by Javaid Iqbal
Recognising the importance of mental health in maternal well-being, integrating mental health services into maternal healthcare programs is essential. Addressing maternal stress, depression, and anxiety can lead to improved pregnancy outcomes and reduce the incidence of high-risk pregnancies.
New research, detailed in the Journal of Global Health, highlights the concerning prevalence of high-risk pregnancies in India, offering crucial insights into this pressing public health concern. The study reveals that 42 per cent of pregnancies in Kashmir are categorized as high-risk, posing significant dangers to maternal and fetal health. Across India, nearly half of the pregnancies (49.4 per cent) are classified as high-risk, with 33 per cent of women experiencing one high-risk pregnancy and 16.4 per cent facing multiple high-risk pregnancies. Moreover, northeastern states such as Meghalaya, Manipur, and Mizoram, along with Telangana in the south, display notably high rates of high-risk pregnancies, underscoring the urgent need for intervention.
Analysis from India’s National Family Health Survey-5, drawing from data on 24,000 pregnant women, illuminates the prevalence and determinants of this troubling pattern. Socioeconomic inequalities play a substantial role in high-risk pregnancies in Kashmir, with financially disadvantaged women facing barriers to accessing crucial healthcare services. Furthermore, restricted educational prospects exacerbate the risk, as women with lower educational attainment may lack awareness about reproductive health and the significance of prenatal care.
Despite India’s notable reductions in under-5 mortality, infant mortality, and neonatal mortality rates, the prevalence of high-risk pregnancies persists at 49 per cent.
Early marriage and adolescent pregnancy exert considerable influence on this prevalence. Particularly widespread in certain regions and communities, early marriage contributes to elevated rates of adolescent pregnancy. Due to their immature reproductive systems and restricted access to healthcare services, adolescent girls face heightened vulnerability to pregnancy-related complications.
Disparities in healthcare infrastructure exacerbate the problem, particularly in rural and remote areas where facilities, skilled medical personnel, and emergency obstetric care services are often lacking. Although institutional delivery rates have risen, concerns persist regarding the quality of maternal healthcare. Inadequate training of healthcare providers, substandard facilities, and deficiencies in emergency obstetric care all contribute to preventable maternal deaths and childbirth complications.
Additionally, malnutrition and micronutrient deficiencies among pregnant women amplify the prevalence of high-risk pregnancies, as poor maternal nutrition heightens the risk of adverse birth outcomes.
Certain pre-existing medical conditions, such as hypertension, diabetes, and obesity, heighten the likelihood of complications during pregnancy. Women with these conditions necessitate specialized prenatal care and monitoring to reduce the risk of adverse outcomes for both mother and baby. Furthermore, geographical location and environmental factors can impact the incidence of high-risk pregnancies, with women in remote or isolated areas encountering difficulties in accessing healthcare services and emergency obstetric care.
Decades of strife in Kashmir have inflicted profound psychological trauma on pregnant women, intensifying the risks associated with high-risk pregnancies. The pervasive atmosphere of fear, violence, and insecurity may elevate stress levels among expectant mothers, thereby amplifying the risk of pregnancy-related complications. Research indicates that exposure to trauma and chronic stress can detrimentally affect maternal health, potentially leading to conditions like preeclampsia, low birth weight, and preterm birth. Additionally, limited healthcare access and disruptions in healthcare infrastructure due to conflict exacerbate the challenges faced by pregnant women in Kashmir.
High-risk pregnancies continue to pose a significant threat to maternal health, particularly among adolescent girls, despite commendable global efforts that have led to a decrease in maternal deaths.
Despite commendable global efforts that have led to a decrease in maternal deaths, pregnancy-related complications remain a significant cause of mortality among adolescent girls. Addressing this issue requires comprehensive strategies tailored to the unique needs of vulnerable populations, particularly in regions like Kashmir.
To tackle high-risk pregnancies effectively in Kashmir, several recommendations have been proposed:
Firstly, targeted outreach programs should be implemented to reach vulnerable groups, including adolescent girls and marginalized communities. These programs should emphasize comprehensive reproductive health education, family planning services, and access to prenatal care.
Secondly, the introduction of mobile health clinics equipped with obstetric care facilities in remote and underserved areas is crucial. These clinics can ensure that pregnant women have access to essential healthcare services such as antenatal screenings, immunizations, and nutritional support.
Recognising the importance of mental health in maternal well-being, integrating mental health services into maternal healthcare programs is essential. Addressing maternal stress, depression, and anxiety can lead to improved pregnancy outcomes and reduce the incidence of high-risk pregnancies.
Investing in strengthening emergency obstetric care services is also vital. This includes training healthcare providers in obstetric emergency management and establishing referral systems for prompt access to specialized care.
Establishing community-based monitoring systems involving local health workers, such as Accredited Social Health Activists (ASHAs), can help identify early high-risk pregnancies and provide support to expectant mothers through regular home visits, counselling, and timely referrals to healthcare facilities.
Furthermore, there is a need to strengthen data collection and surveillance systems to monitor high-risk pregnancies effectively. This involves integrating high-risk pregnancy indicators into existing health information systems and conducting regular assessments to identify areas for improvement.
Allocating resources towards research and innovation in maternal healthcare is crucial for developing novel interventions and technologies to prevent and manage high-risk pregnancies. Collaborative research initiatives between academia, government, and the private sector can drive progress in this field.
Promoting maternal nutrition programs to improve the nutritional status of pregnant women, particularly those at risk of high-risk pregnancies, is essential. Providing access to fortified foods, prenatal supplements, and nutritional counselling can support healthy pregnancies and reduce adverse birth outcomes.
Empowering women through gender equality and decision-making autonomy is critical in reducing the incidence of high-risk pregnancies. Providing education, economic opportunities, and reproductive health information enables women to make informed choices about family planning.
Additionally, fostering partnerships and collaboration between government agencies, non-profit organizations, healthcare providers, and community stakeholders is necessary to coordinate efforts effectively. Pooling resources, sharing best practices, and leveraging collective expertise can maximize impact in addressing high-risk pregnancies.
Finally, establishing mechanisms for continued monitoring and evaluation of maternal healthcare programs is essential to assess their effectiveness and make necessary adjustments for improved outcomes.
Establishing mechanisms for ongoing monitoring and evaluation of maternal healthcare programs is crucial to assessing their effectiveness in reducing the prevalence of high-risk pregnancies. Utilizing data-driven insights will enable the refinement of strategies, efficient resource allocation, and continual enhancement of maternal health outcomes.
Addressing high-risk pregnancies in Kashmir requires a multifaceted approach spanning healthcare, education, infrastructure, and societal norms. Addressing root causes such as socioeconomic disparities, limited healthcare access, and cultural norms contributing to this issue demands systemic change. Policymakers must prioritize maternal and child health by investing in healthcare infrastructure and promoting family planning and educational initiatives.
Strengthening the quality of maternal healthcare services and involving communities through awareness campaigns are pivotal steps toward reducing maternal morbidity and mortality. As advocates and leaders, it is imperative that we collectively commit to prioritizing maternal health and drive policy changes to ensure a safer and healthier future for all mothers and children in India.
(The author is a Health Economist. Ideas are personal)
