Perinatal mortality

Amardeep Singh, inspired by the birth of his son, has written a thought-provoking piece on perinatal mortality in India and the USA. Whilst India has made giant leaps in improving both maternal and neonatal mortality over the last few decades, it still lags well behind the USA (which, incidentally, ranks quite poorly amongst Western countries because of its horrendously poor public health system, horrendous for a rich country that is).

India faces many problems when it comes to child and maternal health. First of all, quite obviously, there is a lack of resources, in terms of trained personnel, training facilities, hospital beds and equipment. Secondly, the medicalization of labour and childbirth that occurred in the West in the 1890's and 1900's has yet to occur amongst the vast masses of India's rural population. It is only the urban middle class and upper classes that utilize obstetric services in India's hospitals. Thirdly, there is a host of traditional practices, which despite being well-intentioned, are often counterproductive and sometimes fatal. I made a comment on Amardeep's post where I described the practice of peri-partum dehydration which contributes to the high rate of stroke amongst women delivering babies in South India. Dehydration, combined with pregnancy, which in itself predisposes women to clots, leads to clots or thrombi forming in various areas of the body; particularly the legs, but also more dangerously in the brain. The clots in the legs go to the lungs and can cause instant death, whilst the brain clots cause strokes, either killing or leaving the women with a range of disabilities.

I learnt of this when I spent a month training in neurology at NIMHAMS, Bangalore. Had I spent some time doing obstetrics, I may well have come across many more similar practices that contribute to perinatal mortality. I know that in certain parts of sub-Saharan Africa, the umbilicus of the newborn baby is smeared with cow dung. Faeces is 70-80% bacteria by mass. This practice results in a massive rate of neonatal infections, and hence mortality. I wonder whether there are other such traditions around the world which are responsible for perinatal deaths. If people know of such things, I'd like to hear about it. These are the sorts of things that should be targeted by primary prevention and rural education programs in India, Africa and other areas where adequate obstetric care cannot be delivered...