 This
topic of EC is very important. There are two important aspects to be dealt with
(a) technology aspect, its application and information sharing, and (b) policy-related
issues.
It is not due to the absence of technology
that our women are dying in the dawn of 21st century, rather it is the lack of
policy. The contextual situation in our country has two important constraints
: (i) Poverty – Women are the poorest lot. 70%
of 3 billion poor in the world are women (World Health Report). In our region,
as it is, 40% of world’s poor are living. Of these, women are the poorer lot.
This is despite the increasing globalisation and privatization.
(ii) Gender – for centuries, values put by society to men and women are different.
There is a marked disparity being reflected in gender development index in UNDP
report (UNFPA), men’s words are always valued more, and gender discrepancy continues,
despite marginal improvement in recent years.
These contextual situations relate to women and influence their access and bargaining
power to good reproductive healthcare which directly affects their life. We have
good technology, but it is not reaching women in a cost effective way.
EC relates to several issues related to women’s health. WHO strategy is :
“Every pregnancy should be wanted, unwanted pregnancies
directly relate to the risk of death”. Pregnancy-related
deaths constitute the leading cause of loss of healthy lives among women of reproductive
age in the South-East Asia Region. This Region alone accounts for 40% of the global
maternal deaths. The national estimate of maternal
mortality rate (MMR) is just the tip of the iceberg as maternal deaths are grossly
under-reported due to non-registration and/or incorrect classification. Studies
in the Region have indicated that over 70% of maternal deaths are under-reported.
Besides, the national MMR averages vary according to socio-economic conditions,
gender, geographical location, ethnicity and other variables. For example, the
national MMR average of 408 for India includes variations ranging from 29 in Gujarat
to 707 in Uttar Pradesh. Safe and affordable
health technologies for preventing almost 80% of all maternal and early neo-natal
deaths exist. However, the capacity of health systems to provide such essential
maternal and newborn health services, especially essential obstetric care, is
often lacking. Even where such services are available, women in need cannot access
them on time, mainly due to lack of referral systems and their poor socio-economic
status. Making Pregnancy Safer [MPS] offers
a health sector strategy to resolve the twin problem of maternal and neo-natal
morbidity and mortality. The MPS strategy calls for incorporating three evidence-based
action messages within health systems. One,
every pregnancy ought to be wanted. Globally, evidence shows that out of 210 million
estimated pregnancies, 39% are unplanned. Such a high proportion of unplanned
pregnancies relates, among others, to a high level of unmet needs for family planning
services of one’s choice and associated risk of death due to unsafe abortion.
Though not reported widely, unsafe abortion constitutes a major cause of maternal
death ranging from 10 to 40% in the Region. Deaths due to unsafe abortions indicate,
among others, a high level of ‘Unmet Need’ for family planning services of good
quality. Easy accessibility to Emergency Contraception
would make a huge difference in preventing unwanted pregnancies and deaths due
to unsafe abortions. Two, all pregnant women
and their newborns should have access to skilled care. Evidence shows that higher
the proportion of skilled attendants at birth, lower is the maternal mortality
ratio. Three, every woman should be able to
reach a functioning health facility in order to obtain appropriate care when complications
arise. Research shows that higher the health systems performance index, lower
is the MMR. The prevention of maternal deaths
requires timely access to both preventive and clinical interventions. The proven
cost-effective interventions needed to prevent maternal deaths do exist. They
are not new. MPS calls for having these essential services incorporated within
the health systems. The on-going health sector
reform in high MMR countries should take into account a few imperatives, a few
pressing examples of which are fairness in the provision and financing of maternal
health and newborn care services, physical and human resources, advocacy with
matching policy and legislation. At the 53rd
Session of the WHO Regional Committee, the Governments in the South-East Asia
Region have endorsed an MPS-based Regional Strategy for the Reduction of Maternal
Mortality for the Region and, accordingly, adopted a Resolution (with 10 member-states,
25% of world’s population and 30% of global maternal deaths) (SEA/RC53/R9).
The most important key message of making pregnancy safer is “Every pregnancy should
be wanted” and the initiative suggests to “establish (or update) national policy
and standards for family planning”. The proposed
regional strategy calls for concerted efforts from all partners in putting the
existing proven interventions into a single package, and mainstreaming it through
different levels of health systems. Its effective application at the ground level
would make a difference - difference in making every pregnancy safer, in saving
lives and in improving the potential of future generations.
| 
