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Preventing maternal mortality in India

Oct 23, 2009

No Tally of the Anguish, a Human Rights Watch report documents the state of pregnant women in northern India and the failure of institutions to identify and address the gaps in healthcare. It recommends timely investigations, targeted interventions and healthcare accountability for achieving MDG on maternal health.

No Tally of the Anguish

Publisher: Human Rights Watch, October, 2009

For an emerging global economic power famous for its medical prowess, India continues to have unacceptably high maternal mortality levels. Of every 70 Indian girls who reach reproductive age, one will eventually die because of pregnancy, childbirth, or unsafe abortion, compared to one in 7,300 in the developed world. More will suffer preventable injuries, infections, and disabilities, often serious and lasting a lifetime, due to failures in maternal care.

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This 150-page report documents repeated failures both in providing health care to pregnant women in Uttar Pradesh state in northern India. Poor maternal health is far too prevalent in many communities, particularly marginalised Dalit (so-called “untouchable”), other lower caste, and tribal communities.

The Indian government in 2005 took steps under its flagship National Rural Health Mission (NRHM) to improve public health systems and reduce maternal mortality in particular. Recent data suggest it is having some success: all-India figures show a decline in maternal deaths between 2003 and 2006.

However the report identifies accountability as a critical issue in healthcare system. It is integral to the progressive realisation of women’s right to sexual and reproductive health and to the realisation of the Millennium Development Goal on maternal mortality reduction.

Failures in two key areas of accountability are an important reason that many women and girls in states like Uttar Pradesh are needlessly dying or suffering serious harm during pregnancy, childbirth, and the postnatal period:

  • Failures to gather the necessary information at the district level on where, when, and why deaths and injuries are occurring so that appropriate remedies can be devised; and
  • Failures of grievance and redress mechanisms, including emergency response systems.

Maternal death investigations identifying health system shortcomings are a powerful method of monitoring the implementation and effectiveness of healthcare schemes at the district level. Studies in different parts of India have repeatedly illustrated their utility in identifying and plugging gaps in healthcare schemes, particularly in underserved areas.

This report documents several continuing barriers to reporting maternal deaths in Uttar Pradesh.

It also states that donor countries and international agencies should provide technical and financial assistance to promote notification and investigation of maternal deaths.

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