Abstract
This chapter describes 40 years of maternal and newborn outcomes at an award-winning hospital in the Ladakh region of India from the perspectives of a medical anthropologist, obstetrician, and pediatrician. We describe how our team of providers at Sonam Norboo Memorial Hospital (SNMH) in Leh, Ladakh collaborated with each other across departments to acquire diverse training, equipment, and essential medicines to build a woman-centered sustainable model of maternity and midwifery care that has saved multiple lives. The hospital’s MMR (maternal mortality ratio) of 37/100,000 live births between 2000 and 2020 was one-sixth of India’s average MMR in the same period. The hospital was twice recognized with the all-India Kayakalp award and its founding obstetrician was honored with two of India’s highest civilian honors, the Padma Shri and the Padma Busan awards, due to its high quality of care and excellent maternal and neonatal outcomes in one of India’s most remote and neglected districts. We close by describing how lessons from Ladakh in lean maternity care can be scaled across other parts of India that still face substantial challenges in improving newborn and maternity care and health outcomes.
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Notes
- 1.
Gutschow calculated the MMR for Leh hospital between 2000 and 2020 using data from SNMH (10 maternal deaths and 27, 318 live births). She calculated the average MMR for India in a similar period using the fibe estimates for India’s MMR—in 2000, 2005, 2010, 2015, and 2017––provided by the WHO (2019) and its partners.
- 2.
Guilmoto and Rajan (2002: 668) report Leh district’s TFR as 1.3 and Kargil district’s TFR as 3.4 in 2001. Contraceptive prevalence rates (CPRs) across India in 2003–2004 were reported by the Indian Institute for Population Sciences at http://www.iipsindia.org/pdf/05_b_13atab13.pdf
- 3.
The names in this chapter have not been changed, and stories were used with permission of the interlocutors, unless otherwise specified.
- 4.
Dr. Lahdol once told me that her greatest influence was not her father––who was the Prime Minister or Kalon (bka’ blon) and served the King of Ladakh during Partition when he organized the defense of Leh from Pakistani invaders (Gutschow 2006) but her mother––who faithfully followed the ten Buddhist virtues (dge ba bcu) her entire life.
- 5.
Padma’s protocols in 2006 were far ahead of her time. Even by 2014, only 41% of eligible mothers received antenatal corticosteroids in 75 developing Countdown countries (Bhutta et al. 2014).
- 6.
The NSSK was first rolled out in Bihar, Rajasthan, Uttar Pradesh, Orissa, Madhya Pradesh, Uttarakhand, Jharkhand, Chhattisgarh, Assam, and Jammu & Kashmir (MoHFW 2009).
- 7.
Other states and union territories with low NMRs include Tamil Nadu (15), Delhi (16), Punjab (17), and West Bengal. There were no NMR data for India’s most remote northern states (Arunachal Pradesh, Manipur, Nagaland, Mizoram, Tripura, Jammu & Kashmir, and Sikkim) in 2014.
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Acknowledgments
We would like to thank the wonderful women at SNMH––both patients and providers––and all the staff of SNMH including the Medical Superintendents who helped make this research possible over the past 30 years. Gutschow would like to thank Padma Dolma and Dr. Landol for help in gathering data and collegial friendship over the decades; Robin Sears for assistance in visualizing the data and reading drafts; and Kai Gutschow and Yeshe Gutschow Rai for helping create the detailed map of Ladakh UT.
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Gutschow, K., Dolma, P., Gonbo, S. (2021). Sustainable Maternal and Newborn Care in India: A Case Study from Ladakh. In: Gutschow, K., Davis-Floyd, R., Daviss, BA. (eds) Sustainable Birth in Disruptive Times. Global Maternal and Child Health. Springer, Cham. https://doi.org/10.1007/978-3-030-54775-2_14
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