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Why Masahun Khatun And 50,000 Pregnant Women Died

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By Prachi Salve and Video Volunteers, Indiaspend.com:

Last year, in eastern Bihar’s Phulvari Sharif, 24-year-old Masahun Khatun was five months pregnant when she fell in the front yard of her house. For the next three weeks, Masahun and her husband shuttled between government hospitals and private practitioners, spending over Rs 40,000 on healthcare, as they tried to get an abortion. Masahun did not survive and her husband, a daily-wage labourer, is struggling to raise their four kids. This is their story:

Almost a decade after the government launched the Janani Suraksha Yojana (JSY; Mothers’ Protection Programme) to reduce maternal and infant mortality by promoting institutional delivery, too many Indian mothers die of causes related to childbirth.

India’s MMR, or maternal mortality ratio (number of maternal deaths per 100,000 live child births), was 178 in 2010-12, worse than poorer countries such as Myanmar and Nepal, and about the same as Laos and Papua New Guinea, according to WHO data. As many as 50,000 pregnant women die every year in India during childbirth, according to this UN report.

The positive news is that the MMR has declined from 212 in 2007-09. Some states, such as Kerala (66), Tamil Nadu (90) and Maharashtra (87) have MMRs that match richer countries such as Brazil (69), Philippines (89) and Cuba (80).

Assam (328), Uttar Pradesh (292), Uttarakhand (292), Rajasthan (255), Odisha (235), Madhya Pradesh (230), Chhattisgarh (230), Bihar (219) and Jharkhand (219) have the eight worst maternal mortality rates in India. These numbers match some of the world’s poorest countries, such as Mauritania (320), Equatorial Guinea (290), Guyana (250), Djibouti (230) and Laos (220).

How the public healthcare system fails the poorest Indians

Three video stories by Video Volunteers (a global initiative that provides disadvantaged communities with story and data-gathering skills) reveal how difficult childbirth is for the poor who have to depend on public-health services, and end up spending money that, in most cases, they do not have:

 

  • Below is the story of a pregnant woman in Bihar who was charged Rs 500 for cutting an umbilical cord. She also had to pay for painkillers needed before her delivery. Women in the village report that when they refused to pay, the ANMs refuse to attend to them. This is despite the government scheme (JSY) that hopes to reduce out-of-pocket expenditure for women below the poverty line by providing free ante-natal checkups, IFA (iron tablets) tablets, medicines, nutrition in health institutions, provision for blood transfusion, and transport to and from health centres.

  • This report below from Deogarh in western Jharkhand reveals corruption among auxiliary nurse mid-wives (ANMs) of a hospital who force pregnant women to pay for their services post-delivery.

  • As this report below details, pregnant women are forced to spend out of their pocket or are referred to other faraway health facilities because there aren’t enough medicines at a state-run health facility. Arti Devi was asked to deposit Rs 500 at a state-run health facility. It was a sum she could not afford, so was asked to go to another government hospital.

The JSY gives pregnant women–who deliver babies at home and live below the poverty line–Rs 500 as cash assistance, irrespective of the mother’s age and number of children, to give birth in a government or accredited private health facility.

The scheme focuses on poor, pregnant women, with a special focus on states with low institutional delivery rates: Uttar Pradesh, Uttarakhand, Bihar, Jharkhand, Madhya Pradesh, Chhattisgarh, Assam, Rajasthan, Odisha, and Jammu and Kashmir.

The scheme also provides performance-based incentives to women health volunteers known as ASHA (Accredited Social Health Activist) to promote institutional deliveries.

Cash Entitlement For Mothers
Category Rural Areas Urban Areas
Mother’s package (Rs) ASHA’s package* (Rs) Mother’s package (Rs) ASHA’s package** (Rs)
Low-Performing  States 1400 600 1000 400
High-Performing States 700 600 600 400

The Promise Of Direct Transfers

A direct transfer of JSY benefits to the bank accounts of pregnant women started in 2013 and is now underway in 121 of 640 Indian districts.

JSY beneficiaries have increased from 0.7 million in 2005-06 to 10.4 million in 2014-15, an indicator that many pregnant women know of the scheme.

About 900,000 ASHAs get performance-based incentives to motivate pregnant women to give birth in health facilities. Of 10.4 million JSY beneficiaries in 2014-15, a large majority (nearly 87%) live in rural India.

State Subsidies Available, Yet Women End Up Paying

As many as 60% of women in Uttar Pradesh acknowledged paying money from their own pockets for certain services, according to an assessment of JSY conducted by United Nations Population Fund in Bihar, MP, Odisha, Rajasthan and Uttar Pradesh in 2012.

Paying For Medical Expenses
Particulars Bihar MP Odisha Rajasthan UP
Percentage of women interviewed who said they made some payment to the institution (%) 28 45 52.1 44 60
Average amount paid as hospital charges (in Rs) 91 42 1070 1389 1016
Average amount paid as medicine charges (in Rs) 550 121 1165.7 820 746
Average amount paid as other charges (in Rs) 78 136 727.8 296 651
Total average amount paid (in Rs) 719 299 1639 1350 839

Women in Madhya Pradesh reported the lowest out-of-pocket expenditure, Rs 299, followed by Bihar with Rs 719.

Households spent an average of Rs 5,544 per childbirth in rural areas, according to a recent survey by the statistics ministry.

Video Volunteers is a global initiative that provides disadvantaged communities with story and data-gathering skills, and IndiaSpend. Salve is a policy analyst with IndiaSpend.

This article was originally published on IndiaSpend.com, a data-driven and public-interest journalism non-profit.

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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.

Read more about her campaign. 

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.

Read more about the campaign here.

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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