Get access

Recognition of and Response to Postpartum Hemorrhage in Rural Northern India


  • Lynn Sibley CNM, PhD,

    Search for more papers by this author
    • Lynn Sibley, CNM, PhD, is Associate Clinical Professor and Academic Director of the Lillian Carter Center for International Nursing. She holds a joint appointment in the Rollins School of Public Health, Department of Global Health, and an adjunct appointment in the Department of Anthropology, Emory University, Atlanta, GA.

  • Leila Caleb-Varkey RN, PhD,

    Corresponding authorSearch for more papers by this author
    • Leila Caleb-Varkey, RN, PhD, is Senior Program Officer at the Population Council, New Delhi, India.

  • Jayant Upadhyay PhD,

    Search for more papers by this author
    • Jayant Upadhyay, PhD, was program manager for the CPSM Project (Shramik Bharti).

  • Rajendra Prasad MSc,

    Search for more papers by this author
    • Rajendra Prasad, MSc (Statistics), retired from active service as Director, National Productivity Council of India and is currently a freelance Consultant in Data Management and Information System, Delhi, India. He was statistician for the CPSM Project (Intrah).

  • Ekta Saroha MA,

    Search for more papers by this author
    • Ekta Saroha, MA, is a Doctoral Fellow at the Department of Maternal and Child Health, School of Public Health, University of Alabama, Birmingham, AL.

  • Neerja Bhatla MD,

    Search for more papers by this author
    • Neerja Bhatla, MD, is Additional Professor, Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India.

  • Vinod K. Paul MD, PhD

    Search for more papers by this author
    • Vinod K. Paul, MD, PhD, is Professor of Pediatrics and in charge of the WHO Collaborating Center for Training and Research in Newborn Care at the All India Institute of Medical Sciences, New Delhi, India.

Lynn Sibley, CNM, PhD, Lillian Carter Center for International Nursing, Emory University, 1520 Clifton Road, Suite 344, Atlanta, GA 30322. E-mail:


This study describes the results of a Morbidity and Performance Assessment (MAP) conducted to provide insight into the medical factors contributing to maternal and newborn morbidity and mortality in a rural district of northern India, and to use these insights to develop a locally appropriate, community-based safe motherhood program The MAP study was based on verbal autopsy method. Five hundred ninety-nine women (or in the case of 9 maternal deaths, a family member) participated in the study. This article describes a subsample of women who reported signs or symptoms suggesting excessive bleeding (n = 159). Findings include a poor knowledge of danger signs; poor problem recognition during labor, birth, and the immediate postpartum period; and a low level of health seeking that was consistent with poor recognition. Maternal sociodemographic characteristics, antenatal care use, and knowledge of danger signs were generally not associated with problem recognition and health seeking. The case fatality rate was 4%. These findings suggest an urgent need to understand the phenomenon of problem recognition and to integrate this into the design of interventions to reduce delays in health seeking.