Policy barriers preventing access to emergency obstetric care in rural India

Abstract

India with its one billion people contributes to about 20% of all maternal deaths in the world. Even though infant mortality has declined in India maternal mortality has remained high at about 540 per 100,000 live births. Recent scientific evidence shows that access and use of high quality emergency obstetric care is the key to reducing maternal mortality and that high risk approach in ante natal care do not help in reducing maternal mortality significantly. This paper analyzes the policy level barriers, which restrict access of rural women to life saving emergency obstetric care in rural India. The paper is based on study of policies, research reports and experience of working in the area of maternal health over last several years. The paper describes how policies restrict basic doctors from performing obstetric surgical procedures including cesarean section even in remote areas where there is no specialist obstetrician available. The para-medical staff such as the Auxiliary Nurse Midwife is also not allowed to manage obstetric emergencies in rural areas. The policy also does not allow nurses or basic doctors to give anesthesia. As there is limited number of anesthetists in rural areas, this further reduces access to life saving emergency surgery. New blood banking rules are very Utopian, requiring many unnecessary things for licensing of a blood bank. Due to this, already limited access to blood transfusion in rural area has further reduced. Thus many restrictive polices of the government have made emergency obstetric care inaccessible in rural areas leading to continued higher maternal mortality in India.