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Social exclusion rampant in India’s maternal healthcare

Sep 24, 2008

At a meeting held in the Indian capital today, several organisations associated with the Wada Na Todo Abhiyan shared their findings on the working of National Rural Health Mission. Though limited in their scope, these surveys reveal prevailing discrimination in maternal healthcare to socially disadvantaged groups.

New Delhi: A husband rushed his pregnant wife, writhing in labour pain, on his bicycle to a government hospital in Rampur Maniharan block. A nurse there demanded a bribe of Rs 500 for admission. Unable to pay the bribe, she was refused admission. The woman delivered a dead baby outside the hospital gates. The husband and wife were dalits. Later the hospital authorities tried to hush up the matter.

This was the story narrated by Nirmala Rani, an activist with Aanchal Grameen Vikas Samajik Sanstha based in Saharanpur district of Uttar Pradesh.

She was speaking at a meeting organised by Wada Na Todo Abhiyan (WNTA) in New Delhi to share the findings of surveys in seven districts of different states on the working of National Rural Health Mission (NRHM) and its associated scheme Janani Suruksha Yojna (JSY) or Maternal Protection Programme.

Urmila, an activist, cited incidents of three children and a pregnant woman dying during childbirth in a span of just one month in Chitrakoot district of Uttar Pradesh. All of them belonged to the dalit communities.

She also said that members of Valmiki community (who work as manual scavengers) are the worst victims of discrimination, when it comes to accessing health facilities at the government hospitals and public health centres. No doctor or nurse likes to touch them.

They have no option left but to go for unsafe deliveries at home by untrained dais or midwives. As a result, many Valmiki women are dying during and after childbirths.

“These women are allowed in hospitals only for sweeping and cleaning but not to access any services,” Urmila added.

No mother wants to lose her child for money

Suresh Taank from Haryana said that in their survey they discovered that dalit women in villages were not aware of either the NRHM or JSY. Of the few who heard of the JSY [cash incentive] were skeptical. “We don’t want to lose our child for the sake of Rs 1,400 because government hospitals have no facilities for the poor,” is the standard reply, says Suresh.

The WNTA campaign aims to highlight the experiences of women from dalits, adivasis, nomadic tribes and Muslim communities in accessing their entitlements under the JSY.

Jasodhra Dasgupta, Coordinator of Sahayog from Lucknow said: “The current health policies in the country have their focus on promoting deliveries in institutions and the pre-delivery and post-delivery aspects of maternal care are not given adequate priority.”

She shared the findings of the survey that her organisation has carried out in some districts of Uttar Pradesh, Uttarakhand and Jharkhand.

These findings, though with a limited sample base, suggest that the various government health schemes, including the JSY, are not working on the ground.

The survey also indicated that caste-based discrimination was rampant. She added that to prove it conclusively, there was a need for a comprehensive study with special focus on the socially disadvantaged groups like the Scheduled Castes and Scheduled Tribes.

Activists from the states of Tamil Nadu and Andhra Pradesh also shared their findings. They too described anomalies in the functioning of various government departments and discriminatory attitude of service providers.

Maternal health a human rights issue

WNTA in its background note says: “Maternal deaths occur more among rural women, women without access to education, low-income and dalit women. This is clearly an issue of equity and social justice.”

Globally half a million maternal deaths occur every year. South Asia and Africa are the regions where most of these deaths take place. India accounts for close to 100,000 such deaths. This means one woman is dying every five minutes in India.

Former UN Special Rapporteur on the Right to health, Paul Hunt had termed this as “a human rights problem on a massive scale.”

Dr Abhijit Das of Centre for Health and Social Justice emphasised on the need to bring about a paradigm shift in the way civil society organisations have been looking at the issue of public health to bring focus on the social exclusion dimension of healthcare.

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