Early Postpartum Maternal Morbidity among Rural Women of Rajasthan, India: A Community-based Study|
The first postpartum week is a high-risk period for mothers and newborns. Very few community-based
studies have been conducted on patterns of maternal morbidity in resource-poor countries in that first week.
An intervention on postpartum care for women within the first week after delivery was initiated in a rural area
of Rajasthan, India. The intervention included a rigorous system of receiving reports of all deliveries in
a defined population and providing home-level postpartum care to all women, irrespective of the place of
delivery. Trained nurse-midwives used a structured checklist for detecting and managing maternal and neonatal
conditions during postpartum-care visits. A total of 4,975 women, representing 87.1% of all expected
deliveries in a population of 58,000, were examined in their first postpartum week during January 2007 -
December 2010. Haemoglobin was tested for 77.1% of women (n=3,836) who had a postnatal visit. The
most common morbidity was postpartum anaemia - 7.4% of women suffered from severe anaemia and
46% from moderate anaemia. Other common morbidities were fever (4%), breast conditions (4.9%), and
perineal conditions (4.5%). Life-threatening postpartum morbidities were detected in 7.6% of women -
9.7% among those who had deliveries at home and 6.6% among those who had institutional deliveries.
None had a fistula. Severe anaemia had a strong correlation with perinatal death [p<0.000, adjusted odds
ratio (AOR)=1.99, 95% confidence interval (CI) 1.32-2.99], delivery at home [p<0.000, AOR=1.64 (95%
CI 1.27-2.15)], socioeconomically-underprivileged scheduled caste or tribe [p<0.000, AOR=2.47 (95% CI
1.83-3.33)], and parity of three or more [p<0.000, AOR=1.52 (95% CI 1.18-1.97)]. The correlation with
antenatal care was not significant. Perineal conditions were more frequent among women who had institutional
deliveries while breast conditions were more common among those who had a perinatal death.
This study adds valuable knowledge on postpartum morbidity affecting women in the first few days after
delivery in a low-resource setting. Health programmes should invest to ensure that all women receive
early postpartum visits after delivery at home and after discharge from institution to detect and manage
maternal morbidity. Further, health programmes should also ensure that women are properly screened for
complications before their discharge from hospitals after delivery.
Anaemia; Community-based studies; Delivery; Morbidity; Mortality; Perinatal mortality; Postpartum care; India