New Delhi, September 3—Maternal Mortality Rate (MMR) due to transfusion of unsafe blood or lack of blood is a spectre that is haunting India for years.
In order to achieve significant reduction in MMR, the government has undertaken various schemes such as increased access to quality maternal health services, state-subsidised financing for pregnant women under the ‘Janani Shishu Suraksha Karyakram’ coupled with societal changes of education of girls and avoidance of early marriage, etc. which have given better results. Still a lot needs to be done.
India is still fighting the deadly of maternal deaths due to Postpartum Haemorrhage (PPH) i.e., excessive bleeding after childbirth, which is the most common and preventable cause of maternal death. i.e. excessive bleeding after childbirth. PPH accounts for about 35% of all maternal deaths globally and about 30% of maternal deaths in India. Replacement of blood and blood products plays an important role in managing PPH. So, access to timely delivery of care and to safe and adequate blood for transfusion can be a game-changer in the effort to eradicate maternal casualties.
Every year, 3 lakh women die during childbirth, 99% of whom are from low and middle-income countries.
According to a new review published in The Lancet, which has considered 196 studies from 67 low and middle-income countries, maternal deaths following caesarean sections in low and middle-income countries are 100 times higher than in high-income countries, with up to a third of all babies dying. For this study, data was compiled from over 12 million pregnancies.
When it comes to deaths due to MMR in rural areas, a significant percentage of pregnancy cases (including high-risk cases) are referred to the community health centres too late. This results in delay in proper care, poor preparedness to handle risks, including managing PPH, and providing access to safe and adequate blood.
Speaking to HealthWire, Dr. Kafeel Khan suggested ways to ensure the availability of safe blood to reduce maternal deaths.
“People need to be made aware of blood donation and a nation-wide medical drive should be launched for it. It is unfortunate that many think that by donating blood, one becomes weak while the reality is just the opposite as the body filters blood in that process and soon gets replenished with fresh blood. There are still 90% of Indians who don’t donate blood. The blood banks in our country have been running because of ‘habitual’ donors who donate every 6 months. Many of them are rickshaw pullers and people doing menial jobs. However, that was declared illegal in around 2005 as unchecked blood donations are also causes for deaths sometimes. But still, we need to have a stable blood donating mechanism where a proper process of blood screening should be allowed before one is allowed to donate blood. The donated blood is precious as it broken down into four components for medical uses.”
Citing the problem of unhygienic blood banks he said, “In many hospitals, the blood banks are being run by people who have complete disregard for basic hygiene norms. Now this is the responsibility of the officers in-charge there to ensure the availability of safe blood.”
Dr. Kafeel also mentioned how the trend of acquiring blood has changed now. “If you talk about villages, we don’t even have proper blood banks there but in the cities we have 10% of blood available as of now. It is because of the older norm that in order to buy blood of a particular blood group, one needed to donate first. But system has been done away with. Now one can just provide Rs. 5000 and acquire blood. Apart from that in many cases, the blood transfused to a mother may have an unverified source which is dangerous. Transfusion of infected blood has also been a cause behind maternal deaths. It is important to note that we need to consider transfusion of blood as equal to transplant of an organ.”
What Does Data Say:
According to World Health Organisation, equitable access to safe blood and blood products and their safe and rational use still remain major challenges throughout the world. While the demand for blood is growing in the developed world with longevity of life and increasingly sophisticated clinical procedures, national blood supplies are rarely sufficient to meet existing requirements in the developing countries.
In 2015, 71% of reporting countries, or 123 out of 173, had a national blood policy. Overall, 60% of reporting countries, or 104 out of 173, have specific legislation covering the safety and quality of blood transfusion, including 79% of high-income countries, 55% of middle-income countries, 45 % of low-income countries, cites WHO factsheet on blood donation.
About 117.4 million blood donations are collected worldwide. 42% of these are collected in high-income countries, home to 16 % of the world’s population. The median annual donations per blood centre is 1300 in the low-income countries, 4100 in lower-middle-income countries and 8500 in upper-middle-income countries, as compared to 23 000 in the high-income countries.
There is a marked difference in the level of access to blood between low- and high-income countries. The whole blood donation rate is an indicator for the general availability of blood in a country. The median blood donation rate in high-income countries is 32.6 donations per 1000 people. This compares with 15.1 donations per 1000 people in upper-middle-income countries, 8.1 donations per 1000 people in lower-middle-income countries, and 4.4 donations per 1000 people in low-income countries.
Where Does India Stand
India faces a challenge of acute shortage of safe blood, which is a critical life-saving pillar of any healthcare system. The WHO estimates that blood donation by 1% of the population is generally the minimum to meet a nation’s most basic need for blood. As per the data of 2016-17, India had a shortfall of 1.9 million units (or 15%) vis-à-vis the WHO norm.
However as per WHO data, India has been successful in reducing MMR by 77% — from 556 per 100,000 live births in 1990 to 130 per 100,000 live births in 2016. However, India has a long road ahead in meeting the Sustainable Development Goal (SDG) target of an MMR below 70 by 2030.