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How Over 50,000 Mothers Die Every Year In India Due To The Failure Of The Public Health System

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By Mannat Tipnis:

“The scale of maternal mortality is an affront to humanity…The time has come to treat this issue as a human rights violation, no less than torture, disappearances, arbitrary detention, and prisoners of conscience.” — Mary Robinson, former UN High Commissioner for Human Rights

While India is the 10th largest economy in the world, it is a pity that it continues to be within the category of some of the poorest nations in the world regarding maternal mortality rates and immunization. While Sierra Leone has the highest number of deaths related to pregnancy, India comes a close second with 50,000 deaths per year. According to the WHO, both India and Nigeria together were accountable for one third of the deaths the world over. There are greater nuances to the problem and solutions go far beyond an increase in the availability of hospitals and decreasing costs, though these in themselves continue to be far beyond the reach of a large section on women in the country, considering the fact that India only spends 4% of its GDP on healthcare.

Picture Credits
Picture Credits

As part of its study on maternal mortality, the Centre for Reproductive Rights, based in the USA, conducted a few case studies that sought to address the nuances of this problem.

July 20, 2006, Andhra Pradesh — Syeda Rizwanabi, a 15 year old girl, conceived a child three months after being married off by her parents. Due to a lack of information, she followed no dietary routine, her mother in law refused to admit her to a hospital when certain complications arose, she suffered convulsions, cardiorespiratory failure and died.

Source: Academy for Nursing Studies, Case Study: Syeda Rizwanabi (2006)

April3, 2007, Madhya Pradesh - Gita Bai, a member of the Banjara community, mother of 2 children. My hospital in Indore refused to admit her, when they discovered she was HIV positive. In pain and on the verge of delivering her baby, the doctors refused to even give her nevirapine to avoid the risk of transmission to her newborn. Gita delivered a baby girl outside the hospital, when admitted later, she continued to be ignored by the doctor. Gita Bai died due to sepsis and excessive bleeding.

Source: Human Rights Law Network, Gita Bai (2007)

December 15, 2007, Uttar Pradesh – Sumitra Devi, 28 years old, poor, illiterate, Dalit woman, a mother of three children, was going through a perfectly normal pregnancy till she proceeded to the Primary Health Center because of the onset of labor pains. There, she was given a total of fourteen injections by the ANM without any explanation. Sumitra’s body went cold, her family was forced to remove her from the bed, lay her on the floor and pay the medical fees, while she lay there dead.

India has a maternal mortality rate of 178 per 1,00,000 live births. This is an indication that the United Nations’ goal will be missed, say two reports – Dead women talking: a civil society report on maternal deaths in India drafted by CommonHealth and Jan Swasthya Abhiyan, and India infrastructure report – the road to universal health coverage”, released by the Infrastructure Development Finance Company.

Most maternal deaths that occur in India, one every 5 minutes, which is also 15% of the death for women of reproductive age, are avoidable. Even the leading causes like health and medical complications have to be looked at from a causative perspective. The National Family Health Survey stated that 55% of women in India are anaemic, in comparison to 24% men. This goes up to 85% pregnant women. This can be attributed to gender based discrimination in access to food, nutrition and healthcare. Thus, government policies should target the issue from the perspective of the background that influences women and their families into making certain health decisions.

9% of total maternal deaths are caused due to unsafe abortion, which is 15% higher than the global average. 6.7 million abortions occur outside government facilities. This is attributed to the fact that in most rural areas, there is a lack of information about safe abortions, and poorly trained doctors and nurses. Only a minuscule minority of women (some statistics say 9%) even know that abortion is legal. Women across class lines are forced into aborting female foetuses. This is done in unsafe conditions without legitimate medical authority, thus contributing to the list of reasons which can be avoided with greater government intervention that is not as generic, but targets each problem specifically.

The limitation of immunization and factors that are conducive to safer pregnancies are also restricted around cast and class lines. Caste continues to remain a social determinant regarding our access to education, and living conditions. Official policies to protect against discrimination haven’t percolated to the health sector.

Conflicts like armed insurgency and religious violence are cutting women off from essential pre and post natal health care services. “I have seen women trying to use home remedies like poultices to cure sepsis just because they don’t want to run into either an army man or a rebel.” — Daniel Mate, a youth activist from the town of Tengnoupal, on the India-Myanmar border, told Stella Paul of the Inter Press Service news agency. Families often stop women from receiving health benefits. In a household where there is a lack of funds, women will most probably be the last one’s to get these benefits. Often because mothers and mother in laws didn’t have access to medical facilities, women are discouraged and disallowed access to them.

There is a disturbing gap in the number of women who receive postnatal care. The NFHS reveals that less than only 36.4% of women across the country receive postnatal care and immunization within two days of delivery. One expert study contends that “half the [maternal] deaths could have been avoided if the health system had been alert and accessible”. While many factors affect the availability of care, studies show that in Indian primary health centers, absenteeism and poor quality of care are the norm. For example, in one part of Rajasthan, community health centers are closed during 56% of regular opening hours.

There is a great disparity in health care services in the north and the south. While 93% women receive antenatal services in the south, only 40% do so in the North. The east is plagued by a lack of communication and transport services, an effort by the government to improve the same has contributed to a steady decrease in the mortality rate but socio-economic and cultural factors require more detailed studies and evaluations.

Various NGO’s like Save the Children, Academy for Nursing Studies, Jaagori,Prerana, Sneha, Manmata Health institute for mother and child are working to spread awareness at the grass root levels and target specific problems. Its time the government wakes up to do the same.

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  1. Prashant Kaushik

    Accolades to the writer. This is an issue which deserves utmost attention and is still ignored. The self proclaimed champions of feminism are busy fighting tooth and nail and writing zealously in their belief to pursue women empowerment about what length of dresses they should wear, what names should be given to Bollywood movies and so on.

    I am happy to see that some writers know what to focus more at this of our history. But unfortunately, this issue is still vastly ignored. Look no comments so far and hardly any articles pop on women and child health. We need to get out of this mess at the earliest. There is no going forward if our women keep dying in a process as old as the mankind ( or perhaps even animal-kind).
    Is anybody listening ?

  2. Amlan

    Indians ignore women so much that even a pregnant women going through the hell in labour is asked bribed and kicked out if unable to pay.Such is the hellishness of Indians.Preventing maternal mortality through proper medical interventions is one of the important goals for feminism and for overall national devlopmen. Most gender equal feminist countries like Sweden , Norway, iceland are also having the least maternal mortalities in the world.So reducing or puting an end to maternal mortality is one of the key goals of feminism and overall national devlopment.Building Smart Cities will be meaningless without smart and safe pregnancies and deliveries.

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An ambassador and trained facilitator under Eco Femme (a social enterprise working towards menstrual health in south India), Sanjina is also an active member of the MHM Collective- India and Menstrual Health Alliance- India. She has conducted Menstrual Health sessions in multiple government schools adopted by Rotary District 3240 as part of their WinS project in rural Bengal. She has also delivered training of trainers on SRHR, gender, sexuality and Menstruation for Tomorrow’s Foundation, Vikramshila Education Resource Society, Nirdhan trust and Micro Finance, Tollygunj Women In Need, Paint It Red in Kolkata.

Now as an MH Fellow with YKA, she’s expanding her impressive scope of work further by launching a campaign to facilitate the process of ensuring better menstrual health and SRH services for women residing in correctional homes in West Bengal. The campaign will entail an independent study to take stalk of the present conditions of MHM in correctional homes across the state and use its findings to build public support and political will to take the necessary action.

Saurabh has been associated with YKA as a user and has consistently been writing on the issue MHM and its intersectionality with other issues in the society. Now as an MHM Fellow with YKA, he’s launched the Right to Period campaign, which aims to ensure proper execution of MHM guidelines in Delhi’s schools.

The long-term aim of the campaign is to develop an open culture where menstruation is not treated as a taboo. The campaign also seeks to hold the schools accountable for their responsibilities as an important component in the implementation of MHM policies by making adequate sanitation infrastructure and knowledge of MHM available in school premises.

Read more about his campaign.

Harshita is a psychologist and works to support people with mental health issues, particularly adolescents who are survivors of violence. Associated with the Azadi Foundation in UP, Harshita became an MHM Fellow with YKA, with the aim of promoting better menstrual health.

Her campaign #MeriMarzi aims to promote menstrual health and wellness, hygiene and facilities for female sex workers in UP. She says, “Knowledge about natural body processes is a very basic human right. And for individuals whose occupation is providing sexual services, it becomes even more important.”

Meri Marzi aims to ensure sensitised, non-discriminatory health workers for the needs of female sex workers in the Suraksha Clinics under the UPSACS (Uttar Pradesh State AIDS Control Society) program by creating more dialogues and garnering public support for the cause of sex workers’ menstrual rights. The campaign will also ensure interventions with sex workers to clear misconceptions around overall hygiene management to ensure that results flow both ways.

Read more about her campaign.

MH Fellow Sabna comes with significant experience working with a range of development issues. A co-founder of Project Sakhi Saheli, which aims to combat period poverty and break menstrual taboos, Sabna has, in the past, worked on the issue of menstruation in urban slums of Delhi with women and adolescent girls. She and her team also released MenstraBook, with menstrastories and organised Menstra Tlk in the Delhi School of Social Work to create more conversations on menstruation.

With YKA MHM Fellow Vineet, Sabna launched Menstratalk, a campaign that aims to put an end to period poverty and smash menstrual taboos in society. As a start, the campaign aims to begin conversations on menstrual health with five hundred adolescents and youth in Delhi through offline platforms, and through this community mobilise support to create Period Friendly Institutions out of educational institutes in the city.

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A student from Delhi School of Social work, Vineet is a part of Project Sakhi Saheli, an initiative by the students of Delhi school of Social Work to create awareness on Menstrual Health and combat Period Poverty. Along with MHM Action Fellow Sabna, Vineet launched Menstratalk, a campaign that aims to put an end to period poverty and smash menstrual taboos in society.

As a start, the campaign aims to begin conversations on menstrual health with five hundred adolescents and youth in Delhi through offline platforms, and through this community mobilise support to create Period Friendly Institutions out of educational institutes in the city.

Find out more about the campaign here.

A native of Bhagalpur district – Bihar, Shalini Jha believes in equal rights for all genders and wants to work for a gender-equal and just society. In the past she’s had a year-long association as a community leader with Haiyya: Organise for Action’s Health Over Stigma campaign. She’s pursuing a Master’s in Literature with Ambedkar University, Delhi and as an MHM Fellow with YKA, recently launched ‘Project अल्हड़ (Alharh)’.

She says, “Bihar is ranked the lowest in India’s SDG Index 2019 for India. Hygienic and comfortable menstruation is a basic human right and sustainable development cannot be ensured if menstruators are deprived of their basic rights.” Project अल्हड़ (Alharh) aims to create a robust sensitised community in Bhagalpur to collectively spread awareness, break the taboo, debunk myths and initiate fearless conversations around menstruation. The campaign aims to reach at least 6000 adolescent girls from government and private schools in Baghalpur district in 2020.

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A psychologist and co-founder of a mental health NGO called Customize Cognition, Ritika forayed into the space of menstrual health and hygiene, sexual and reproductive healthcare and rights and gender equality as an MHM Fellow with YKA. She says, “The experience of working on MHM/SRHR and gender equality has been an enriching and eye-opening experience. I have learned what’s beneath the surface of the issue, be it awareness, lack of resources or disregard for trans men, who also menstruate.”

The Transmen-ses campaign aims to tackle the issue of silence and disregard for trans men’s menstruation needs, by mobilising gender sensitive health professionals and gender neutral restrooms in Lucknow.

Read more about the campaign here.

A Computer Science engineer by education, Nitisha started her career in the corporate sector, before realising she wanted to work in the development and social justice space. Since then, she has worked with Teach For India and Care India and is from the founding batch of Indian School of Development Management (ISDM), a one of its kind organisation creating leaders for the development sector through its experiential learning post graduate program.

As a Youth Ki Awaaz Menstrual Health Fellow, Nitisha has started Let’s Talk Period, a campaign to mobilise young people to switch to sustainable period products. She says, “80 lakh women in Delhi use non-biodegradable sanitary products, generate 3000 tonnes of menstrual waste, that takes 500-800 years to decompose; which in turn contributes to the health issues of all menstruators, increased burden of waste management on the city and harmful living environment for all citizens.

Let’s Talk Period aims to change this by

Find out more about her campaign here.

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A former Assistant Secretary with the Ministry of Women and Child Development in West Bengal for three months, Lakshmi Bhavya has been championing the cause of menstrual hygiene in her district. By associating herself with the Lalana Campaign, a holistic menstrual hygiene awareness campaign which is conducted by the Anahat NGO, Lakshmi has been slowly breaking taboos when it comes to periods and menstrual hygiene.

A Gender Rights Activist working with the tribal and marginalized communities in india, Srilekha is a PhD scholar working on understanding body and sexuality among tribal girls, to fill the gaps in research around indigenous women and their stories. Srilekha has worked extensively at the grassroots level with community based organisations, through several advocacy initiatives around Gender, Mental Health, Menstrual Hygiene and Sexual and Reproductive Health Rights (SRHR) for the indigenous in Jharkhand, over the last 6 years.

Srilekha has also contributed to sustainable livelihood projects and legal aid programs for survivors of sex trafficking. She has been conducting research based programs on maternal health, mental health, gender based violence, sex and sexuality. Her interest lies in conducting workshops for young people on life skills, feminism, gender and sexuality, trauma, resilience and interpersonal relationships.

A Guwahati-based college student pursuing her Masters in Tata Institute of Social Sciences, Bidisha started the #BleedwithDignity campaign on the technology platform Change.org, demanding that the Government of Assam install
biodegradable sanitary pad vending machines in all government schools across the state. Her petition on Change.org has already gathered support from over 90000 people and continues to grow.

Bidisha was selected in Change.org’s flagship program ‘She Creates Change’ having run successful online advocacy
campaigns, which were widely recognised. Through the #BleedwithDignity campaign; she organised and celebrated World Menstrual Hygiene Day, 2019 in Guwahati, Assam by hosting a wall mural by collaborating with local organisations. The initiative was widely covered by national and local media, and the mural was later inaugurated by the event’s chief guest Commissioner of Guwahati Municipal Corporation (GMC) Debeswar Malakar, IAS.

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