70% miscarriages in Maharashtra are from rural areas, says health dept

Around 70% of miscarriages reported in Maharashtra every year are from rural areas, which has 55% of state’s population (as per 2011 census), revealed data available with public health department. Gynaecologists and activists blamed the gap in availability of medical resources in urban and rural areas for the disparity.

However, public health officials denied there was disparity in quality of medical services provided in the state. They said the data, being accessed from Health Management Information System (HMIS), may be skewed as reporting of cases in urban areas of the state is not as effective as it is in rural parts of Maharashtra.

Figures provided by all private and public hospitals in the state show that out of 60,495 cases of spontaneous abortions (commonly known as miscarriages) in 2017-2018, 18,290 (30.2%) were from urban areas and 42,205 (69.8%) from rural areas. In terms of national average, Maharashtra comes second after West Bengal (75,202) and is followed by Rajasthan (57206) while reporting cases of miscarriage.

“Majority of causes behind spontaneous abortion are clinical and can be prevented with better diagnostic and treatment facilities. Manageable medical conditions like hypertension, anaemia, cardiac anomalies or infection control need better medical attention and can easily reduce the rate of abortions in these rural parts of the state,” said the activist, who shared the data.

Gynecologist Nikhil Datar said miscarriage, being a multifactorial issue, causes cannot merely be related to availability of medical services and infrastructure. “In 95% cases, which take place in first trimester of pregnancy, chances of its survival are low. Hence, one has to look at the data with perspective of total number of pregnancies. There is a possibility that because number of pregnancies in rural parts are high, they report more cases of miscarriages,” he added.

Other experts said higher rate of medical complications and infrastructure or diagnostic limitations in rural areas are directly related to higher cases of miscarriage.

“In urban areas, preventable causes of miscarriage such as nutritional support or infection control are better managed owing infra support. Better diagnostic facilities often reveal cardiac, neurological or structural defects in foetuses earlier than in rural women owing to which preventive treatment takes place on timely basis,” said Dr Ashok Anand, head of gynaecology unit, Sir JJ Hospital.

He added lack of nutrition, anaemia and hypertension makes rural women vulnerable to early labour and preterm deliveries, which result in spontaneous abortions.

“Moreover, radiological facilities and regular check-ups increase the chances of diagnosing fatal conditions in foetus before second trimester and it becomes easier for doctors to manage the conditions. In rural areas, scarcity of diagnostic services and cost of private facilities reduce the frequency of women’s visit to centres,” Anand said.

Dr Archana Patil, additional director, directorate of health services, said statistical difference is mainly owing to poor reporting in urban areas and not lack of resources .

“Our experts haven’t noticed any major difference between statistics and we have equally good resources and infrastructure available in rural Maharashtra to handle such complications,” she said.

She added since 2018, they have decided to up the ante of reportage in urban areas.

“The reporting system of urban areas isn’t as effective as it is in rural parts, which may be the cause of statistical polarisation. With funds available from National Urban Health Mission (NUHM), we have decided to strengthen human resources components in urban areas,” Patil added.