To check high MMR, Punjab to conduct C-section data audit

Tribune News Service

Ludhiana, September 1

High Maternal Mortality Ratio (MMR) in the state has put the health department in a tizzy forcing it to resort to different measures including making it mandatory for all pregnant women to have a check-up with medicine specialists, imparting basic antenatal care training to the doctors of Aam Aadmi Clinics and community health officers and also led to first ever data audit of C-section deliveries in the state.

The department is also required to stay in contact with each woman during her term of pregnancy. The data has been collected in context of the state recording a very high MMR.

The maternal mortality ratio (MMR) is a measure of the number of maternal deaths per 100,000 live births in a given time period. ‘Health’ is the main indicator of the progress of any country and MMR being the most crucial.

The current maternal mortality ratio of Punjab as per the last National Family Health Survey is 105 as compared to the national average of 97.

According to the official sources in the department, in July 2024, the state recorded MMR at 138.

Sources further added that in the last financial year, 2023-24, Punjab witnessed 403 maternal deaths. A sudden increase in maternal mortality was witnessed when 87 deaths were reported between April and June last year.

In April this year, 14 and in May, 28 maternal deaths were reported in the state which rung the alarming bells. The number increased further in June and July which has spiked the Punjab’s MMR in June to 113 and in July it has further risen to 138, according to the official sources in the department.

Apart from other reasons, one of the important reasons behind high MMR is also the increased number of C-section deliveries as it can lead to Postpartum haemorrhage (PPH), which further can result into death.

Taking serious note of the high MMR and increasing number of C-section cases being reported from the state, Director Health Services, Punjab has now asked the Civil Surgeons of all the districts in the state to carry a C-section data audit for the month of July.

Recently, The Tribune also highlighted the issue of increasing number of C-sections in Ludhiana. The rate of C-section at Sub Divisional Hospital, Khanna and Samrala was found to 45.20 percent and 51.42 percent respectively in a year.

Similarly, one-year data of 191 private hospitals revealed that there were five private hospitals that have not conducted even a single normal delivery at their hospital, so, their rate of C-section procedures was 100 per cent. Then, there were 52 private hospitals in which the C-section delivery rate was between 70-96 per cent.

In the letter sent to the Civil Surgeons, Dr Hitinder Kaur, Director Health Services has asked the Civil Surgeons to conduct C-section audit for every C-section delivery in the district.

Officials have been asked to complete the detailed information for July 2024 which should include the total number of C-sections in the district, percentage of C-sections relative to the total number of deliveries, major reasons contributing to C-sections in the district and specific strategies or areas where interventions could help reduce the C-section rate.

Dr Hitinder said that former Ludhiana Civil Surgeon, Dr Jasbir Singh Aulakh got the audit done which brought forward some startling revelations. Now, the department has decided to follow the practice in the entire state.

C-section rate in Punjab has been on the rise and even the NHFS-5 has reported a rate of 38 per cent of C-sections in the state against the permissible limit of 10-15 per cent, she said.

Maternal mortality rate in Punjab is increasing and at the same time, the incidences of PPH are also on the rise. PPH is severe vaginal bleeding after childbirth, which most likely occurs after C-section and can lead to death.

In Ludhiana, the rate of C-section deliveries for the entire district is 22 per cent and this year 16 maternal deaths have occurred in the district so far while last year the number was 50 out of which 11 were in transit.

In Jalandhar, the percentage of C-sections conducted in government health establishments this year is 33 per cent while last year it was 34.6 per cent. Till now, 24 maternal deaths have been reported compared to 27, last year.

Meanwhile in Amritsar, as compared to 37 per cent C-Section deliveries at government hospitals during the four months; from April to July, the private hospitals have conducted over 80 per cent of caesarean surgeries for childbirth.

In the government sector, Employees State Insurance hospital, has conducted a maximum of 76 per cent C -Sections during the period.

(With inputs from Aparna Benerji in Jalandhar and Manmeet Singh Gill in Amritsar)