Indian Journal of Community Medicine

ISSN No. 0970-0218

Sir,
What is the percentage of institutional deliveries in the villages of Veerapandi Panchayat Union (community development block) as compared to the national average figure of 35%,¹ was the research question. Other connected data like percentage of caesarean, expenditure for delivery, deliveries in private hospitals, percentage of full antenatal care, percentage of puerperal sterilization, deliveries attended by doctors, etc. were also collected in the study. The letter shares these data with the readers of IJCM.

The study was a community-based, cross-sectional, questionnaire-based survey method conducted by female interviewers, namely female compulsory rotatory resident interns and female medical students. The villages of Veerapandi Panchayat Union have a population 109,183 (males 57,470 and females 51,713) as per 2001 Census.

Nine hundred women of the reproductive age group of 15-45 years living in the villages of Veerapandi Panchayat Union participated in the study. Women with children below 2 years alone were interviewed to facilitate easy recall of facts.

The percentage of institutional deliveries was 87.8%, which is much higher than the national figure of 35%, although this rural area was situated 20-30 km from Salem city.

Other data obtained from the study were:

1. Percentage of deliveries by caesarean: 24.7%.
2. Percentage of women who underwent puerperal sterilization: 24.7%.
3. Expenditure for delivery:
   Below Rs. 500: 22%
   Rs. 501-1000: 10%
   Rs. 1001-2000: 10%
   Rs. 2001-3000: 10%
   Rs. 3001-5000: 12%
   Rs. 5001-7000: 6%
   Rs. 7001-10,000: 10% (a few were caesarean section)
   Above Rs. 10,000: 20% (mostly caesarean section)
   Total – 100%
4. Sixty percent of deliveries were in private hospitals.
5. Seventy-nine percent of deliveries were attended by doctors.
6. Eighty-five percent of women had full antenatal care (three or more antenatal check-ups).
7. Ninety percent of women had TT immunization during antenatal period.
8. Sixty-seven percent of women have two children or less.

This is evidence of the high level of awareness of people in the study area about the importance of institutional deliveries. This corresponds to a low total fertility rate of 2.0 and low birth rate of 18.5 in Tamil Nadu state as compared with the total fertility rate of 4.7 and birth rate of 31.6 in the state of Uttar Pradesh,¹ similar high rates are prevalent in other states of India. The maternal mortality rate (MMR) in Tamil Nadu is only 76¹ per 1 lakh live births as compared to the national figure of 407² per 1 lakh live births. For comparison, the MMR in Uttar Pradesh is 707 per 1 lakh live births.¹

Tamil Nadu has been doing well in the family welfare programme, child survival and safe motherhood programme and recently reproductive and child health programme. Earlier the international organizations like World Health Organization, UNICEF, World Bank, etc. appreciated the Kerala model of development. Now, they also appreciate the Tamil Nadu model of development. It has to be remembered that Tamil Nadu does not have as high literacy as Kerala.

One of the National Socio-Demographic Goals to be achieved by the year 2010 under the National Population Policy 2000 is 80% institutional deliveries and 100% deliveries by trained personnel.¹ In his address to the Tamil Nadu Legislative Assembly, His Excellency the Governor of Tamil Nadu quoted institutional deliveries as 94% on the first day of the first session of the Legislative Assembly in January 2006.

As the population of the Veerapandi Panchayat Union was 109,183 as per 2001 Census, the sample size was fixed at 900, which is more than 5% of the number of eligible couples in the panchayat union population (community development block).

Data were collected from all the 25 village panchayats proportional to the population of the village panchayats.

Data collection was carried out from 5 July 2004 to 6 December 2004.

Every year in India, more than 26 million women give birth (estimated population for 2006, 110 crore; birth rate, 24 per 1,000 population). Among these, more than 1 lakh women die of pregnancy-related issues every year, without any concern/advocacy expressed by professional organizations in the medical and paramedical fields and women?s national-level/state-level organizations. Further, more than 1 million babies die in the neonatal period every year (pregnancy wastage).

It is unfortunate that even after 60 years of Independence, such a scenario continues. The suffering women are certainly the most important stakeholders in rapidly reducing MMR and neonatal mortality rate by achieving 80% institutional deliveries, which is recognized in the National Population Policy 2000. Further, 33% reservation for women in the Lok Sabha and State Legislative Assemblies has to be encouraged to help improve women empowerment. Gender justice is one important requirement to achieve the Millennium Development Goals in India by the year 2015. If 100 deaths may occur in some state due to some epidemic, there will be a big hue and cry in that state’s legislative assembly. On the other hand, there is no concern over the 1 lakh women and 1 million neonatal babies dying in India every year due to pregnancy/delivery-related causes.

The Bhore Committee, which was appointed in the year 1943, submitted its report in 1946 in four volumes. Is it being kept in cold storage? The committee recommended a long-term programme (also called the 3-million plan) of setting up 75-bedded primary health units for each 10,000 to 20,000 population and 650-bedded secondary health units for 2-3 lakh population and 2,500-bedded tertiary hospitals at the district level.¹

We have completed nine 5-year plans and almost going to complete the tenth 5-year plan shortly. However, we have only six beds at the primary health centres, that too mostly non-functional due to various reasons. Seventy- five bedded primary health centres (30,000 population) will give a ratio of 2.5 beds per 1,000 population whereas health centres in developed countries have more than 10 beds per 1000 population.

The Millennium Development Goals place health at the heart of development. Goal 5 of the Millennium Development Goals is “Improvement of Maternal Health” and target 6 is to reduce maternal mortality ratio by three quarters before 2015 with reference to the MMR in the year 1990. Goal 4 of the Millennium Development Goals is reduction of child mortality.¹

Let us achieve the Millennium Development Goals by 2015.

References

1. Park k. Textbook of Preventive and Social Medicine, 18th ed. M/S Banarsidas Bhanot publishers : Jabalpur. India ; 2005 p. 346, 357, 413, 361, 671, 689.
2. Government of India. Ministry of Health and Family Welfare, New Delhi; Annual Report 2003-2004. p. 157.

Further Reading

1. Sugathan KS, Mishra V, Rutherford RD. Promoting institutional deliveries in rural India: The role of antenatal – care services, National Family Health Survey subject Reports, Number 20. International Institute of population sciences, Mumbai, India and East – West centre, population and Health studies, Honolulu, Hawaii, U.S.A; 2001.
2. Annual Report 2003-2004 and subsequent Annual reports, M.O.H.F.W, G.O.I: New Delhi.
3. Sharma S. Population research centre, Institute of Economic growth, University Enclave, Delhi, Reproductive and child health status in India, District level Analysis.
4. Balaji R, Dilip TR, Duggal R. Utilization and Expenditure on delivery care services: Some observations from Nashik District, Maharashtra (From Internet).

C Kannan
Community Medicine Department, V.M.K.V. Medical College, Salem, Tamil Nadu, India.
E-mail: ckannandr(at)yahoo.co.in
Received: 28.09.05
Accepted: 08.01.07