Poor facilities deny safe motherhood

Bhopal: Village Sarari Khurd in Sheopur district has a primary health centre but no doctor. The villagers cannot recall the time when a doctor was in attendance there. A nurse opens the centre four days a week but it does not have any equipment and it has hardly ever been cleaned.

Sarari Khurd is not an exception. There are other non-functional health centres. At the Karahal block community health centre, 20 km away from Sarari Khurd, there is no staff.

Three out of the four positions at the centre are vacant. There is no gynaecologist. Karahal block officially has a mobile health van to reach out to inaccessible areas. But the single mobile health van, even if operated daily, would take 35 days to complete a round of all the villages.

Shepour district, with 533 villages and a population of 5.60 lakh, is served by a single district hospital. There are just 166 beds in the district hospital and other small private clinics.

Promises not fulfilled

For more than a decade, there has been no expansion or improvement of medical facilities.

For the last two years, the Madhya Pradesh government has been making tall claims about promoting safe motherhood. But no gynaecologist has been appointed at health centres like Karahal, which have a rural outreach programme.

The state government claims that any woman opting for institutional childbirth would get Rs 1,700 worth of financial aid, transport fare and free medicines.

But when Babhuti, a poor rural woman, was taken to a hospital at the time of delivery, her family had to pawn their land for completing the process.

Meanwhile, the Government of India has released figures related to maternal mortality for the first time since 1998.

The report, Maternal Mortality in India: Trends, causes and risk factors - 1997-2003, claims that the Maternal Mortality Rate (MMR) has declined from 498 per 100,000 childbirths to 379 during the period.

But the report is riddled with technical flaws. This study of MMR has been conducted on the basis of a limited number of cases in a specific situation.

The survey was conducted over a period of six years and the low MMR is reported in Madhya Pradesh and Chhattisgarh on the sample basis of 365 cases, although during this period about 103,000 cases of maternal mortality were reported in the two states.

The second point is that these 365 cases are those that have been registered in official records while analyses tell that only one out of three maternal deaths get officially recorded. It is also to be noted that in district hospitals and community health centres, deaths during childbirth are recorded as general mortality.

Appalling figures

In contrast, the State Family Health Evaluation 2005 of the Madhya Pradesh Government showed that in the rural areas of the state, MMR is as high as 763 per 100,000, which reveals that the situation is far graver than the conclusion provided by the GoI figures. The base for the state government study was 25% population of each district.

The controversy regarding the discrepancy should not remain limited to statistics because the medical infrastructure in the state clearly reveals a far bleaker scenario.

An analysis based on state government figures shows that one hospital bed is available for every two villages. There are 1.7 million births in the state every year and 40% of the people in the state live below the poverty line.

The government provides only Rs 150 per person per year as health budget, of which Rs 126 is spent on salaries and other infrastructure costs.

Only 137 posts of gynaecologists and obstetricians are approved in the entire state, many of which were vacant for years. After a long battle, the government began the process of filling the vacancies last year: 78 posts of gynaecologists and obstetricians, and 112 posts for anaesthetists. But only 31 applications were received for the former and only 12 anaesthetists posts could be filled.

Not many doctors are willing to take up government jobs owing to lack of facilities, including diagnostic equipment, medicines and general sanitary facilities. In this kind of a dire situation, doctors often have to face the wrath of family members of a patient in case s/he dies.

Government apathy

Pervasive corruption at all levels is making conditions far more dangerous for pregnant women. This is partly rooted in the government's new policy of centralised purchase of medicines.

As a result, most of the Rs 700 provided to a pregnant woman under the Janani Suraksha Yojana is spent on bribing the local health staff.

Despite unreliable data, statistics show that out of 1.47 million maternal deaths in the country every year, 97,000 are from Bihar, Madhya Pradesh, Rajasthan and Uttar Pradesh, also known as the four BIMARU states, and the three newly carved ones of Jharkhand, Chhattisgarh and Uttarakhand.

This figure has been corroborated by the World Health Organisation (WHO). Half of the maternal deaths in south Asia are contributed by India's states of Rajasthan, Madhya Pradesh, Bihar, Uttar Pradesh and Orissa.

Any attempt to show a lower MMR through manipulation of statistics cannot be successful. The fact is that MMR is directly related to social disparity, exploitation and poverty.

The government has opted for a narrow definition of poverty in terms of hunger, and this shrinks the space of the rights of women for safe motherhood. This is indeed the time to implement the programme for safe motherhood.

A debate is on over the issue but lack of political commitment is apparent. There is need for a comprehensive policy and coordinated effort for child and maternal health care instead of grandiose schemes to please the politicians.