Maternal deaths in Mumbai have increased 40% over the past five years. Data from the civic body, which records these deaths every month, revealed that the top cause of maternal deaths in Mumbai is tuberculosis, an infectious disease that is curable. The finding assumes significance given the resurgence of drug-resistant tuberculosis in the city and other parts of the country.
Last year (2014-15), the Brihanmumbai Municipal Corporation’s (BMC) maternal death review committee recorded 319 maternal deaths across hospitals in the city as against 222 deaths reported in 2010-2011. In the past two years, the number of deaths has increased 15%.
Civic body and public health experts are baffled at the findings of the maternal death review committee, which analyses the reasons for such deaths in order to frame preventive polices. “Deaths as a result of anaemia have reduced drastically, but tuberculosis has emerged as the top cause for maternal mortality,” said Dr P Keskar, executive health officer, BMC, adding that the rise in maternal deaths is a result of better reporting. Half of the maternal deaths reported in city hospitals are of women referred from neighbouring districts, said civic officials.
After tuberculosis, hepatitis A and hepatitis E (foodborne infections) have killed most pregnant women admitted at hospitals in Mumbai. Earlier, the most common causes for maternal deaths were pre-partum and post-partum haemorrhage (bleeding during, before and after childbirth), pre-eclampsia or pregnancy induced hypertension, sepsis as a result of infection.
The civic body's data also showed that maternal deaths reported in Mumbai between April 2014 and March this year is the highest ever. In fact, although India has witnessed a drop in overall maternal mortality, the country may miss the Millennium Development Goals set by United Nations (UN) to reduce maternal deaths, said experts.
“The access to reproductive health is the key to reduce maternal mortality. The urban poor living in Mumbai often find it difficult to continue and follow up with antenatal care owing to language barriers and overcrowded hospitals,” said Dr Aparna Hegde, chairperson, Armman, a non-profit working for improving maternal health.
Dr Lalit Anande, chief medical officer at the GTB (group of tuberculosis) hospitals, recalled a case where a 24-year-old woman undergoing treatment for drug-resistant TB got pregnant. “Doctors advised her medical termination of pregnancy as her life was at risk. She was referred to various hospitals, but she was turned away,” said Anande, adding that a dedicated obstetric facilities for pregnant women with TB need to be established in the wake of such deaths.
Doctors said that pregnancy also reduces women’s immunity, making her more vulnerable to TB infection. “Recently, we lost two pregnant women with TB. Poor nutrition is to be blamed. If treated appropriately, most pregnant women with TB can survive childbirth and also get cured,” said Dr Ashok Anand, professor of gynaecology department at JJ Hospital, Byculla, adding that some anti-TB drugs cannot be administered to pregnant women.