Safe motherhood still a distant dream

The latest UNICEF data tells a grim story
By A Special Correspondent

It is imperative to raise awareness of pregnancy deaths besides scaling up health services if maternal mortality is to be brought down.

Even as the government has been proclaiming time and again that it has achieved remarkable success in reducing child and maternal mortality rates, the UNICEF surveys tell a grim story year after year. These striking disparities have come up in a recently released UNICEF’s State of the World’s Children report that paints a very despairing picture of India’s maternal health scenario. A perusal of the report shows that about 78,000 women die annually in India due to complications arising out of pregnancy and childbirth. This, once again proves that having a child continues to remain among the most serious health risks for women in the country. In truth, high maternal mortality during pregnancy, childbirth and post-delivery is a fact of life in India.

“Women in the least developed nations are in fact 300 times more likely to die of childbirth and pregnancy related complications than the women in industrialised countries. No other mortality rate across the world is so unequal”, says the report. This is clear indication that in India and other developing countries the record of providing basic healthcare facilities to a large portion of the vulnerable population is quite dismaying. This is shocking for a country that aspires to be a super-power in the near future. But the real surprise is that despite high budgets of health schemes of the Union Health and Family Welfare Ministry, maternal mortality rates continue to be high and have not recorded a significant reduction in the past one decade. Ironically, considering that a majority of these deaths are entirely preventable!

Despite the much touted economic growth, it is quite disappointing that India continues to face major challenges in healthcare. As per the report, a large percentage of maternal deaths occur in states like Uttar Pradesh, Uttarakhand, Bihar, Jharkhand, Orissa, Madhya Pradesh, Chhattisgarh, Rajasthan and Assam. With one woman dying every seven minutes on an average, 20 others suffer from pregnancy related complications. It is estimated that nearly 10 million women suffer from these problems each year, while 60 percent of the women continue to deliver babies in homes without even the help of trained midwives. Yet, all that is needed to stop these unnecessary deaths from happening is to make available basic facilities that would ensure safe childbirth as well as effective post-natal care. It is quite discomfiting that despite all the advances in medical and surgical treatment such deaths should occur at all. But equally, one cannot escape the fact that there exists a yawning gap in our health system that makes all the difference between the life and death of women. This gap is intricately linked to availability and access to better healthcare infrastructure facilities and awareness of such facilities in their particular area.

It needs no reiteration that only a healthy mother can give birth to a healthy baby. It is in this context that the UNICEF report brings dismal tidings. According to the report, one million children born in India are dying every year even before they become 28 days old. A child born in India 14 times more likely to die during the first 28 days than one born in US or UK. “Maternal and infant survival is inextricably linked”, it says. In other words, we need to save mothers first if we want to safeguard the lives of their children. Thus any health-programme directed at preventing neonatal deaths has to lay equal emphasis on the pursuit of safe motherhood.

While the UNICEF report paints a bleak picture of India’s maternal health laying emphasis on not to allow any complacency on this score, one needs to ask, why is it so? There are a host of reasons for this—the main one being early marriage and the subsequent child birth. It has been estimated that in India, 27 per cent women are married before the age of 15 years and 58 per cent before the age of 18 years. “Girls who have babies before 15 years have 5 times higher risk of dying at childbirth than women in their 20’s”, says Dr Karin Hulshof, UNICEF India representative.

However, it is also true that a women’s overall health, including her nutritional level and HIV status, have a considerable impact on the chances of safe pregnancy and childbirth. Other factors contributing to a high maternal mortality in India include lack of inadequate healthcare facilities, absence of skilled personnel during childbirth and other socio-economic factors like poverty, poor awareness of emergency situations, lack of transport, cost of seeking medicare and delay in availing of lifesaving measures, especially in rural areas.

The report lays bare the fact that various programmes introduced by the government for the welfare of mothers and infants, are not enough to bring down maternal mortality rates. We may not deny the existence of government funded health organisations but no one needs to debate the abysmal condition of these facilities. While doctors and other trained staff continue to remain on extended leave or the posts are not even filled in such organisations, there is also total lack of surgical and emergency facilities, including life saving drugs. Other crucial factor contributing to mothers dying is the lack of emergency transport to rush pregnant women to hospitals with facilities to attend to medical and surgical emergencies. Also, many women in rural areas don’t have easy access to appropriate anti-natal care. Unfortunately, the government-run programmes on reducing maternal mortality do not lay emphasis on the dissemination of information regarding pregnancy related problems and awareness on when to seek medical care.

Also, high literacy rates and low maternity deaths seem to go hand in hand. That way, the UNICEF report was only stating the obvious by recognising that literacy levels in an area have a lot to do in curbing maternal mortality. This is why Kerala, which is the most literate state in the country, records only one maternal casuality in 500 women. On the other hand, in Uttar Pradesh where literacy level is low, a woman has a 1-in-42 lifetime risk of maternal death. This is due to the fact that in Kerala, almost all deliveries are taken care by skilled medical personnel while as in Northern States illiteracy is a great impediment to seeking delivery or post-partum care. There are no two opinions that even the best of healthcare facilities are ineffective unless women are aware and have easy access to them.

Another reason that precious little has been achieved in reducing maternal mortality rates has its roots in our culture that lays a low premium on female life. It is a grim fact of life that woman has been an object of persecution since the inception of mankind. Dowry, female infanticide and martial physical abuse are all manifestations of this attitude. It is this mindset of the society that makes social discrimination and inequality a terrible fact of life for many unfortunate women. This lack of empowerment and ignorance about their human rights makes them succumb to societal pressures thus automatically limiting their choices.

There are no easy solutions to the problem. Nonetheless, the government must make all efforts to scale up health services to ensure the lives of both mother and child. It is imperative upon the government to provide proper pre-delivery, during delivery and after delivery care, especially to poor and needy women who cannot bear the cost of such services. Other interventions that can benefit the country’s health system are – HIV testing and counseling, skilled attendance at birth and family planning counselling. There is also a pressing requirement for a referred transport scheme and an emergency obstetric helpline.

There are also reports that the government has a plan to offer cash incentives to expectant mothers. However, it remains to be seen if such schemes can bring about a qualitative change in our national health indices. More than anything else, there is an urgent need to change the attitude of the society towards women so that it recognises the women’s right to seek appropriate healthcare. For, if the society respects human life irrespective of gender, the battle for safe motherhood is half won.