In Jawa Block of Rewa district 4 maternal deaths occurred in health institutions. These are the deaths which are reported whereas several other maternal deaths are still unreported. Out of these 4 women, we visited families of 3 to find out facts and probable causes of death. Causes of all these deaths are different thus we will present it in the form of case study. Jansankhya Sthirata Kosh has given a performance based ranking to all of the districts and Rewa is on 35th rank. The rank has been calculated on various child and maternal health and other related indicators.
Case study 1:
Name of village: Mahua Tola of Harijan Pura
Name of Panchayat: Kalyanpura 57
Name of deceased women: Santosh Kumari W/O Rajesh
Name of respondent: Ramesh Kumar
Relationship with women: Father-in-law
Age of women: 25 yrs.
Caste: Scheduled Caste
Delivery at: Community Health Centre, Jawa
Date of death: 27 September 2010
Place of death: Community Health Centre, Jawa
Died during: Within 12 hrs. after delivery
Status of delivery: Live birth of a girl child
Status of baby: Died after 6-7 days
Santosh Kumari was taken to CHC two days prior to expected date of delivery. After examination BMO Dr. N.K. Pandey reported that delivery will be commence after 2 days. Instead of returning back to home women and other family members stayed at Jawa and wait. After two days Santosh delivered a girl child in CHC at 7.00 AM. Delivery was normal and everything was OK. Weight of baby was also good (3.00 Kg.).
After 4-5 hours she got fever and got medicine for fever and temperature came to normal. At 3-4 P.M. she complained for dizziness and doctor recommended for medicine and give intravenous drug. Santosh Kumari died at 6 PM in presence of BMO when he was observing her pulse.
At the time of delivery and death her mother and mother-in-law accompanied her. Village has difficult access to pucca road. One has to walk around 3-5 Km. to reach pucca road. Vehicle of Janani Surksha Yojna can reach upto pucca road only and women having labour pains have to walk to take vehicle. In absence of pucca road dead body of Santosh Kumari brought on a cot by four persons from pucca road.
Investigating team also visited CHC Jawa to get facts from BMO but BMO went to a meeting so team had telephonic conversation and he responded that Santosh Kumari was anaemic because she had dysentery before 15 days of delivery and due to anaemia she had PPH (Post Partive Haemorrhage) due to which she succumbed. Situation of CHC was also observed by Investigation team and it was observed that there are two maternity wards and on an average 6-7 deliveries took place every day. Capacity of wards are insufficient and ANM/LHV reported that many times they have to use corridor of the hospital as ward. Enclosed photograph is evidence of the situation where a corridor of CHC is being used as ward which has open windows and there were no bed sheets over mattresses.
After 6-7 days of her death her father-in-law took the baby (Prabhuta Devi) to CHC Jawa as BMO ask him to bring her for routine check up. Doctor refers Prabhuta to Rewa district hospital and when they are taking her to Rewa she also died before reaching Rewa. When BMO was inquired about the cause of death of Prabhuta he replied that after death of mother baby could not received due attention as well as nutrition and become weak so BMO referred her for better care.
Mr. Ramesh Kumar responded that Dr. (BMO) did not talk to any attendant and talk only with ANM and ASHA so they could not inquire about the condition of Santosh Kumari
Family background:
Mr. Ramesh Kumar told that their family is well to do family so they did not prefer to take SNP from Anganwadi. Although Santosh Kumari was registered at AWC and she had MCP card on which it was recorded that she received one vaccine of TT on 11.6.10. Santosh Kumari married with Mr. Rajesh, in April-May 2009. She was healthy and had no problem during her pregnancy. Mr. Rajesh is working at Eicher Motors Factory Pithampur, Dhar.
Mr. Ramesh Kumar reported that AWW and ANM both are performing their works satisfactorily in the village.
He reported that their expenditure for staying at Jawa before delivery and for delivery was around Rs. 20,000-22,000.
Few Facts:
No delay in reaching health Institution Doctor did not tell family members about the risk of being anemic Family is well to do hence no problem of malnutrition and baby is also of normal weight Doctor was quite aware about the episode of dysentery and being anemic due to it but neither told to family members nor arranged blood. Doctor is reporting for PPH while family members denied for it. Woman could not received second vaccine of TT and any tablet of IFA After death of mother family members should be convinced to pay extra attention towards baby so that she might survive. Under NREGA Panchayat should construct a path upto all villages for four wheelers so that in case of any emergency not only pregnant women but also other persons can get some or the other facilityCase II
Name of village: Bhingaona
Name of Panchayat: Bhingaona
Name of deceased women: Rita Devi W/O Munnilal
Name of respondent: Gendalal Kahar and Sharmila
Relationship with women: Elder Brother-in-law and Sister
Age of women: Approx. 25 yrs.
Caste: OBC
Delivery at: Way to Hospital
Date of death: 10 October 2010
Place of death: Way to Hospital
Died during: Within 2 hrs. after delivery
Result of pregnancy: Live birth to a girl and a boy child
Status of baby: Died after 1-2 hours
Rita Devi was complaining weakness in 4-5th month of pregnancy so her sister and mother suggested to having Ultra Sonography examination. From Ultra Sonography it was confirmed that she had twince in her womb. Her husband Munnilal is a labour at Gwalior
From Bhingaona Rita Devi was examined by Doctor at CHC Jawa and reported that due to twince they are unable to conduct her delivery. After getting refusal from Jawa CHC they went to Allahabad Allahabad
Rita and her husband had nuclear family and their house is in remote area quite difficult to reach. The way to their house is very rough terrain and a normal person felt difficult to reach then how pregnant women with labour pain used to walk on such path. It is about 2-3 Kms. from the side where any four wheeler can reach. On the day of our visit we found Janani Suraksha Ambulance in the village getting a mother back with her baby from Jawa CHC. It clearly indicates that Janani express is working in the area. When we are returning back to Jawa the same vehicle is bringing another mother from CHC to her village.
Few Facts:
Doctor of Allahabad either miscalculated EDD or not convinced couple regarding possibility of early delivery from EDD. Under NREGA Panchayat should construct a path upto all villages and tolas for four wheelers so that in case of any emergency not only pregnant women but also other persons can get some or the other facility We could not analyse any papers and documents as husband of the woman could not be contacted due to his absence from village. Her sister responded that their family is well to do and there was no lack of any resources. According to her sister Rita was severe anaemic and it might be possible that doctors could not made them aware about the seriousness of her condition. Services received from AWC/ANM could not be determined Case III
Name of village: Dabhoura
Name of Panchayat: Dabhoura
Name of deceased women: Nankai W/O Babbu
Name of respondent: Hiralal, Bholidevi and Kailasiya
Relationship with women: Elder Brother-in-law, Maternal Aunt and Sister-in-law
Age of women: Approx. 30 yrs.
Caste: ST (Kol)
Delivery at: District Hospital
Date of death: 19 October 2010
Place of death: District Hospital
Died during: Within 24 hrs. after delivery
Result of pregnancy: Still birth of a boy
Status of baby: Still birth
Nankai, mother of already 4 children, was on the way to give birth to her 5th child showing thumb to all schemes of RCH and Family Planning, and this was her last time to bring a child in world. Not only her child but she also could not be survived. Left 4 children and husband behind her to struggle with her memories and all of them are even struggling with their own lives in district hospital of Satna
Family members reported that Nankai was registered with Anganwadi Centre and regularly received SNP and Immunization, but cards could not be observed because there was no one at her house. She also had fever for about 15-16 days prior to death.
Nankai did not married with Babbu with all customs of community. Her parents home was in neighbour of Babbu. She got married with some other person in another village, where she started her life with husband. After 1-2 yrs. she left her husband and started living alongwith Babbu. Her mother did not forgive her and never visited her house.
Babbu was a migrant labour living at Mumbai and she used to earn food for her family by selling wood. Her family is a joint family and other brothers of Babbu are residing in same campus. Family did not have any agriculture land. They have more than 20 goats. Other females of the family are also selling wood in nearby villages.
Due to her 5th pregnancy she was already at risk. She got treatment from Pvt. Dr. Chouhan, who is a B.A.M.S. Degree holder. Kailasiya reported that before delivery bleeding was started and when contacted Dr. Chouhan he referred her to Satna District Hospital
Dr. Chouhan was also contacted to analyze overall situation and technical facts. He reported that she was severe anaemic and after started bleeding Dr. Chouhan advised to take her to District Hospital, but Nankai was not taken to any hospital for next two days and got treatment from another Dr. Tiwari. For this reason the condition of Nankai was got worsen.
Few Facts:
Although Nankai was registered at Anganwadi Centre and received immunization against Tetanus then inspite of severely anaemic why she did not consumed IFA is remarkable. Awareness generation regarding measures of contraceptive was very poor and made question mark on work performance of AWW/ANM/ASHA. Delay for taking to health institution by the family plays important role in death of Nankai as well as her fetus, it shows that technical persons did not clarify seriousness of the condition to family members. House of Nankai has easy access for every vehicle, then reaching any institution was not the problem. Family members also reported that husband of Nankai given 3 unit of his blood and due to this he became weak and fall ill. Nankai husband is a migrant labour and she had to work hard to earn food for herself and her children. If any work was carried out under NREGA and he received job in his village he can pay due attention to his family. Details of NREGA and status of PDS for the family could not be obtained due to absence of head of the family. 
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