Recognition of and Response to Postpartum Hemorrhage in Rural Northern India

Abstract

This study describes the results of a Morbidity and Performance Assessment (MAP) conducted to provide insight into the medical factors contributing to maternal and newborn morbidity and mortality in a rural district of northern India, and to use these insights to develop a locally appropriate, community-based safe motherhood program The MAP study was based on verbal autopsy method. Five hundred ninety-nine women (or in the case of 9 maternal deaths, a family member) participated in the study. This article describes a subsample of women who reported signs or symptoms suggesting excessive bleeding (n = 159). Findings include a poor knowledge of danger signs; poor problem recognition during labor, birth, and the immediate postpartum period; and a low level of health seeking that was consistent with poor recognition. Maternal sociodemographic characteristics, antenatal care use, and knowledge of danger signs were generally not associated with problem recognition and health seeking. The case fatality rate was 4%. These findings suggest an urgent need to understand the phenomenon of problem recognition and to integrate this into the design of interventions to reduce delays in health seeking.

Cultural Theories of Postpartum Bleeding in Matlab, Bangladesh: Implications for Community Health Intervention

“…Returning to the Delay Model, a theoretical and practical issue raised in this study is the relative contribution of health-related beliefs, individual attributes, and socioecological constraints to care and care-seeking for obstetric emergencies. This represents a relatively-unexplored agendum in safe motherhood (8-9). Addressing this agendum is necessary if we are to improve programming to reduce maternal death and disability during the transition to skilled birth attendance for all women.…”

“…This presents a daunting challenge for global safe motherhood. Targeting PPH in these vulnerable populations with effective, culturally-appropriate interventions is necessary to achieve Millennium Development Goal 5, which aims at reducing maternal mortality by 75% by 2015 (6-9). …”

“…There is a paucity of research focusing on the first delay—decision to seek care in the event of PPH (8-9). To address this gap, during 2005-2006, the Center for Research on Maternal and Newborn Survival of Emory University and the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B) initiated a study among childbearing women and maternity-care providers in Matlab, Bangladesh.…”

Constructing illness: How the public in eight Western nations respond to a clinical description of “schizophrenia”

“…For example, among Chinese speaking individuals in Australia with anxiety disorders, the most frequently endorsed reason for seeking out formal services was problem recognition (Ho et al, 2008). Mismatches between “lay” and “expert” diagnoses have been associated with the length of untreated psychosis or other mental health problems (Bergner et al, 2008) and for postpartum hemorrhage documented in rural India (Sibley et al, 2005). While not fully consistent, this research suggests the need to consider controls.…”

Post-Partum Excessive Bleeding among Bangladeshi Women; Determinants, Perceptions, Recognition, Responses

“…Another study done in rural Bangladesh reported that approximately 67% of the study participants perceived a delay in deciding to seek care, while 12% and 24% perceived delays in access to transportation and in reaching the providers for care, respectively [15]. While, a study from northern India found that low levels of health seeking was associated with poor problem recognition before and after delivery [16]. Postpartum care utilization has also been linked with the perceived nature and severity of the problem, [17] and socio-cultural factors, such as practice of seclusion [18][19][20].…”