In this cynical age, with photographs and figures of horrors committed by us on ourselves, by nature on us, accidents and war, what figure of deaths would jolt us out of boredom? Fifty thousand? Hundred thousand? Five hundred thousand – that is half a million? And what about figures of those maimed or injured for life? Would a figure thirty times half a million wake you up? And if I were to say that about 80 to 85% of these needn’t have happened, would that make you feel regretful? Sad? Despairing?
In fact these figures are real, not hypothetical. And they refer to women who either lose their lives or are maimed by what should have been the most natural thing in the world – childbirth.
India has 20% of the world’s maternal deaths. And about 32% of the infant deaths. That is one of the reasons that the advanced world’s health officials are currently looking at us with interest, hope and alarm.
The Millenium Development Goals (MDG) set and agreed upon by most countries of the world have undertaken to bring down these figures by 75% by 2015. While most countries have made progress over the last ten years, and many billions of dollars of new money has been pledged to achieving this, the difference in progress amongst countries, and within countries amongst regions, remains enormous. While in the most developed countries there is one death per 30,000 women, in countries like Malawi the ratio is one death per six women giving birth! (In India the rate is about 46 based on an all India average, though our state has a figure of between 54 and 55, and Kerala much lower).
The two main issues that lead to high rates of maternal mortality are poverty and gender biases. Recently in a year long survey and project done on the subject by Darpana for Development in the Chhota Udepur tribal belt we were repeatedly confronted with both men and older women telling us “If this one dies, we will get another”. Women are still dispensable baby machines. In most villages we found that instead of pregnant women eating green leafy vegetables and drinking milk, for the last couple of months of pregnancy, and the first few post pregnancy months they were kept on a diet of oil and rice, in the mistaken belief that other foods caused indigestion. Even worse were the practices of child birth in the villages of neighbouring Jhabua. As a woman’s labour pains began, all other women were herded out of the cottages and big burly men entered. They tied the woman down and one of the men, the ‘expert’ stood over her head and kicked at her belly to push the baby out. That any women survived this was a miracle.
In many parts of the world, India included, poverty and lack of roads to a health care facility, or the lack of a nearby health care facility leads to women giving birth at home, sometimes with and sometimes without midwives. Birthing superstitions take over, many of which lead to septicaemia or women bleeding to death. Even successful government schemes like our Janani Suraksha Yojana, which has brought more women to hospitals for giving birth by offering monetary inducements, can be subverted by corrupt or lazy doctors. Our own Chiranjivi scheme, though offered up as a success by the government, is fraught with scandal as doctors, finding the government fee of Rs 1500 per birth too low, pass on half the money and all the work to unqualified nurses or cleaning staff.
Why is this of sudden and particular relevance? If India does not start doing better and that too fast, there is no way that the MDG of a 75% reduction can be reached. Besides us, the 18 or 20 countries which have in fact reached a momentum that can help achieve the goal, too need to keep this up rather than rest on their laurels. Not an easy task. But we need to think beyond the numbers – to each family made woman- less, each child motherless by these unnecessary deaths. Perhaps then we shall be spurred onto care.
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