtain the consent of her husband for particular health care interventions, requirement for parental authorization which has a different impact on girls, and laws much needed by women criminalize medical procedures. Governments are in violation of their obligations when they fail to implement laws that effectively protect interests or allocate health resources to meet womens particular need for safe pregnancy and child birth. Safe motherhood is perceived as a human right under pinned by laws that support effective action to increase womens access to appropriate services. Families and communities have a major role in making that access possible which protecting womens health through improved nutrition level and if needed by preventing unwanted pregnancy. The health sector is encouraged to provide quality services including essential care against obstetrics complications. These should be made available to all women during pregnancy and child birth. In this regard particular emphasis on ensuring that a skilled attendant is present at every birth.

CHAPTER-III
RESEARCH METHODOLOGY

RESEARCH

METHODOLOGY

Methodology refers to the procedure and whole plan of study in undertaken so as to ensure objectivity of the findings and generalization. It is a plan comprising researcher, decision about the procedure few collection of data, sampling and analysis of data for a given study without wasteful expenditure of time, energy and money. The methods have greater importance in energy and money. The methods have greater importance in earning scientific theory on research investigation. Because science goes with method not with subject matter. The research constitutes the real scientific basic of any research work. A specific methodology saves time and energy also help in subsequent verification assessment of a particular piece of research work. The decision about methodology to be adopted has also another utilitarian purpose. It helps the researcher to prepare himself for unforeseen situations and problems if one anticipate problems on difficulties he is likely to face them when they actually accrue designing the research ensures against the frailer of discontinuity, of a research work. It is economical in the long run, because it to retails the possibility of fruitless enquiry. The researcher engaged on preparing a methodology prepares and idealized research design specifying the major steps to be followed. As he actually outers in the field and status administering the method.

Title of Dissertation: Maternal death: - A gross violation of Human right in the state of Orissa. (A study of Khariar and Komna block of Nuapada District)

About the study area:

The present study was conducted in the district of Nuapada. It is both analytical as well as empirical. The researcher with the critical bent of mind has tried to understand the diversity of the maternal death and its consequence. Nuapada is one of the most back ward district of Orissa and one among the worst in the area of maternal death. with prepared scheduled researcher has gone to his study field and has come up with his own findings and observations out of 5 blocks of Nuapada district the researcher has selected two block; Khariar and Komna. The data were collected from different types of respondent like relatives of death women, pregnant women, head of the village, people representative, (sarpanch, ward members), government officials (Doctors, B.D.O, B.P.O, and C.D.P.O) and last but not least the civil society and NGOs.

Profile of the study area ORISSA

The state of Orissa extends from 170.49N to 220.34 N latitude and from810.28 to 870.29 Longitude in the eastern coast of India Andhra Pradesh in the south ,Chhattisgarh surround Orissa in the west, Jharkhand in the North and West Bangles in the north-east and the Bay of Bengal in the east.

NUAPADA

Demography- The total population of this district as per 2001 census is 5, 30,690 out of which 2, 64,396 are males and 2, 66,294 are females. Density: According to 2001 census, the density of population was 138 per sq. km... Scheduled Caste:- Caste plays an important role in the socio-economic life of the district. The main castes on the basis of occupation and traditional social divisions are Bairagi, Bangti, Bhulia,Domb. Scheduled Tribes: - The population of the scheduled tribes in the district constitutes 34.71percent of the total population. Of the 46 tribes found in this district. Literacy Rate:The literacy rates for the district calculated during the 2001 Census is as follows: Census Year 2001 Total 42.00 Male 55.4 Female 25.7

Health institutions in Nuapada No. of District Hospitals No. of Sub-Divisional Hospitals No of Other Hospitals No of PPCs No of UGPHC No. of Block PHC/CHC No. of Mobile Health Units No. of Sub-centers with Main centers No. of Ayurvedic Dispensaries 1 0 2 1 1 19 7 96 11

No. of Homoeopathic Dispensaries

KHARIAR
The total land area of the block is 308.87sq.km. There are 116 villages and 21846 house hold .According to 2001 census the total population of the block is 93,018 out of which46, 408 male and 46,610 female. The scheduled Tribe population is 25,539 and scheduled Caste is 14,491.It is located 70 km distance on road from District headquarters. In this block 105 primary, 33 secondary, 26 middle school and 2colleges. Literacy rate is total 42.5%, 59.3% male and 25.92%female. There is no medical hospital but 1 UGPHC, 3 PHC, 1 mobile health unit and 1 maternity care centre. In allopathic medical institution 7 Doctors, 4 AYUSH doctor and 4 Nurses.

KOMNA
The total land area of the block is 651.77sq.km. There are 162 villages and 27150 house hold .According to 2001 census the total population of the block is 1, 17,082 out of which 57,906 male and 50,176 female. The scheduled Tribe population is 51,297 and scheduled Caste is 16,029.It is located 40 km distance on road from District headquarters. In this block 147 primary, 48 secondary, 33 middle school and 2 college. Literacy

rate is total 28.85%, 43.16 male and 14.95 female. There is no medical hospital but 1 CHC, 3 PHC, 1PHC (new) , 1 mobile health unit and 2 maternity care centres. In allopathic medical institution 5 Doctors, 3 AYUSH doctor and 9 Nurses.

Objectives of Study:
1. 2. 3. 4. To know the different socio-economic and psychological causes behind the maternal death. To know different health care facilities provided to the pregnant women. To understand basic human rights values, of maternal health care during pre-natal and post-natal stage. To know the different rights of women concerning the safe motherhood.

Research Design:
We have prepared our research project by the help of descriptive research design. The major goal of a descriptive research is to describe events, phenomena and situations since description is made on the basic of scientific observation. It is expected to be more accurate and precise than casual. Decision regarding what, where, when, how much by what means concerning an inquiry or a research study constitutes as a research design. A

research design it the arrangements of the conditions for collection analysis of data in a manner, that to combine relevance to research purpose with economic in procedure.

Sampling:
In order to have a scientific and systematic study there is need of sampling. At first stage the researcher has selected Nuapada District of Orissa which is more convenience for her. Second stage the researcher selected two blocks i.e. Komna and Khariar. Finally the researcher cover all the family in which the maternal death report is concerned.

Source of data Collection:

The data were collected from both secondary and primary sources. The primary source of data includes the family of deceased women people representative, pregnant women and district officials of Khariar block of Nuapada district on the other hand the secondary data includes statistical data mentioned in census of India information from PHC and CHC centers, books, journals, frequents conversation with the lectures and resource persons who work on maternal and child health.

Tools of Data Collection:

Interview is the primary method of collecting data for the study. The researcher had directly interviewed the respondents from the research fields using an interview schedule. The schedule is a set of questions regarding personal details, health conditions of women, position of women in family socio-economic condition. The researcher filled himself following direct interview with the respondents all the schedules. The researchers also keenly observation the respondents spontaneous reactions, feelings attitudes etc. while responding to the various questions.

Significant of the study:

Nuapada is more valuable in the field of maternity death the researcher belongs from this district. So it easier to study in the Nuapada district, the research focuses of the different dimension of the maternal death. The Nuapada is a most tribal dominant district there is no proper road communication with in the district.

Data Analysis:
The research data are mostly qualitative & quantitative & the data are collected through interview schedule & personal observation. After the collected data the interview schedule has been scrutinized & coded. The coded has been transferred to master sheet after which the tabulation has been made. There after the data have been analysised through appropriate statistical method. Then it is presented through graphs & diagram.

Chapterization:
The entire research study has been divided into the following chapter: Chapter-I Chapter-II Chapter-III Chapter-IV Chapter-V Chapter-VI Introduction Statement of the problem & profile of study area. Research Methodology Review of literature Data Analysis Major findings, suggestion & Conclusion

Limitation of the study:

The data of research is collected from the family member of deceased mother. In this research method there is dual respondent & both of views are different. There is some area which is very important for research is located in accessible place. The resources of the researcher such as funds time & mobility have been very much limited.

CHAPTER- IV
REVIEW OF LITERATURE

REVIEW OF LITERATURE:Literature review is very crucial in scientific study designed to be scientific as to maintain its objectively. It gives fundamental as well as detailed information to the researcher a study will be informative, technical, journalistic and authentic if the researcher has sufficient knowledge on his subject. To find out the reality and authenticity a research should organize the information systematically for his research study to make ones meaningful as well as intensive a scholar should think rationally, search with exactitude and analyze the available information honestly. Literature review helps to determine their relevance of the study to the present situation and it gives right direction to the investigator. As the knowledge of the researcher on the topic of study is severely limited he depends more on this particular topic. So reviled of literature available on the subject for this far purpose reviewing researcher and journals selected some books studies on this topic.

1.

Womens link Vol.7 No.2

Many of the issues in womens health have their origin in non

medical factor. Social perception of equating motherhood with women hood, the status of women in the society and equitable access to health care facilities ensuring safe motherhood have been the major issue in womens health. In the light of high maternal death, in accessibility of institutional health care services to the three-fourth of pregnant women and growing nutrition deficiency among pregnant women still remains to be major

challenges to the human rights of women apart from the much debated womens right to have control and decide over the reproductive health.

2. In the book encyclopedia of women heath

Parvesh Handa. The author focuses on different aspects of womens health.

3.

Health Action:According this article the women all important role in the

development of society. So the author focuses on the women health especially during the period of pregnancy. According to author Women build homes. Homes make societies. The well being of a society depends on the health of its mother and progeny. Only when mother survived and thrive child survive and thrive. And society prospers. Maternal mortality is a matter of long-term public health, as opposed to disease and so we need an approach which is different from the way we tackle disease. There is no quick or simple Solution whats needed is a wide ranging holistic approach with fundamental changes in perceptions and parameters. For no country can build human development and reduce poverty without establishing a robust health system which makes maternal health a priority.

4.

UNICEF report on maternal and new born health-2009:This report said that the continuum of care aims to

integrate maternal new born and child can be summarized as follows: essential services for follows: essential services for mother, new born and children are most effective when they are delivered packages at critical points in the life cycle of mothers and children in a dynamic health system that spans key locations underpinned by an environment supportive of the right of

women and child. The critical points of service delivery are adolescence prepregnancy, pregnancy, birth post- partum, neonatal, infancy and childhood.

5.

Vision, Article Health status of women in India

In this magazine author tried to focus on different aspect of maternal

L.N.Dash:Health. He state that Right to reproductive health also includes the right to safe termination of pregnancies, information about various health issues and most importantly to make decision about child birth and birth spacing. Institutional support during and after birth influences reproductive health. It contributes significantly to the reduction of maternal mortality and mortality. Many Indian Women receive birth support and service outside of medical institutions only 25.5 percent deliveries occurred in medical institution and health professionals assisted at 34.2 percent of deliveries.

6.

Women Development:In this book author tried to focus inter-state variations in

mortality rates. The book state that how the status of women in education and health impact on maternal death. She also focuses the issue of abortion in India. As far abortion in India are concerned the traditional remedy was through oral consumption of herbs which would produce heat within the body of a women and hence lead to the abortion of the fetus or through the insertion of a piece of wood in the uterus for purposes of scarping out the fetus from it. Both methods were dangerous and often led to excessive bleeding, leading to death. Abortion was not legally allowed in the country till 1971. Illegal abortions were done in unscientific fashion but in unhygienic surrounding leading to sepsis and death.

A number of women, both in government and in the voluntary sector, advised the legitimizing of abortion as an instrument for improving womens health, reducing the maternal mortality rate and promotion of family welfare. As a result of this effect of sensitization, the government passed the medical termination of pregnancy act in 1972.

7.

Health Action, Article How a care for is the paragon of

In the Article the writers are states that good

care, the women Deekha Sharma and sheel Sharma:wealth and optimum nutrition are basic to human advancement are inadequately accessible to the women right for their birth. They also states that the concern to words the health of women in India milies can be assessed by the fact that still most of the times delivery happens at homes in the guidance of untrained midwives (Dhais). In this article writer mention that reducing the number of women dying in child birth by three-quartos by 2015 is one of the key goals of the millennium declaration. This goal was agreed from 189 countries at the UN millennium summit in September 2000.

8.

Social Welfare: Article Our Bodies ourselves; listen to

According to Manipadma Jena in his Articles that the three main

KALAHANDIs women:reasons for a high MMR in Kalahandi. Where nearly half of the populace comprises vulnerable scheduled tribes and castes are early marriage, low institutional deliveries and low intake of vitamin supplements during pregnancy.

9.

Health action: December 2007, Article Adolescent Health

Hence the writers state that pregnant women die in

and Human Right concerns:this country due to reasons ranging from poverty and illiteracy to lack of quality and affordable health facilities. These disadvantages are compounded further for the vast majority of women who experience gender based discrimination and the have little autonomy or decision making power.

10. Health care system and managements Goal:In this Book writer focus different health care services provide by government. Like ICDS is one among them. Cares for pregnant women through ICDS are:Important of early registration. Auto-natal check. Motivation pregnant women to register early and seek attendant care. Nutritional advice during pregnancy. Common symptoms and sigh (danger signs) when pregnant women should seek immediate medical help.

11. Women Empowerment: Article Gender Discrimination and womens Health by Dr. Rupa Sharma.
According to her only 42 percent of birth in the country are supervised by health professionals. Most women deliver with help from women in the family who often lack the skills and resources to save the

mothers life if it is in danger. Even a small investment in upgrading the levels of knowledge and skills of these women can have huge returns. The ability to recognize the danger signals and the availability of transport and all weather roads so that a woman in labour can be rushed to a hospital adequately equipped to deal would reduce maternal mortality half.

12. Socio cultural Dimension of Reproductive child health

Article Maternal Child Health Care practice some issue related to primitive communities mitashree Mitra in this Article she state that the health seeking behavior show that they seek the relief from diseases first of all through local traditional medicine man sirha or Baiga who are supposed to be touch with spirits. An allopathic medicine is the last resort. Writer also point that most delivery occurred at home. Unhygienic and primitive practice for parturition which is the main cause of maternal mortality.

13. Socio cultural dimension of reproductive child health Article so understanding womens Reproductive health need in urban slum: A rapid assessment. N.P. Das and Urvi Shah
The paper states that about 36 percent of the deliveries are still taking place at home. Most of these home deliveries (87 percent) are attended by untrained dais and relatives. Among the institutional deliveries, the preference is for a private clinic over the government facilities. The health of the mother and the child is further compromised as only 7 percent of home deliveries were conducted using a safe disposable delivery kit.

Chapter- v
DATA ANALYSIS

Table 1 The Block wise Distribution of Respondent

Name of the block Khariar Komna

No. of Respon dent 17 23

Percentage (%) 43% 57%

Noof Respodent
Khariar kom na

From the above table it is clear that there are 57% respondent from Komna Block and 43% from Khariar Block. It shows that Komna have more maternal death than Khariar Block. The table reveals that Komna have more STs/SCs population than Khariar Block.

Table -2 Age wise distribution of deceased women.

Age 15-20 20-25 25-30 30-35

No. of Death 4 13 9 14

Percentage (%) 10% 34% 21% 35%

Age of Death is one of the most important factors. Most of respondents (35%) cane from 30-35 age groups about 34%respondent belong to 20-25 age group. It shows that 30-35 age groups are more valuable to death than women of other age group.

Table -3 Data on the respondents who are the head of the families of the deceased. Head of Family Husband Mother-in-law Father-in-law Brother-in-law No. of Percentage (%) Responden t 28 70% 2 5% 9 23% 1 2%

Head of the family makes important decision for the family which affects the health of the women before delivery of the Child. The above table shows that 70% of family heads are husbands and rest are 30% family heads are mother-in-law. Father-in-law Broth-in-law. Significantly it reveals that most of the family heads are males.

Table -4 Table depicting the distribution of the place of death. Place of death Home Hospital On the way to home to Hospital On the route from Hospital to Home No. of death 11 16 12 1 Percentage (%) 28% 40% 30% 2%

From above table are found that most of the maternal death occur at the hospital that is 40%, 28% of death of home accounts for deceased rest 32% maternal death occurs while on the way to the hospitals from above 16 it is found that most of the i.e. 40% take place as Hospital maternal death most are comes where only complicated cased are brought when turning serious. This observation is also reflecting over the negligence of caused by the referral system of the Hospitals.

Table -5 Distribution of Deceased women on the basis of Level of education attained. Level of Education Illiterate Primary Secondary Higher secondary No of Percentage Decease (%) d women 23 58% 10 25% 5 12% 2 5%

It makes women conscious about their health & impending danger to the life due to negligence. The above table reveals that most of the deceased women were uneducated and illiterate only 25% of them attained primary education Real 17% attained secondary education. The table cleanly shows that the illiterate women are more vulnerable to death may be due to their ignorance about health.

Table -6 Income wise distribution of data. Level of Income Antyodaya BPL APL High income No. of family 15 20 5 0 Percentage (%) 37.5% 50% 12.5% 0

Income level plays on important as it is the indicator of the deceased standard of living. It also control over the authority for decision making and ability to get medical treatment which ultimately plays an important role in maternal death from above table we have found that about above 50% of the women belong to BPL catalog 37.5% women belong to Antyodaya category. These people constitute the poorest section of the masses hence lack financial strength as to available minimum medical attention.

Table -7 Caste wise distribution of deceased home. Caste No. of Percentage decease (%) d women 13 32.5% 16 40% 8 20% 2 5% 1 2.5%

SC ST OBC General Other

I In the Indian society caste plays an important role particularly in the process of socio economic development. They are innumerable castes in India. But the SCs & STs being as weaken section no out society. Above table shows that 40% of deceased women being STs and another 20% belong to OBC. 32.5% of maternal death occurs among women belonging to scheduled castes groups. This table brings about an understanding fact that the rate of maternal death of OBC women is equal to that the STs who are the most vulnerable section.

Table -8 House pattern wise distribution of data. Type of house Kachha Kachha&pacca Pacca No. of deceased women 34 2 4 Percentage (%) 85% 5% 10%

Above table is the manifestation of the fact that most of the deceased women live Kachha house (85%). Kachha house among all the three categories indicate abject poverty most of the BPL category of people live in such accommodation who are the most suspectable to neglect and maternal death. Among the studied families poverty strictly ones proven are the longest in number.

Table -9 Distribution of the victims of maternal death on the basis of time of occurrence. Death period Pre-delivery period During delivery period Post delivery period No. of deceased women 7 13 20 Percentage (%) 17% 33% 50%

Timing of death is quite significant as it indicates care on negligence o the part of family concerned. Above table shows that 50% of women died after the delivery of the child. Similarly about 33% deceased women face death. During the delivery rest 17% lost their life before delivery took place. It shows that post partum to moreover play on important role in maternal death which might be due to predisposing causes like less intake of nutritious food and consequent condition.

Table -10 Distribution of sample data on the basis of registration ANM. Registratio n with ANM Yes No. No. deceased women 35% 5% Percentage (%) 88% 12%

Above table shows that about 88% of deceased women were registered by ANM. While rest 12% of deceased women were not even registered for the purpose of delivery. These causes of unregistered were. They were migrant labour. It quite a number of cases they could contact at the time of delivery as they were migrant labours.

Table -11 Distribution of sample data on the basis of antenatal care-. No. of Antenat al Care 1 times 2 times 3 times Nil No. of receipt ant deceased women 6 20 12 2 Percentage (%)

15% 50% 30% 5%

Above table shows that 50% of deceased women received antenatal care twice during pregnancy whereas another group decreased women did their received antenatal checkup thrice during pregnancy. However 15% of the deceased women availed such care only once which turned to be deceased women.

Table -12 Distribution of deceased on the basis of intake of folic acid tablet. Folic Acid tablet intake Yes No. Yes but not properly as instruction No. of decrease women 17 5 18 Percentage (%) 43% 13% 44%

Above table shows that the about 87% of deceased women got folic acid tablet. 13% of deceased women did not get folic acid tablet. But the important point shows by the table but it is quite note worthy that reveals is about 43% deceased women would not did not take folic acid tablet regularly. This write be reason for the spatiality which they ultimately suffered.

Table -13 Distribution of sample respondent according ICDS benefits. ICDS Benefits Yes No. No. of deceased women 30 10 Percentage (%) 75% 25%

ICDS is an important scheme of government, which improver the nutritional status of pregnant women and 0-6 years child. Above table-13 shows that the 75% deceased women were received benefits from the ICDS program. Rest 25% of deceased women were not received this benefit due to different causes.

Table -14 Distribution of respondent on basis of Nutritious food intake. Neutrious food intake Yes No. No. of deceased women 10 30 Percentage (%) 25% 75%

Above table shows that about 75% of deceased women were not received nutritious food 25% of deceased women were received nutritious food during their pregnancy period.

Table -15 Distribution of data on the basis of distance of home to hospital (basic facilities). Distance from home to hospital 0-5 5-10 10-15 15-20 20-25 25-30 No. of deceased women 8 5 9 12 5 1 Percentage (%) 20% 13% 22% 30% 13% 2%

Above table show that 30% of deceased women were live 15-20 k.m. distant from Hospital. Which show the expensiveness to get the formal health care and 22% of deceased women were lived in 10-15 km distance from Hospital.

Table -16 Distribution of data according to place where fatal illness begin. Place of fatal illness begin Home Hospital On the route Relative home No. of deceased women 31 5 2 2 Percentage (%) 78% 12% 5% 5%

Above show than about 78% of deceased women were at home during their fatal. Illness began only 12% of deceased women were at Hospital during the fatal illness started. 5% deceased women were on the way and 5% deceased women were lived in their relatives house.

Table -17 Distribution of data according first steps taken by deceased women family.

Step taken by family Home Care Formal Health Care

No. of Percentage Decease (%) d Women 19 48% 21 52%

Above table-17 shows that 48% of deceased women were got home care by their family. 52% of deceased women were got formal health care by their family.

Table -17 Distribution of data according to way of treatment by the family. Treated as Out patient Hospitalized Consulted by register practioner Consulted by un register practioner Not do anything Dhai 3 9 7% 23% 10 25% No. of deceased women 0 17 1 Percentage (%) 0% 43% 2%

No. of D eceased W om en
Out Patient Hospitalised Consulted by Register Practitioner Consulted by Register UnPractitioner Not do Anything

About table shows how the deceased women treatment by their family. 43% of deceased women were hospitalized after their fatal illness begin 25% of deceased women were treated by unregistered practitioner about 23% of deceased women were treated in the inspection of Dhais.

Table -19 Distribution of data according to time of medical attention provides. Step taken Immediate Same day Family after system become serious No. step taken 10 25% No. of deceased women 9 6 15 Percentage (%) 23% 15% 30%

Above table shows that 30% of deceased women were treated when their system become more serious. 25% deceased women not received any formal treatment during the delivery period about 23% of deceased women were received treatment immediately rest 15% treated in same day 39%.

Table -20 Distribution of Data as per the place of registration. Registratio n Centre Sub-centre Hospital Maternity Home Nursing Home Both sub centre and hospital No. of deceased women 32 15 0 2 1 Percentage (%) 80% 39% 0% 5% 2%

Above table shows that 52.5% of deceased women were registered at the Sub-center ,5% of deceased women at Hospital ,5% at Nursing home and rest of 32.5% at both Sub-center Hospital.

Chapter- VI
MAJOR FINNING, SUGGESTIONS & CONCLUSION

MAJOR FINDINGS:
Most of maternal death occurs in the tribal area. The most of maternal death are from the ST and OBC caste. OBC comes under economically backward classes. Hospitals are not properly equipped. There is much less facilities than required. Several villages have hospitals but without doctor and other basic facilities. The pregnant women are not supplied with nutritious food. Basically they get normal diet which other women take at normal times. There is no sanitation facilities exclusively with the house hold. Sub-centers fail to provide basic facilities to women for delivery purposes. There is no proper co-ordination between ANM, AWW and ASHA. The most of decisions relating to pregnant women are taken by the male persons. Pregnant women do not use folic acid tablet regularly. In some cases the pregnant women fail to avail required maternity facilities due to their (migrant worker status) Home delivery in Villages is done under the supervision of the quacks contained practitioner which spells danger for the life of the women. Mother-in-law plays an important role in the house. Mostly they presence daughter-in-law & daughter to deliver at home. Tribals have their own traditional practices. Some tribal do not allow non family member to touch their pregnant women let alone any alien. Awareness level concerning maternal death.

Illiteracy deprives women safe motherhood rights. Demolition of joint family system has indirectly cast its impact on family care. Proper care is seriously lacking during post natal period. Most of the deaths occur within 6 days of the post delivery period.

IMPORTANT SUGGESTION:
Strengthening of the basic infrastructure in hospitals. Improvement in the referral system in all hospitals. Raising of the awareness level of people concerning safe mother hood. Appoint obstetrics & gynecology section should gynecologists specialist be strengthened in the hospitals. Minimum three ante-natal checkup in case of pregnant women should be ensured. Strengthening ICDS unit which helps maintain nutrition level of pregnant women. To Blood banks should be made in inmates of extra considerate towards maternity ward. Improve human resource by offering community based. Strengthen Midwifery of relevant staff Strengthening the PRIs.