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Birth pangs in India's Sunderbans

Dec 21, 2011

Expectant mothers living in inaccessible island villages across the East Indian state of West Bengal are finally able to access community health centres for institutional deliveries.

South 24 Parganas: Kalpana Jana, 24, resident of a region in West Bengal's South 24 Parganas district, would have died while giving birth to her fourth child had she not made it to a nearby community delivery centre on time. When she was brought to the centre - which operates from a gram panchayat building - Jana was barely breathing and constantly retching.

women-healthcare-sunderbans

After a difficult delivery at the centre, she was shifted to a nearby hospital for postnatal care along with her newborn. "Had she not been brought to the community delivery centre on time she would have probably suffered from severe infection, trauma and postnatal depression, very common among our rural women," elaborates Md M A Wahab, Director of Southern Health Improvement Samity (SHIS), the NGO that runs the community delivery centre that treated Jana.

When young Momina Bibi's labour pains began her husband quickly bundled her into his rickshaw and hot-footed it to the Sebayan Matri Sadan, also run by the SHIS, near their village of Satulia, which falls in the South 24 Parganas district. It was the first time that Bibi had ever had a baby in a hospital -- the only one in Bhangur block. Although she had not undergone the mandatory antenatal check-ups, Bibi escaped the trauma of a complicated childbirth because her daughter was born under the expert care of the Auxiliary Nurse and Midwife (ANM) at Sebayan Matri Sadan. The new mother has now been given Rs 500 for her treatment from the central government's Janani Suraksha Yojana (JSY) fund, along with a hypothermal kit that includes a cotton sari, a pair of cotton nappies, a mosquito net and a dress for her baby.

Mothers' home

Although the Sebayan Matri Sadan initially began as a modest community delivery centre, it has now been upgraded to a hospital that can handle complicated medical cases. But despite its new-found status, it still primarily serves as a 'matri sadan' (mother's home) for pregnant women from surrounding villages who, until recently, had no real access to even the most basic medical support.

"Women actually thought that since pregnancy was not a disease they didn't need any special medical assistance or attention"
Aarti, midwife at Sebayan Matri Sadan

Of the 102 islands located in the South 24 Parganas, 54 are inhabited by more than 40 lakh people. The difficult terrain and lack of essential infrastructure like roads and electricity in these islands has meant that more often than not pregnant women here end up delivering their babies at home. Another reason for the low number of institutional deliveries in this region is that most women are ignorant of their specific health needs during and after delivery. Says Aarati, a midwife at the Sebayan Matri Sadan, "Women actually thought that since pregnancy was not a disease they didn't need any special medical assistance or attention. They failed to understand that during this very crucial time, they need to be properly taken care of; they need medical assistance, extra care and nutrition."

Today old attitudes are slowly changing as scores of women living in unknown island villages gain access to health facilities in the form of the SHIS-run community delivery centres and hospitals. The idea behind establishing these centres was to promote institutional deliveries in remote areas where doctors or proper medical assistance were unheard of. The state government's health and family welfare department lends its support through schemes like the JSY and Nischay Yan, a subsidised emergency transportation service for pregnant women in remote areas.

Alam Khokan, the Project Coordinator of institutional delivery at SHIS, puts it this way, "Earlier, women would shy away from institutional delivery. But ever since the establishment of the community delivery centres that are exclusively run by women, women are now even visiting their nearest hospitals for antenatal care."

Delivering joys

Community delivery centres, complete with basic medical facilities and trained midwives for assistance, have been set up within the panchayat buildings of 30 panchayats in the district. While basic deliveries are handled at these centres, the complicated cases are referred to the SHIS hospital. The ones that can't be handled even by the SHIS hospitals are then further referred to hospitals at the district headquarters. The Below Poverty Line (BPL) mothers receive financial support after the first two antenatal check ups they undergo to encourage them to go in for institutional deliveries.

"We find that women are still often reluctant to reach delivery centres for childbirth and that's our biggest challenge"
Dr Sachidnanda Sarkar, Chief Medical Officer, State Health Services

Every day more than 200 women queue up for antenatal checkups at the SHIS hospitals that are presently running in four blocks. Women living on faraway islands are ferried here by motor boat ambulances. Besides transporting patients, these boats also function as mobile dispensaries and a platform to promote awareness on institutional deliveries. Ever since the Sebayan Matri Sadan came up in Bhangur block over two years ago, more than 1,800 babies have been born, with about 200 caesarean section operations having been performed. "We generally recommend a complicated case to the city but a general caesarean section is done with ease at the hospital," reveals Dr Dilip Das, resident doctor of Sebayan Matri Sadan. 

Under the Matri Sadan hospital there are more than eight community delivery centres. An ANM is present 24x7 for medical assistance during deliveries. "Most of the time it is pre-natal shock and post-natal infections that endanger the lives of the mother and newborn. The idea of the community delivery centre is to provide these unattended mothers the basic medical assistance," says Dr Sachidnanda Sarkar, the Chief Medical Officer of the State Health Services, West Bengal. He adds, "It is a part of the congregated health system that is being promoted for medical support in rural areas. The central government, DFID (the British Government's Department for International Development), the state government and non-governmental organisations are working together to provide basic medical support to these mothers and babies."

In West Bengal, the State Health Services hopes to establish a hospital that has facilities for caesarean section deliveries within a 30-km radius, while there are plans to set up community delivery centres that can handle normal deliveries within a 10-km radius. The government, with support from various NGOs working in this area, is also looking for options like the SHIS hospital to ensure postnatal treatment in order to achieve safe motherhood and a higher level of child survival in the state. 

But Dr Sarkar is conscious of the problems ahead, "The lack of general awareness is a major concern today. We find that women are still often reluctant to reach delivery centres for childbirth and that's our biggest challenge."

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