Academic journal article Journal of Health Population and Nutrition

Availability and Use of Emergency Obstetric Care Services in Four Districts of West Bengal, India

Academic journal article Journal of Health Population and Nutrition

Availability and Use of Emergency Obstetric Care Services in Four Districts of West Bengal, India

Article excerpt


Many health indicators have dropped sharply over the last two decades but there has been no significant reduction in rates and ratios of maternal mortality in many states of India, including West Bengal. India alone accounts for 25% of such deaths worldwide (1,2). Reduction in the number of maternal deaths requires, besides essential obstetric care, timely access to effective, affordable, and appropriate emergency obstetric care (EmOC) services when complications arise. Universally, EmOC has broadly been categorized into two groups--basic and comprehensive--based on the performance of certain signal functions (3). Basic EmOC includes administration of injectable antibiotics, oxytocics, and sedatives/anti-convulsants, performance of manual removal of placenta, removal of retained products, and assisted vaginal delivery. In addition to these six signal functions, comprehensive EmOC also includes blood transfusion and caesarean section (3).

The maternal mortality rate alone is difficult to use as an outcome or impact indicator of an intervention and does not yield the information needed to monitor safe-motherhood activities (4). Moreover, maternal deaths are often misclassified and under-reported. Hence, the World Health Organization/United Nations Children's Fund/United Nations Population Fund (WHO/UNICEF/UNFPA) recommended process indicators (3) to monitor safe-motherhood activities, especially EmOC services. The seven process indicators (Table 1) measure the availability, accessibility, use, effective coverage, and quality of services provided by EmOC facilities (3,4).

In most states of India, such an exercise to apply the indicators has not yet been undertaken. In this context, the present study was conducted in certain districts of West Bengal to assess the availability and use of EmOC services based on seven process indicators as prescribed by WHO/UNICEF/UNFPA.


A health facility-based case-finding study, cross-sectional in nature, was undertaken in 2002 in four districts of West Bengal, namely Purulia, Bankura, Purba and Paschim Medinipur, selected purposively as desired by the sponsoring agency (UNICEF). These are the already-identified target districts for focused activities by UNICEF in relation to reproductive and child health. UNICEF needed baseline data on EmOC in these districts before launching a special programme in collaboration with the state government.

All the government health facilities and registered private health institutions providing maternity services in the four selected districts comprised the final sample of facilities. Thus, in total, 408 different categories of health facilities were surveyed in the study that included one medical college hospital, three district hospitals, eight sub-divisional/state general hospitals, 96 rural hospitals/block primary health centres, 256 primary health centres, and 44 other health facilities (Table 2).

Trained investigators, comprising faculty members from the departments of Gynaecology and Obstetrics and Community Medicine, visited the health facilities. Data were collected using a pre-designed assessment schedule developed by UNICEF, predominantly through review of available records and registers (e.g. admission register, maternity register, delivery log book, referral register, death register, etc.) of the facilities. Key health officials and members of staff at the facilities were also interviewed for clarification of any recorded data, if required. Great care was taken to avoid duplication within and between facilities; identification numbers of users and referral registers were used for this purpose. Necessary administrative support and cooperation from the appropriate authority was sought to ensure data-sharing by the facilities, particularly the private nursing homes.

Relevant numerator data for calculation of the process indicators were obtained from records and registers of the identified facilities in the four districts. …

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