Health dept. flags maternal suicides

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This year, from April to September, 12 out of 74 maternal deaths were suicides

A consistent pattern in maternal suicides – mostly by troubled young women in their early gestation – is emerging as a significant health and social concern and one which has begun to reflect in the maternal mortality ratio of the State.

Official figures of Health Department say that this year, from April to September, 12 out of 74 maternal deaths were suicides. In October, there were three or more such cases (yet to figure in official list).

Last year too, there were about 12 such deaths and in 2017-18 also, some 13 cases of maternal suicides were reported.

Verbal autopsies

“We have flagged the issue and reproductive and child health officers will now conduct verbal autopsies in connection with every incident,” a senior Health official said.

In fact, it is not sure if this is a new trend or if these suicides were actually reported as maternal deaths. It is only now that a clear message has been sent out to field staff to take note of maternal suicides.

Kerala Federation of Obstetrics and Gynaecology, which is in charge of conducting confidential reviews of maternal deaths (CRMD) in the State, has also taken note of the issue.

“In the West, post-partum depression is the major cause of maternal suicides. In Kerala, however, most cases of suicides are by young women in their early pregnancy. Social causes — domestic violence, partner’s alcoholism, financial problems, issues in love marriages — seem to be the driver here. The social environment in the State has become very stressful and volatile, producing extreme reactions from vulnerable individuals. A clear action plan for multi-sectoral intervention has become extremely important,” said V.P. Paily, who has been leading the CRMDs in Kerala.

Depression

Perinatal depression (depression during pregnancy and childbirth, lasting for over an year after delivery) can have serious repercussions for maternal as well as infant health. Yet, the problem is not addressed adequately as the Ob-Gyn clinics are way too crowded and young women of all social strata, have hardly any opportunity to voice their emotional concerns, anxieties or insecurities, pointed out Dr. Paily.

He suggested that ante-natal classes by a core medical faculty, including psychologists, be made compulsory at all OB-Gyn OP clinics.

“Every pregnant women registered in the OP should be made to attend the classes, where coping with psycho-social stressors and emotional issues should be a regular topic, so that the stigma attached to counselling is not there,” he said.

The Health department has already formulated a screening programme, ‘Amma Manassu’, to address perinatal depression in the community.

Trained workers

Trained ASHAs and health workers will flag cases of depressive disorders in the community and refer the women to appropriate PHC/FHC. Three ante-natal and post-partum screenings have been planned, to synchronise with the women’s Ob-Gyn OP appointments.

“More attention would have to be paid to creating social structures and support systems to address crucial issues like alcoholism, discordant relationships, domestic violence,” the State nodal officer for mental health P.S. Kiran said.

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