Emergency obstetric care: measuring availability and monitoring progress

To reduce maternal deaths substantially, the facilities for Emergency Obstetric Care (EOC) must exist, be accessible, be utilized by complicated cases and be successful. Accordingly, a new set of indicators, viz., number of functional EOC facilities, geographic bed distribution within a district, proportion of expected births and expected complications managed at these units, and case fatality rate for complicated cases, were assessed in ten districts drawn from ten major states of India. The paper discusses the findings and some of the problems of data collection and interpretation. In general, maldistribution of beds within the district, low levels of cesarean section rates and, sometimes, high case fatality point to a need for an improvement in availability, distribution and quality of EOC. Similarly, low institutional birth rate and much lower than expected number of complications reaching the facilities point to the need for encouraging families to use them. Changes in these indicators over time will help gauge improvements in provision and utilization of EOC. The study findings and methodology are serving as an important element for developing a monitoring system for EOC under Safe Motherhood in India.