Lok Sabha Question No. 4006 (UNSTARRED), answered on 2023-03-24
Subject: Postpartum Issues among Pregnant Women
Ministry: WOMEN AND CHILD DEVELOPMENT
Asked by: M. K. Raghavan

## GOVERNMENT OF INDIA MINISTRY OF WOMEN AND CHILD DEVELOPMENT

## LOK SABHA

## UNSTARRED QUESTION NO. 4006 TO BE ANSWERED ON 24.03.2023

## POST PARTUM ISSUES AMONG PREGNANT WOMEN

## 4006.  SHRI M.K. RAGHAVAN:

Will the Minister of WOMEN AND CHILD DEVELOPMENT be pleased to state:

- (a) whether it  is  a  fact  that  postpartum  issues  are  on  the  rise  among  pregnant women;
- (b) if so, whether the Government has statistics of such cases in India, if so, the details  thereof,  State-wise  indicating  the  number  of  such  postpartum  issues reported from Kozhikode in Kerala;
- (c) the corrective steps being taken by the Government in this regard;
- (d) whether the Government proposes any special campaign to reduce postpartum depression,  delivery  stress  amongst  women  in  India  and  if  so,  the  details thereof;
- (e) whether there is rise in caesarean deliveries in India, if so, the details thereof, State-wise including the number of such deliveries in Kozhikode; and
- (f) the steps taken for promoting normal deliveries over C Section deliveries in hospitals?

## ANSWER

## MINISTER OF WOMEN AND CHILD DEVELOPMENT (SHRIMATI SMRITI ZUBIN IRANI)

(a) & (b) As per the information furnished by the Ministry of Health & Family Welfare, the first 48 hours of the post-natal period, followed by the first one week, are the most crucial period for the health and survival both of the mother and her new-born. Most of  the  fatal  and  near-fatal  maternal  and  neonatal  complications  occur  during  this period.

World Health Organisation (WHO) recommendations on maternal and new-born care for a positive postnatal experience state that upto 30 percent  of maternal deaths occur in  the  post-natal  period.  The  majority  of  the  complications  such  as  postpartum haemorrhage (PPH), Sepsis and eclampsia, which may lead to maternal mortality, occur during this period.

(c) & (d) Public health and hospitals is a State subject, however, Government of India (GoI), has issued various guidance to all States/UTs to prevent such deaths during the postpartum period as given below:

-  As per guideline on 'Antenatal care and Skilled Attendance at Birth by Auxiliary Nurse Midwife (ANM)/ Lady Health Visitors (LHVs)/ Staff Nurses (SNs)', an ANM  provides  social/psychological  support  to  pregnant  woman  during  her antenatal visits. In post-partum period, four Post Natal Care (PNC) visits are

conducted by ANM for ascertaining the wellbeing of baby and the mother. First visit  is  conducted within 24 hours in case of home deliveries, second visit is conducted on 3rd day after delivery, third visit is conducted on 7th day after delivery and fourth visit is conducted 6 weeks after delivery. During her 2nd and 3rd visits, the ANM assesses and counsels all the postnatal women for any postpartum depression and refers to the Medical Officer for further management if required.

-  GoI is implementing Home Based New Born Care (HBNC) programme, under which Accredited Social Health Activists (ASHAs) conduct 7 home visits on the 1 st day (within 24 hrs), 3 rd  day, 7 th day, 14 th day, 21 st day, 28 th  day and 42 nd  day to check the mother and new-born, for their well-being. In case of institutional delivery,  Reproductive  Maternal  Newborn  Child  Adolescent  Health  Plus Nutrition (RMNCAH+N) Counsellor/SN provides counselling to mother.

(e) & (f) As per National Family Health Survey (NFHS)-5, birth delivered by Caesarean Section has increased from 17.2% in 2015-16 to 21.5% in 2019-21. The State-wise percentage of birth delivered by Caesarean Section is Annexed.

The steps taken by the Ministry of Health & Family Welfare (MoHFW) for promoting normal deliveries over Caesarean Section deliveries in hospitals are as follows:

-  Guidelines on Midwifery Services in India has been disseminated which aims to promote natural birthing.
-  WHO  statement  (2015)  on  Caesarean  section,  has  been  shared  with  the Principal Secretaries, Mission Directors of all States and UTs urging them to share the WHO statement (2015) with all the Obstetricians and Gynaecologists working in public health facilities in their respective States/UTs. The Ministry has issued another OM M.12015/182/2015-MCH to the Federation of Obstetric and Gynaecological Societies of India (FOGSI) to share the WHO statement (2015) among the Obstetricians and Gynaecologists under its umbrella.
-  All  Central  Government Health Scheme (CGHS) empanelled hospitals have been  directed  to  display  the  information  regarding  ratio  of  deliveries  by Caesarean Section vis-à-vis normal deliveries.
-  Caesarean Section rates in public and private facilities are captured routinely at  Health  Management  Information  System  (HMIS)  portal.  During  the  State review meetings, the issue of Caesarean Sections especially if found high is flagged  based  on  the  data  captured  in  the  portal.  The  states  with  high caesarean section rates are urged to look into the issue and take appropriate actions.
-  Labour Room Quality Improvement Initiative (LaQshya) guideline of GoI entails that the facility shall ensure that information about the treatment is shared with patients  or  attendants  regularly  and  a  system  is  in  place  to  involve  Patient and/or relative in decision  making  about  pregnant  women's  treatment. Furthermore, the guideline also ensures that written consent with details of the procedure  with potentials risks and  complication should be  signed by patient/next of kin and one witness. Separate consent is taken for Anaesthesia procedure.
-  Apart  from  these,  caesarean  section  audit  tool  and  guidelines  have  been shared  with  the  States  which  aim  to  ensure  that  caesarean  sections  are undertaken  judiciously,  in  only  those  cases  which  require  such  surgical interventions.

Statement referred to in reply to part (e) and (f) of the Lok Sabha Unstarred Question Number 4006 for answer on 24.03.2023 raised by Shri V.K. Raghavan regarding 'Postpartum issues among Pregnant Women'

## State-wise details of percentage of births delivered by Caesarean  Section

|   Sl. No. | State/UT                                 |   Percentage of births delivered by Caesarean Section |
|-----------|------------------------------------------|-------------------------------------------------------|
|         1 | India                                    |                                                  21.5 |
|         2 | Andaman and Nicobar                      |                                                  29.9 |
|         3 | Andhra Pradesh                           |                                                  42.4 |
|         4 | Arunachal Pradesh                        |                                                  14.8 |
|         5 | Assam                                    |                                                  18.1 |
|         6 | Bihar                                    |                                                   9.7 |
|         7 | Chandigarh                               |                                                  31.3 |
|         8 | Chhattisgarh                             |                                                  15.2 |
|         9 | Delhi                                    |                                                  23.6 |
|        10 | Goa                                      |                                                  39.5 |
|        11 | Gujarat                                  |                                                  21   |
|        12 | Haryana                                  |                                                  19.5 |
|        13 | Himachal Pradesh                         |                                                  21   |
|        14 | Jammu and Kashmir                        |                                                  41.7 |
|        15 | Jharkhand                                |                                                  12.8 |
|        16 | Karnataka                                |                                                  31.5 |
|        17 | Kerala                                   |                                                  38.9 |
|        18 | Ladakh                                   |                                                  37.6 |
|        19 | Lakshadweep                              |                                                  31.3 |
|        20 | Madhya Pradesh                           |                                                  12.1 |
|        21 | Maharashtra                              |                                                  25.4 |
|        22 | Manipur                                  |                                                  25.6 |
|        23 | Meghalaya                                |                                                   8.2 |
|        24 | Mizoram                                  |                                                  10.8 |
|        25 | Nagaland                                 |                                                   5.2 |
|        26 | Odisha                                   |                                                  21.6 |
|        27 | Puducherry                               |                                                  33.3 |
|        28 | Punjab                                   |                                                  38.5 |
|        29 | Rajasthan                                |                                                  10.4 |
|        30 | Sikkim                                   |                                                  32.8 |
|        31 | Tamil Nadu                               |                                                  44.9 |
|        32 | Telangana                                |                                                  60.7 |
|        33 | The Dadra & Nagar Haveli and Daman & Diu |                                                  22.9 |
|        34 | Tripura                                  |                                                  25.1 |
|        35 | Uttarakhand                              |                                                  20.4 |
|        36 | Uttar Pradesh                            |                                                  13.7 |
|        37 | West Bengal                              |                                                  32.6 |

*****