Pratap Kumar Sahoo, et al. Improved access to blood can save mothers' lives 1208 International Journal of Medical Science and Public Health | 2014 | Vol 3 | Issue 10 IMPROVED ACCESS TO SAFE BLOOD MUST BE PRIORITIZED AS A CORE COMPONENT OF COMPREHENSIVE EFFORTS TO PREVENT MATERNAL DEATHS IN UTTAR PRADESH, INDIA Pratap Kumar Sahoo 1 , Sunil Saxena Raj 2 , Suneedh Manthri 2 1 Health Promotion Division, Public Health Foundation of India, New Delhi, India 2 HIV/AIDS Partnership for Impact through Prevention, Private Sector and Evidence-based Programming (PIPPSE) Project, Public Health Foundation of India, New Delhi, India Correspondence to: Pratap Kumar Sahoo (pratap.kumar@phfi.org) DOI: 10.5455/ijmsph.2014.080720143 Received Date: 03.06.2014 Accepted Date: 08.07.2014 ABSTRACT Background: Postpartum hemorrhage is responsible for 39% of maternal deaths in India. Provision of blood transfusion is one of the key components of functional First Referral Units (FRU) meant for providing Comprehensive Emergency Obstetric Care (CEmONC). However, in the absence of functional FRUs, there is hardly any facility available which can provide safe blood transfusion to a haemorrhagic woman in Uttar Pradesh (UP). Aims & Objectives: The objective of this study was to argue for improving access and availability of safe blood transfusion for women, who are haemorrhagic and/ or severely anaemic, on priority basis, to prevent maternal deaths. Materials and Methods: Community based maternal death review and facility review was conducted in district Unnao, UP, and information gathered on maternal deaths. Out of the 57 maternal deaths analyzed, 37 were due to hemorrhage and severe anaemia. Pearson correlation test was performed between maternal mortality ratio (MMR) and number of estimated pregnancies per blood bank, for five key states including UP. Results: Out of 57 maternal deaths, 37 maternal deaths were due to hemorrhage (39%) and severe anaemia (26%). Out of 15 facilities assessed; only the district hospital (6.7%) had a blood bank and transfusion facility and the rest 14 (93.3%) of the facilities had no provision for blood transfusion, blood storage unit (BSU) or dedicated staffs to handle any emergency. A significant correlation was observed between the MMR and number of pregnancies per blood bank (r = 0.970, p=0.006). Conclusion: Given the role of blood transfusion in multiple obstetric emergencies, provision of blood bank /BSU at the FRUs, district hospitals, sub-divisional hospital (SDH) or community health center (CHC) needs to be given high level of priority to avert preventable maternal deaths in UP. Key Words: Blood storage Units; Maternal Deaths; Postpartum Haemorrhage; Basic Emergency Obstetric and Neonatal Care (BEmONC); Comprehensive Emergency Obstetric and Neonatal Care (CEmONC) Introduction Globally, 35% of all maternal deaths were due to haemorrhage, especially postpartum haemorrhage (PPH). [1,2] It is estimated that anaemia contributes to more than 115,000 maternal deaths and 591,000 perinatal deaths globally per year. [3] Maternal Mortality Ratio (MMR) in India is 212 maternal deaths per 100,000 live births. UP is the second largest contributor to maternal mortality in India, with 359 maternal deaths per 100,000 live births. [4] In India, major causes of these deaths have been identified as anaemia, hemorrhage (both ante and postpartum), toxaemia, obstructed labor, puerperal sepsis, and unsafe abortions. [4] In rural India, about 40% of the maternal deaths are due to avoidable causes such as hemorrhage and anaemia. [5] From 2010 to 2012, most of the identified First Referral Units (FRUs) could not be fully operationalized due to lack of skilled man power (particularly anaesthetics and gynaecologists), adequate infrastructure, medicines, and blood storage facilities. [6-8] Institutional deliveries were very low, at 47% in India and 24.6% in UP. [9] The objective of this paper was to argue for improving access and availability of safe blood transfusion for women, who are haemorrhagic and/ or severely anaemic, on priority basis, to prevent maternal deaths. Materials and Methods Study Setting: The Unnao district had a population of 3.1 million, comprising 1.5% of the state’s population. [11] The health indicators of Unnao for the year 2011 were as follows: birth rate = 22.2; estimated number of annual births = 69,055; number of institutional deliveries =14,488; estimated number of maternal deaths=248. [12] The female literacy was 57%; total fertility rate was 2.58. [11] Study Design: A facility review was undertaken in 15 public health facilities, and a community based Maternal Death Review (MDR) was also conducted using a cross sectional study design. RESEARCH ARTICLE