Collaborative Action in Lowering Maternity Encountered Deaths

The Collaborative Action in Lowering Maternity Encountered Deaths (CALMED) project aims to send vocational training teams (VTTs) to provide training for a group of ‘master trainers’ in two different areas of Mumbai, to reduce maternal and newborn mortality.

The authors' team devised a structured ‘Train the Trainers’ programme to enable ‘master trainers’ to use a variety of teaching techniques, which included the use of manikins. The objectives were to pass on effective basic obstetric and neonatal skills to frontline workers. The targeted area for this project was Jawhar, a tribal area about 156 km north east of Mumbai with a high maternal and neonatal mortality rate. The programme is anticipated to last 3 years (Rotary in London Spring, 2013).

Although the life-time risk of maternal death dropped from 1:38 in 1990 to 1:170 in 2010 in India, it is still huge compared to the UK where the risk in 2010 was 1:4600 (World Health Organization (WHO), 2014). Within India, maternal mortality rates vary widely in different areas. Jawhar has been identified as having one of the highest rates: 150–300 deaths of 2000 women a year (Basu, 2012). Jawhar covers a rural population of 0.5 million and health care is provided by 11 primary health centres and one district health subcentre. In India in 2010, UNICEF identified that 47% of women had an institutional birth and 53% had their births assisted by a skilled birth attendant in the community. UNICEF also highlighted that as many as 49% of pregnant women did not have three antenatal visits during pregnancy and only 46.6% of mothers received iron and folic acid for at least 100 days during pregnancy (UNICEF, 2014). Before the authors visit in March 2013, personal communication identified that in the year 2012/2013 the maternal death rate had improved to 1:750—four women in 3000 died. Of these women, one was registered and three were unregistered. Two women died from septicaemia, one from postpartum haemorrhage and one from infective hepatitis. This followed the set-up of anaemia camps in the area and an increase in the rate of institutional delivery in Jawhar to 90%. After our visit, it was reported that there were no maternal deaths from March to December 2013 in the area (email communication Rotary District 1130, 2014).