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.
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 -Â 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.