Availability and Use of Emergency Obstetric Care Services in Four Districts of West Bengal, India

• Published in: Journal of health, population and nutrition Vol. 23; no. 3
• Main Authors: Biswas, Akhil Bandhu, Das, Dilip Kumar, Misra, Raghunath, Roy, Rabindra Nath, Ghosh, Debdatta, Mitra, Kaninika
• Format: Journal Article
• Language: English
• Published: icddr,b 20-07-2006
• Subjects: Caesarean section; Case-fatality rate; Cross-sectional studies; Emergency obstetric care; Health services; India; Maternal mortality; Process indicators
• ISSN: 1606-0997

Process indicators have been recommended for monitoring the
availability and use of emergency obstetric care (EmOC) services. A
health facility-based study was carried out in 2002 in four districts
of West Bengal, India, to analyze these process indicators. Relevant
records and registers for 2001 of all studied facilities in the
districts were reviewed to collect data using a pre-designed schedule.
The numbers of basic and comprehensive EmOC facilities were inadequate
in all the four districts compared to the minimum acceptable level.
Overall, 26.2% of estimated annual births took place in the EmOC
facilities (ranged from 16.2% to 45.8% in 4 districts) against the
required minimum of 15%. The rate of caesarean section calculated for
all expected births in the population varied from 3.5% to 4.4% in the
four districts with an overall rate of 4%, which is less than the
minimum target of 5%. Only 29.9% of the estimated number of
complications (which is 15% of all births) was managed in the EmOC
facilities. The combined case-fatality rate in the basic/comprehensive
EmOC facilities was 1.7%. Major obstetric complications contributed to
85.7% of maternal deaths, and pre-eclampsia/eclampsia was the most
common cause. It can be concluded that all the process indicators,
except proportion of deliveries in the EmOC facilities, were below the
acceptable level. Certain priority measures, such as making facilities
fully functional, effective referral and monitoring system, skill-based
training, etc., are to be emphasized to improve the situation.