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Maternal Mortality in India Soumitri Varadarajan Date March 2010

Problem ✤

20 - 25% of Maternal Deaths on this planet occur in India.

In 38% of the cases the deaths are due to Post-partum Hemorrhage (PPH)

An injection - Misoprostol, Oxytocin, Endometrine - can stop the hemorrhage!

The solution: Drug to be available at the time of Delivery!

(Research Field Trip)


Oxytocin easily available in rural contexts - dairy uses

Improved availability will not change the situation

Who will deliver the injection?

Direct versus Indirect causes

Drug delivery is not the solution!

SEWA Rural ✤

With 75% home delivery, SEWA Rural could reduce MMR by 40% and NMR by 45% in three years with specific interventions at community level backed up by a functional FRU. ✤

Empowering TBAs/ Local women volunteers ensuring satisfactory Birth Preparedness/ Complication readiness

Clean and Safe normal delivery ensuring critical new born care and post natal follow up

Timely identification of any complications during delivery and ensuring prompt referral to SEWA Rural’s functional FRU

Professional provision of basic and comprehensive emergency obstetric care by SEWA Rural FRU

Vajpai, Smita (CHETNA). November 21st 2006. "Building Community Based Mechanisms: Workable Solutions to reduce Maternal Mortality in India Presentation at the Civil Society Window on Maternal Mortality." In Presentation at the Civil Society Window on Maternal Mortality. New Delhi: Planning Commission of India.

Indirect Causes: Risk of PPH ✤

Most maternal deaths occur in women from tribal/dalit communities, poor socio– economic status, living in rural, remote regions. Women do not have access to complete, continued care from the public health system

Risks, Causes - known/ unknown

Youth Pregnancy/ <15 yrs age



Physical, socio- cultural and economic barriers affect access to institutional health services

List Causes - and need for risk elimination, or being risk aware and acting accordingly Key slide!!! On predicting the liklihood of PPH

Maternal Deaths global ✤


Spheres of Engagement

Modes of Engagement

Capacity for Intervention

(global project - India focus?)

Maternal Health facts ✤

85% of the women will deliver normally

20-25% deaths occur during pregnancy

10-15% women will develop complications that will need medical intervention

40-50% deaths occur during labour and delivery

25-40% deaths occur after childbirth (more during the first seven days

3-5% women will need surgical interventions (blood, cesarean etc.)

Source: Vajpai, Smita (CHETNA). November 21st 2006. "Building Community Based Mechanisms: Workable Solutions to reduce Maternal Mortality in India Presentation at the Civil Society Window on Maternal Mortality." In Presentation at the Civil Society Window on Maternal Mortality. New Delhi: Planning Commission of India.:

MMR - India

MMR Distribution

Three tier strategy: (in 100s) (in 200-300s) (in 400s)(above 400)

“I think Australia should focus upon Assam” - Aparajita Gogoi

Janani Suraksha Yojana ✤

(Safe Motherhood Programme)

India - MMR MDG target of 100

Funding - Elements of NRHM focussing upon MMR

NRHM Focus upon MMR has Gaps! ✤

Reliance on Accredited Social Health Activist (ASHA)

Data and interventions not always related

Quality of service


(National Rural Health Mission)

Well Funded

Proportion of MOHFW:International Funding (92:8)

State level program-proposal development - Three tier strategy: (in 100s) (in 200-300s) (in 400s)(above 400)

Program evaluation reports

(Only 6 countries

Tamil Nadu ✤

Success Story: Model! check this

Change: 300 to 145

Innovations ✤

90% Institutional Delivery

State Health Care service

Verbal Autopsy

Trained personnel

Padmanaban, P., P. S. Raman and D. V. Mavalankar. 2009. "Innovations and challenges in reducing maternal mortality in Tamil Nadu, India." J Health Popul Nutr 27(2):202-219.

What is the project then? ✤

Filling the Gap!

What is the Gap?

What can Australia do?

What can RMIT do?

How can the project be constructed?

What will the project look like?

Safe Motherhood Project 2010-15 A Multidimensional Support Project Consultation Paper

Breakthrough strategies against maternal mortality are grounded not only in best public health practice, but in a constructive framework of accountability and human rights. This is provided for in human rights treaties and commitments made in the Beijing Platform for Action and the Cairo Programme of Action.

Oral Statement at 54th CSW Session ORAL STATEMENT DELIVERED AT THE 54TH SESSION OF THE UN COMMISSION ON THE STATUS OF WOMEN, 1-12 MARCH 2010 This statement is delivered on behalf of Action Canada for Population and Development, Amnesty International, the Center for Economic and Social Rights, the Center for Reproductive Rights, Human Rights Watch, the International Initiative on Maternal Mortality and Human Rights, the International Planned Parenthood Federation, Ipas, and the Women's Global Network for Reproductive Rights.

Project Aims ✤

Helping (Assam) reach Millennium Development Goals

Responding to articulated needs

Supporting agencies in their work

Adding to existing/ongoing efforts in Capacity Development

Collaborating with Universities and NGOs on the ground

Facilitating social innovation enterprises

Providing education opportunities - for key stakeholders

Focus upon Assam ✤

MMR Assam - 490

NGO Assam - The ANT

University Link: IIT Guwahati, University of Guwahati, TISS

Health Secretary (Govt.)


Strategic Project! ✤

RMIT: Design + Health

International Project

Business Case

Profile in India

Industry Engagement

Government Participation

Institution Development

Discussion with CF/PVC Decisions: Key Drivers - Aus Govt Key Drivers - RMIT University Supported Project

RMIT Project (D+H)? Decision to be taken To set up a Strategic Project and to resource it! ✤

Home: DSC College/ RMIT

Cost Centre: Independent (How will Government fund it? What will University put in?)

Staffing Plan: Project Manager, Coordination and academic team/ group

Goals: Effective participation to reduce MMR in Assam

International collaboration with own funding (if University)

Risk in Program location (College location)

Project March 2010 ✤

Next Steps:

Ongoing Work - Soumitri Varadarajan in Industrial Design, with GPK/ DRI support College Support - for additional RA

Report ( Field Trip Feb 2010)

Consultation Process

Funding (8K GPK+RA/MW+RA+...)

Projects and Programme Definition

2015 Outcomes and impacts

Disciplines EOI ✤




Computer Science

Art, theatre, music


Connected to RMIT Project

1 Direct Intervention Design, invited projects

Product Service System design ✤

The transport service

The Midwives

The hospital

EmOC Transport


The Data service

The blood bank

The Training Course

The village health unit

The Safe Abortion Service

New Enterprises, Social Innovation

2 Indirect Intervention Capacity Development, Training, Research Date

1. Endeavour Project ✤

2011 - 2015 (GC Project - agenda)

125, 000 K/ year - 625, 000 K

Incoming Cohort (15-20/year): Capacity Development in Social Innovation

Outgoing Cohort(6/ year): Field work project in NGO spheres

Documentation: Film, Web, local narratives

Local Women as Focus

2. Health pathway ✤

Special Programme-Pathways inside Industrial Design

Upper Pool Studio: Design Project on infrastructure and services

Year 4 studio: A Service Design Studio (Participle Link)

International Collaborative Studio: Regional or Great Civ focus

University elective on Safe Motherhood

Industry MOU on Health Service Design

3. Research Cluster-Cohort ✤

(students from Assam - capacity development)

Masters by Research - cohort (Bus) model of 15 sponsored students

PhD slots in “Safe Motherhood”

Grad-Dip sponsored cohort in Service Design, Social Innovation, (Nursing), (Public Health Management)

(Masters by Coursework in Health Service Design)

Additional Notes ✤

Many Projects and International agencies

Midwifery Project - SIDA/ Karolinska Institute

Focus upon Assam-NE

Direct Interventions: Data gathering and analysis, Midwifery,

Indirect Interventions: Capacity Development, Technology Development, Resource Development

make direct and indirect interventions into sketches

Safe Motherhood Project 2010-15 A Multidimensional Support Project Development Vision

Maternal Mortality in India  

Exploring the project space: This is a document that has been used as a presentation internally among academic staff. Its a draft document -...

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