Goa boasts of excellent health parameters. However, the Economic Survey 2018-19 has indicated two negative aspects in health care: There has been nearly threefold increase in maternal mortality rate (MMR) in the year 2018. Goa has recorded a maternal mortality rate of 123 per lakh of live births in 2018 (till November) as against 44 per lakh of live births in 2017. The MMR has been below hundred for more than a decade and was 16 during the year 2015. Not only the maternal mortality rate, even infant mortality rate (IMR) in the state has risen. The infant mortality per thousand live births in Goa rose from 11.06 in 2016 to 11.82 in 2017. The state MMR and IMR are much below the national level, but that should not give any room for complacency. The state health authorities need to find the reasons behind the rise in MMR and IMR and take corrective steps to bring them down.
Though the state has made good progress in most health indices, these two negative features ought to draw the attention of the health department and doctors in government hospitals, who should find ways to check the alarming rise in MMR and significant rise in IMR. After all, the health of mother and child is the base on which the well-being of the population rests. According to official data, over 96 per cent of the deliveries in the state were institutional with at least seven antenatal visits by expectant mothers on an average. The sudden big increase in MMR needs an investigation into the causes that led to the death of many women. Maternal death (or maternal mortality) has been defined by experts as the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes. Likewise infant mortality rate is defined as the number of infants dying before reaching one year of age, per thousand live births, in a given year. It is an important indicator of the health status of the community.
According to health experts, medical causes for maternal mortality are around 30 per cent, which is almost constant all over the world. The direct medical causes for maternal mortality include haemorrhage (PPH, accidental haemorrhage, ruptured uterus), pregnancy induced hypertension, HELP syndrome and sepsis. Besides, anaemia, cardiac disease and hepatitis have been identified as other indirect causes of death. Doctors attribute social factors, like neglect of medical care during pregnancy and malnutrition to 70 per cent of maternal deaths. All the maternal deaths reported in the state are unlikely of the ethnic population as expecting Goan mothers have been availing of medical care in government sector hospitals or in private sector. The state health authorities are giving importance to MMR; it is clear from the fact that maternal ‘near-miss’ cases, where mothers could have almost died, are being studied by the health authorities and corrective steps are taken to prevent them. Health care officials feel a large number of maternal deaths occurred in poor migrant families where expecting mothers do not get the required nutrition or may have other complications. Nearly one-fourth of the deliveries take place in the Goa Medical College and Hospital, the rest in other government hospitals or private hospitals. According to health officials, pregnant women visiting hospitals for regular checks could be checked easily for pregnancy-related problems and corrective steps taken to prevent maternal deaths. If the problems are diagnosed at the time of delivery, there is less scope of medical intervention to prevent death.
As a large number of expectant mothers dying during pregnancy are from migrant families and from neighbouring states of Karnataka and Maharashtra. who visit Goan hospitals for treatment and deliveries, the state authorities need to intervene to provide them adequate health care. There is need for combined approach of the departments looking after labour, industries, health, factories and boilers, tourism and others, the sectors in which migrants are employed. The health department must make the employers of migrants support and pay for the nutrition and other aspects of health care of pregnant mothers in their families. The health department can charge nominal fees for providing the services, which should be paid or reimbursed by the employers. Providing such facilities would help the state in arresting the rising MMR and IMR figures. The health department can work with the employers of migrant labourers to provide health cards to them and the members of their families.