The number of women dying during pregnancy and childbirth has more than halved in the Indian state of Karnataka, due largely to a training programme conducted by a team from Singapore General Hospital (SGH). This is the third maternal and child health project SingHealth teams have completed successfully in India, but there is still more work to be done. 

It is now safer for a woman to give birth in the Indian state of Karnataka than the US state of Louisiana. The maternal mortality rate (MMR) in Karnataka this year is 62 per 100,000 live births compared to an estimated MMR of 72 in Louisiana1, according to the Health of Women and Children Report 2019, published by the United Health Foundation.
Five years ago, though the situation was very different. In 2014, the MMR for Karnataka stood at 143 – over 1,550 mothers died that year as a result of complications during pregnancy, childbirth or within 42 days of delivery. 

To address this, the State Institute of Health and Family Welfare (SIHFW), Government of Karnataka partnered with Singapore International Foundation (SIF) and SingHealth. Together they developed the three-year Enhancing Maternal and Child Health Services (EMCH) Programme which began in August 2016. 

Working as Singapore International Volunteers, a team of SGH obstetricians, neonatologists, midwives and senior nurses conducted clinical workshops and symposia in Karnataka. Training focused on managing high-risk complications, such as excessive bleeding during childbirth, pre-eclampsia (which can cause dangerously high blood pressure during pregnancy) and infections. Over the three-year programme, the team trained nearly 180 healthcare professionals from secondary and tertiary hospitals across the state, including 31 Master Trainers who also learnt teaching skills so they could cascade the information to staff in their hospitals.

The experience was an eye-opener for the SGH team.

“The scale of childbirth in Karnataka is truly astonishing – about one million babies are born each year and a busy maternity unit will typically deliver about 50 to 60 babies a day,” said team lead Associate Professor Tan Hak Koon, Senior Consultant, Department of Obstetrics and Gynaecology, SGH, and Academic Chair (Designate), Obstetrics & Gynaecology Academic Clinical Programme. “Many of the doctors and nurses do not have access to the high-tech and costly equipment that we take for granted in Singapore, but they learn how to handle challenging situations and innovate to find cheaper but equally effective solutions to improve care.” 

Prof Tan shared that imported kits which are used to stop bleeding after childbirth are very expensive, but a senior doctor from Bangalore Medical College and Research Institute & Vanivilasa Hospital managed to create his own device costing just S$2.

Such low cost healthcare alternatives are not unique to Karnataka. When the doctors and nurses from KK Women’s and Children’s Hospital (KKH) ran successful maternal and child health training programmes in Tamil Nadu from 2009 to 2013 and 2015 to 2018, they also witnessed how budget solutions saved lives. These included the use of duct tape to demarcate sterile zones in neonatal intensive care units to enhance infection control, and posting of information about the servicing of vital equipment on walls for easy to access and follow-up.   

For the SingHealth team, the valuable lesson was seeing how such low-cost innovations had on improving healthcare outcomes.

“These overseas training programmes are wonderful opportunities for mutual learning and knowledge exchange. Our counterparts in India gain clinical knowledge and skills that have saved the lives of hundreds of mothers and newborns, while the SingHealth teams return with a broadened mindset that we too can adopt low-cost here to help counter rising healthcare costs,” says Ms Vijaya Rao, Director, International Collaboration Office, SingHealth.

The training that the KKH team conducted in three districts in Tamil Nadu has helped to reduce the state’s MMR to 60, one of the lowest rates in India. But every maternal death is one too many. 

“The impact of a mother’s death reaches far beyond her loved ones’ grief. It rips a hole in the family that is difficult to heal, depriving children of the love, care and attention they need to thrive and develop into healthy adults,” say Ms Rao. 

SingHealth is now working with the state’s government and SIF to roll out the Enhancing Maternal and Child Health Programme to the remaining districts across Tamil Nadu and the programme is also spreading further afield. 

The state of Madhya Pradesh, which had an MMR of 173 between 2014 – 2016, has now partnered with Tata Trusts, Temasek Foundation and SingHealth to build capabilities in the state to reduce infant and maternal mortality rates. Under the three-year programme, which started in September 2018, doctors and nurses in Madhya Pradesh are learning how to manage high risk pregnancies and enhance obstetric and neonatal care in emergencies and intensive care.

With support from Tata Trusts and Temasek Foundation, the programme is now developing a fully-equipped skills laboratory with the necessary infrastructure to continue training once the programme ends. This will ensure that future healthcare professionals can receive the clinical skills and knowledge they need to keep pregnant women and mothers safe and give their babies a healthy start in life. 

The United Nations Population Fund estimates that annually around 85,000 women die in Asia and the Pacific during pregnancy and child birth. Up to 90 per cent of these deaths could be prevented with quality antenatal, obstetric and perinatal care.

“It’s satisfying knowing that our work in parts of India is making a real difference but this is just the tip of the iceberg. No woman should die in pregnancy or childbirth, but sadly this is still the reality for tens of thousands of women every year. This is why there is much potential for philanthropists and grant makers who are looking to make a real and deep impact by supporting this area of work,” says Ms Rao.

1 Page 85, Health of Women and Children Report 2019, America’s Health Rankings, United Health Foundation.