Severe pre-eclampsia and eclampsia are common causes of maternal deaths
worldwide and more so in developing countries. Magnesium sulphate
(MgSO4) is now the most-recommended drug of choice to treat these
conditions. Despite favourable policies for the use of MgSO4 treatment
in India, eclampsia continues to take a high toll. This study examined
the availability and use of MgSO4 treatment in the public health system
and poor women's recent experiences with eclampsia treatment in
Maharashtra state. A mix of qualitative and quantative methods was
used. A facility-based survey of all secondary and tertiary healthcare
facilities (n=44) in 3 selected districts and interviews with public
and contracted-in private sector obstetricians, health officials, and
programme managers were conducted. A list of recently-delivering women
from marginalized communities, with up to two livebirths, was drawn
through a community-level survey in 272 villages covered by 60
subcentres selected at random. Mothers were selected for interviews,
using maximum variation sampling, and interviews were conducted with
17% of the mothers who reported having experienced eclampsia; 61% of
facilities had no stock of MgSO4, the stock-out position continuing
from a period ranging from 3 months to 3 years while another 20% had
some stock, although less than the expected minimum quantity. No
treatment for eclampsia was provided in the recent 3 months at 73%
facilities. Our survey of recently-delivering mothers recorded a
history of eclampsia in 3.2% pregnancies/ deliveries. Interviews with
10 such mothers revealed that treatment for eclampsia has been sought
from public as well as private hospitals and from traditional healers.
However, facilities where women have received medical treatment are
exclusively in the private sector. Almost all public and private care
providers were aware of MgSO4 as the gold standard to treat eclampsia;
however, it is unclear if they knew of its use to treat severe
pre-eclampsia. The private care providers routinely used MgSO4 for
eclampsia treatment while the public care providers seemed hesitant to
use it fearing risks of complications. We stress the need for improved
inventory control practices to ensure sustained availability of
supplies and building confidence of care providers in using MgSO4
treatment for severe pre-eclampsia and eclampsia in public facilities,
in addition to teaching expectant mothers how to recognize symptoms of
these conditions