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Maternal mortality: 'A silent genocide'

Mar 12, 2009

Maternal deaths in India continue unabated due to dismal state of public healthcare, lack of awareness, and non-access to affordable nutritional food. National Federation of Indian Women’s general secretary Annie Raja reflects on the status of the fifth Millennium Development Goal and calls for all-round empowerment of women.

In September 2000, 189 world leaders committed their nations to the Millennium Declaration and the Millennium Development Goals, which include improving maternal health and thereby bringing down the rate of untimely death of young mothers by three quarters between 1990 and 2015.

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Today in India, we have a female ‘Indian Idol’. For the first time in the history of independent India, we have a woman President. More than a third of the three- tier Panchayats, the system of governance at the village level, is headed by women. India is world famous in medical tourism.

It is the destination of the West and the East for cheaper treatments and surrogate mothers. Yet one woman dies of preventable causes related to pregnancy and child birth every six minutes.

Only 17% of all deliveries take place in a hospital or assisted by a nurse or health worker at home

Where does it go wrong and how has it gone wrong? Has the system failed us or have we failed the system? These are some of the questions that should be asked by everyone in this country on International Women’s Day.

Costing high

Paul Hunt, the UN Special Rapporteur on the Right to Health, has said that each preventable maternal death is a fundamental human rights violation. India has experimented with many schemes and announced several policies, from Child Survival and Safe Motherhood in the 1990’s to the National Rural Health Mission in 2006, to tackle this issue.

Despite all these schemes, only 17% of all deliveries take place in a hospital or assisted by a nurse or health worker at home.

Acceptance of neo-liberal economic policies as a one-point formula to solve any issue by successive governments has worsened the already weak healthcare system.  Unfortunately, even the eleventh five-year plan continues to echo the mantra of public- private partnership in this sector.

Household out-of pocket expenditures in India constitute 69% of overall health care expenditures

It is a herculean feat for those 80% of the people living on less than a dollar each day to access healthcare. India recently witnessed an unprecedented number of suicides by farmers and poor people because of indebtedness.

It should be noted with utmost seriousness that the major cause of indebtedness of the common person in this country is healthcare expenditure. Household out-of pocket expenditures in India constitute 69% of overall health care expenditures.

It is interesting to note that delivery in government institutions has now declined by 5.5% to 18.5%. Most surprisingly, it is the women in the more privileged states which have rejected government institutions the most (the decline in the number of women delivering in government institutions in Andhra Pradesh, Kerala, Karnataka, Maharashtra and Tamil Nadu are 9.8%, 28.9%, 10.2%, 9.1% and 15.3 % respectively).

This points to a cruel reality that the public health system, which was once the sole source of healthcare for around 80% of the population, especially for the women of this country, can no longer provide free or affordable treatment and quality and timely care to needy people.

Access to public healthcare systems is very minimal. Many women die because of the delay in getting medical assistance. By the time a woman with pregnancy-related or childbirth complications reaches a primary hospital, she will have lost crucial amounts of blood, leaving very little chance for survival. Considering that around 80% of India's population is in villages, many more health centers are needed. 

Poor service delivery

Lack of availability of contraceptives, as well as early marriage, have also added to the high level of maternal mortality in India. Seventy percent of couples who want contraception do not get it. The 2001 census shows that there were around 300,000 married girls who become mothers before the age of 15. 

According to the recent NFHS-3 study, more than 60% of women aged 18-45 are victims of anaemia

But the major reason for the high maternal mortality rate is the widespread prevalence of anaemia among women. According to the recent NFHS-3 study, more than 60% of women aged 18-45 are victims of anaemia. The Janani Suraksha Yojana scheme, which aims to reduce the overall maternal mortality rate and increase institutional deliveries under the National Rural Health Mission, is nothing but crying over spilt milk.

Structural adjustments have destroyed the Public Distribution System (PDS) of this country. People were able to get almost every essential commodity through the PDS. It satisfied a major portion of the nutritional needs of poor people.

But the withdrawal from this area by the successive central governments and the cutting down of the food subsidy at the insistence of international financial institutions snatched away the right of the people to have nutritional food. Uncontrolled price rise and inflation have also created a very grave situation.

What is to be done?

The duty of any government is to ensure at least basic services like health, education and employment for its people. In India, because of the strong preference for sons, girls are being denied their rights. The budgetary allocation for education and health indicates that the central government is satisfied with false promises.

Women should be able to assert control over their bodies and have quality lives

A country with more than 90% of its working population in the unorganised sector spends just over a percent of its GDP on healthcare. Reducing the drop-out rates in school, especially amongst girls, will be a big step towards women’s empowerment.

This will help in solving the issue of high maternal mortality in India to a great extent. Women should be able to assert control over their bodies and have quality lives.

The government should strengthen the quality of the public health system. Accessibility should also be increased. Instead of promoting private accredited hospitals for service delivery, the government should invest adequately in the improvement of infrastructure in government hospitals.

It should also increase the budgetary allocation so that doctors and other paramedical staff are paid well, which will in turn encourage them to remain in the public sector.

Transparency and accountability can prevent widespread corruption in service delivery. All-around empowerment of women, especially political empowerment, is the urgent need of the hour.

Women’s voices and concerns should be reflected in decision making processes and forums. The involvement of genuine civil society organisations with a mass base and commitment is important for the success of any program.

India has succeeded marginally in bringing the issue of maternal mortality, the silent genocide, to the mainstream. But achieving the fifth Millennium Development Goal by 2015 is a distant dream for India.

It is a society which does not ponder seriously the death of a young woman because of pregnancy-related or childbirth complications. Many prefer to use god’s anger as the reason for death rather than the non-availability or failure of medical care.

Ensuring women’s health, education and employment should be treated as non-negotiable if we are to achieve the Millennium Development Goals by 2015.

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