Pergamon 80277-9536(96)00105-0 Soc. Sci. Med. Vol. 43, No. 10, pp. 1507-1516. 1996 Copyright © 1996Elsevier ScienceLtd Printed in Great Britain.All rights reserved 0277-9536/96 $15.00 + 0.00 OBSTETRIC MORBIDITY IN SOUTH INDIA: RESULTS FROM A COMMUNITY SURVEY JAGDISH C. BHATIA ~ and JOHN CLELAND -~ 'Indian Institute of Management, Bangalore, India and 2Centre for Population Studies, London School of Hygiene and Tropical Medicine, London, U.K. Abstract--A sample of 3600 mothers with at least one pre-school age child were interviewed in detail about obstetric problems associated with their last confinement. About 10% reported one or more of the classic symptoms of pre-eclampsia; and 8% reported symptoms of potentially life-threatening conditions during delivery, most notably prolonged labour of over 18 hr. Disorders during the post-partum period were more common; 10% reported excessive bleeding, loss of consciousness or convulsions (all indicative of potentially serious conditions) and an additional 17% reported symptoms of infections. The level of health care received by women is described. Copyright © 1996 Elsevier Science Ltd Key words--obstetric, maternal, morbidity, self-reports, health services INTRODUCTION The policies and plans of many nations have long accorded priority to maternal and child health (MCH) programmes. Though better maternal health has been an implicit goal, this concern has rarely been translated into effective services. Priority has always been given to child survival and mother's health has remained relatively neglected. This neglect is all the more regrettable in view of the well documented linkages between mother's and child's health and the difficulty of ensuring the health and survival of a child without adequately safeguarding the health of the mother. Moreover maternal health is important in its own right, irrespective of its implications for child welfare. Maternal health received greater attention after the safe motherhood initiative was launched at an international conference held in Nairobi in 1987 [I]. During the conference and thereafter, emphasis has been mostly on maternal mortality. Mortality statistics are often, and justifiably, used as a weapon of international advocacy. Just as the case for prioritising child health programmes was buttressed by publication of infant mortality rates, maternal mortality estimates are now used to highlight the plight of pregnant women in less developed countries. It is commonly claimed that about half a million women die each year because of the complications of pregnancy and childbirth and that all but 6000 of these deaths take place in developing countries [2]. It has also been reported that maternal mortality ratios are 15-20 times higher in developing countries and that the life time risk of maternal death in developing countries is I in 51 as compared to ! in 1687 in developed countries [3, 4]. WHO estimates also suggest that 88-98% of pregnancy-related deaths are avoidable. A study in India reported that 78 % of maternal deaths occurring in the study population could have been prevented by specific timely actions [5]. In the developed countries also, serious pregnancy-related morbidities arise, but deaths are averted through early medical interven- tions. In a study conducted in the U.K. obstetric morbidity was reported in approx, one-fourth of the cases and about 1% of these were life-threatening or "near miss" episodes [6]. Maternal mortality is just the tip of the iceberg of the obstetric health problems of women. Many women do not die of causes related to pregnancy but suffer severe morbidities. A small prospective study conducted in a village in India reported that there are 16.5 pregnancy-related morbidities for every ma- ternal death [7]. A study from Nigeria found that, for every woman who dies of maternal causes, 15 suffer from permanent disabilities [8]. Another analysis indicates that in developing countries for each maternal death, a further 10-15 women suffer serious impairments [9]. Based on some of these estimates, it has been calculated that there are 8.25 million morbidities each year worldwide [10]. Others have calculated that there are over 100 acute morbid episodes for every maternal death, giving a global total of 62 million morbidities annually [11]. These estimates, though crude and unreliable, nevertheless point to the magnitude of the problem of maternal morbidity. As the realisation grew about the magnitude of maternal morbidity and preventability of maternal deaths, attention shifted from studying levels of maternal mortality to investigating the levels and determinants of pregnancy-related morbidity. There 1507