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Attitudes must change if India is to reduce maternal mortality rates

Feb 02, 2009

A recent report found that women in developing nations were 300 times more likely to die during pregnancy or childbirth than those in developed countries. Columnist Kalpana Sharma argues that in India, only a seismic shift in societal attitudes towards women and poverty can combat the problem.

In the recent Hollywood film directed by Clint Eastwood, Changeling, actress Angelina Jolie plays the role of Christine Collins, a telephone operator in Los Angeles, California, whose nine-year-old son, Walter, disappears while she is at work.

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The story, set in the 1920s, brings out not just the callousness of the police department, who refuse to investigate for 24 hours insisting that the child will turn up, but also the attitude of the police towards single mothers like Christine.

When another boy is produced after a few months, and she refuses to accept that he is her son because she can clearly see that he is not, she is told by the police that she is purposely not accepting the child because she has got used to her 'freedom' from motherhood.

She is also accused of being a bad mother for having left her child alone in the house. In today's America, it is unlikely that any police department would go on record with such outrageous statements even if individual policemen might still think along these lines.

The film reminds us of the constant challenge that women face as they shoulder the primary responsibility of motherhood. In our context in India, it is also a reminder that just the process of becoming mothers, of producing children, is fraught with grave risk for millions of women.

The solution has been known for years. The problem is the will to make it work.

New plan for safe motherhood

Last fortnight, several newspapers carried stories on this reality on their front pages. The unlikely stories about maternal mortality, given that such news rarely merits any serious attention from the media, was prompted by the release of UNICEF's 2009 State of the World's Children report.

Amongst other facts, the report reminded us that 1500 women die every day in the world due to complications arising during pregnancy and childbirth. The chances of a woman in developing countries dying before or during childbirth are 300 times greater than for a woman in an industrialised country like the U.S. Such a gap does not exist in any other social indicator.

Dismal scene

The largest number of maternal deaths in the world is in South Asia. In India alone, an estimated 141,000 women die each year during pregnancy or childbirth.

This is a result of a variety of factors: child marriages where girls give birth before their bodies are ready; poverty and poor nutrition that results in high levels of anaemia in pregnant women; unsafe abortions by women who are unable to access legal facilities; unattended deliveries; often in unhygienic conditions, leading to infections and complications; and unavailability of affordable healthcare post delivery to ensure that the mother and child pull through the first hours and days.

One of the abiding mysteries of our country is why, when our growth rate is still reasonably high despite the global recession, is our progress so slow in ensuring that millions of women do not die in the process of something as routine as giving birth.

The solution has been known for years. The problem is the will to make it work. We also know that the solution would benefit everyone, not just women. Yet, affordable and accessible health care, for instance, has not received the thrust that is needed.

Despite efforts to increase the number of women who can have trained help during delivery, one in every four women in India who was pregnant or delivered a child received absolutely no care in the last five years. The chances of such women developing complications, and even dying in the process, are extremely high.

The UNICEF report underlines the need to improve not just health delivery but many other aspects of living that would benefit the larger community. For instance, the absence of safe water and sanitation has a direct impact on poor women who are pregnant. Even if they survive the pregnancy and childbirth, they risk infection and even death because of the conditions in which they live and deliver.

The UNICEF report contains little that is not already known. But one of the important points it emphasises is the importance of creating what it calls a "supportive environment" for maternal and newborn health ...

"Creating a supportive environment for maternal and newborn health requires challenging the social, economic and cultural barriers that perpetuate gender inequality and discrimination.

"This involves several key actions: educating women and girls and reducing the poverty they experience; protecting them from abuse, exploitation, discrimination and violence; fostering their participation and their involvement in household decision-making and economic and political life; and empowering them to demand their rights and essential services for themselves and their children.

"Greater involvement of men in maternal and newborn health care and in addressing gender discrimination and inequalities is also critical to establishing a supportive environment."

Cultural issue

What this underlines is that reducing maternal mortality is not just a technical matter - that of providing enough trained help for women during delivery, or access to healthcare during pregnancy.

It also means taking steps that would make our society as a whole more just and humane, where poverty will not exclude you from access to education and health, where gender will not deny you the right to participate in economic and political affairs, and where being a woman will be equivalent to being a human being who has rights and is valued by society.

It is indeed ironic that in a society where 'motherhood' is virtually deified, we pay so little attention to making sure that women don't die in the process of becoming mothers.

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