Free of cost 24X7 108 emergency ambulance service has not only pushed the graph of institutional deliveries up in Himachal Pradesh over last seven years, but has put spotlight on gaps too in maternal health care in the hill state.

Official figures of pregnancy-related calls at the 108 emergency call centre point to an increase in the rate of Birth Before Arrival (BBA) in hospital and Inter-Facility Transfer (IFT) of pregnant women in Himachal Pradesh, the factors which need immediate attention of government.

BBA is defined as a birth that occurs in inappropriate location, usually outside a health facility, regardless of whether there is appropriate health practitioner present. Or a birth that occurs without a skilled birth attendant, regardless of location. For ambulance paramedic, it includes an unplanned delivery en route to hospital.

The Northern hill state Himachal has a population of 6.8 million, as per 2011 census, with 90 per cent people residing in rural areas.

State head of 108 service provider, GVK-EMRI in Himachal, Mehul Sukumaran said an analytical report on BBA brought to light that since 108 service was launched in Himachal in December, 2010 to March 2017, 807,548 calls were received by 108 emergency call centre, out of which 166,523 (20.6 per cent) were pregnancy related.

Of this, 159,119 pregnant women (95.6 per cent) were transported to health institution for delivery, while 7404 (4.4 per cent) experienced Birth Before Arrival (BBA).

In this, 64.5 per cent BBAs occurred in the ambulance itself, and 35.5 per cent at the scene. Of the total 7404 BBAs assisted by the EMTs, 6895 were assisted in regular pregnancy emergencies and 509 in IFT pregnancy emergencies.

Over time, the IFT showed an increase from 9.4- 64.5 per cent of pregnancy calls and BBAs increased from 3.9- 4.5 per cent. The most sparsely populated districts in the hill state had highest rates of IFTs and BBAs.

The primary transfers in pregnancy calls in the specified period were 84.8 per cent, and remaining were IFTs.

Majority IFTs originated from civil hospitals (45 per cent) followed by Community Health Centres (30 per cent) and then Regional/ Zonal hospitals and Primary Health Centres at 10 per cent each.

The report highlighted that backward Sirmaur district topped in BBA (1544), both in regular pregnancy emergency and IFT out of 19291 pregnancy calls.

Sukumaran said a subset of patient care record review was also done for 387 BBAs that occurred between October 2016 and March 2017 to know complications encountered by Emergency Medical Technicians (in ambulances) and the intervals from initial emergency call to BBA.

The review showed complications in 41 per cent women and 6.4 of their neonates.

‘A challenge is percentage of institutional deliveries (63) with average of last three years out of total number of registered pregnant women in Himachal. Of total institutional deliveries, 41 per cent women have utilised 108 emergency service to reach the health facility safely,” the report said.

It throws up the need for better health infrastructure and strength of specialist doctors in government hospitals, with majority people dependent on public health sector in HP.