Preventing Maternal Deaths: How Karnataka Can Bridge Gaps and Strengthen Maternal Healthcare Systems
By Arunima Rajan
The maternal deaths in Ballari, Karnataka, have brought to light critical gaps in the state’s healthcare system. Between November 9 and 11, 2024, four women who underwent cesarean sections at the Ballari District Hospital lost their lives. A fifth death on December 5 pushed the total to five within a month.
These incidents highlight systemic issues—questions around the quality of medical care, oversight of drug supply chains, and hospital management practices. While maternal mortality has declined significantly over the years, such events expose vulnerabilities that persist, particularly in resource-constrained healthcare settings. The Ballari deaths are a stark reminder of the need for tighter regulation, better infrastructure, and a renewed focus on safeguarding maternal health outcomes.
In an interview with Arunima Rajan, Dr. Yasmin Imdad, senior consultant, Gynaecology at Kinder Hospitals, Bangalore talks about challenges and potential solutions for improving maternal health outcomes, particularly in high-risk pregnancies.
From your perspective, why do certain regions struggle more than others in improving maternal health outcomes?
Certain regions struggle to improve maternal health due to socioeconomic disparities, limited access to healthcare facilities, shortage of trained staff, and lower education levels, which hinder timely medical interventions.
High-risk pregnancies require timely interventions and strict monitoring, but tracking them consistently remains a challenge. What are the practical barriers to effective monitoring, and how can healthcare systems address these gaps?
Tracking high-risk pregnancies remains challenging due to a shortage of healthcare workers, inadequate digital infrastructure, lack of centralised health records, and poor patient compliance.
To address these challenges, we must implement robust digital health records and tracking systems, train ASHA workers to identify and escalate high-risk cases. Providing incentives to mothers for attending regular check-ups also could be considered.
According to news reports, maternal deaths in Ballari were linked to substandard IV fluids and potential protocol lapses. How do such incidents reflect on the broader challenges of quality control in maternal healthcare, and what safeguards should be in place?
These incidents highlight the need for robust quality control systems and adequate storage facilities. Quality standards should never be compromised due to cost considerations. Providing proper training and ensuring strict compliance with these protocols are essential to prevent such lapses.
C-section rates have risen dramatically in Karnataka’s public and private hospitals. What drives this trend, and how does it impact the health of mothers and babies, especially in high-risk pregnancies?
The increase in C-section rates can be attributed to lower pain tolerance among mothers, a rise in high-risk pregnancies, increased cases of IVF pregnancies, fear of litigations, limited facilities to manage complications in low-resource settings. While C-sections are life-saving for high-risk cases, unnecessary procedures can lead to increased maternal morbidity, prolonged recovery times, and neonatal complications such as respiratory distress syndrome (RDS) and longer NICU stays for the baby.
The government’s merger of Drugs Control and Food Safety departments aims to enhance quality oversight. From your clinical experience, how critical is the role of drug quality in ensuring safe maternal care?
The quality of drugs is crucial for maternal care, as substandard medications can lead to severe complications. For example, poor-quality IV fluids may cause infections, and ineffective oxytocin injections can fail to control postpartum hemorrhage (PPH), potentially resulting in maternal deaths. Strict measures must be enforced to penalise violations of drug quality standards.
What measures can help ensure a steady and continued improvement in maternal health outcomes?
The recent rise can be attributed to increasing high-risk pregnancies, gaps in healthcare systems, post-COVID impacts, worsening poverty, delayed childbirth, and a lack of adequate facilities for underprivileged populations. To sustain progress, it is essential to improve healthcare access for all, particularly in rural areas, ensure timely referral of high-risk cases, expand telemedicine services, enhance emergency treatment facilities, and maintain high-quality government supplies.
Rural areas and smaller public health hospitals often lack the infrastructure or specialists needed for high-risk pregnancies. What immediate steps can be taken to bridge this gap, and how can private hospitals contribute?
Implement teleconsultation services for high-risk cases.
Enhance basic healthcare infrastructure.
Ensure high-quality medical supplies with strict monitoring.
Promote public-private partnerships and regular online monitoring systems for remote areas
Conduct training programs for healthcare professionals and ancillary staff in rural set ups are some of the steps that can be taken.
Midwifery-led care units and programs like Janani Suraksha Yojana are designed to reduce maternal mortality. How effective do you think these initiatives are in addressing the unique challenges of high-risk pregnancies?
Improving maternal health outcomes requires a comprehensive approach that includes providing health education for all and addressing cultural barriers that may delay care. Regular health check-ups play a crucial role in preventing high-risk pregnancies through early identification and intervention. Expanding access to family planning services can help reduce unplanned pregnancies, while ensuring timely referrals to higher centers is essential for managing complications effectively.
Maternal health is deeply tied to socioeconomic and cultural factors. How do you think community-level interventions, such as education and awareness, can complement medical efforts to reduce maternal mortality?
Community-level interventions are vital in reducing maternal mortality by educating women about healthcare, regular antenatal care, and the importance of institutional deliveries. Since people are more likely to engage in community activities, these initiatives can significantly contribute to improving overall health outcomes and promoting health for all.
As a specialist working directly with high-risk pregnancies, what systemic changes—whether in training, resource allocation, or policy—do you believe are most urgent to improve maternal health outcomes in Karnataka?
In my opinion, the urgent changes that are required are:
Training health care workers to manage high-risk pregnancy better
Emergency departments should be well geared up for the same in rural areas
Referral systems should be strengthened. If possible, a centralised tracking system and remote digital health monitoring
Ambulance facility for transfers should be increased
Birth attendants should be trained to identify high-risk cases and to timely referred
Allocate more funds in rural areas in underprivileged areas
Regular audits in place to see system adherence