Giving voice to dead women

MATERNAL MORTALITY

Sumitra (name changed) gave birth to a girl at a Public Health Centre (PHC) in Udaipur district, Rajasthan.

Both the Auxillary Nurse Midwife (ANM) and the nurse who attended on her left for home within half an hour of her delivery and before the nurse of the next shift arrived. When Sumitra started bleeding there was no one to attend to her.

 Sumitra’s husband kept calling the doctor but he arrived only after an hour and referred Sumitra to the medical college 40 kms away. Since the PHC did not have a vehicle, the family was forced to spend time arranging for a private vehicle. Unfortunately, Sumitra died on her way to the hospital. 

Like Sumitra there are hundreds of women who die each year soon after delivery owing to poor healthcare facilities. Highlighting this poor scenario, as many 20 Non-Government Organisations (NGO) worked for two years to document these stories in the report ‘Dead Women Talking’ which was released in the city recently. The NGOs compiled stories of 124 deaths in 10 states – Maharashtra, Gujarat, Uttar Pradesh, Bihar, Jharkhand, West Bengal, Odisha and Assam. 

According to the report, the women who died belonged to socially and economically disadvantaged section of the population. The report describes how women with vulnerabilities are left out of services like antenatal and post-partum care. 

“It is because of the way health services are structured and delivered presently,” says Renu Khanna, founder, Jan Swasthya Abhiyan.  

“Anaemia, though a huge problem, was left undetected and untreated. Blood tests were not often done during the antenatal care and when done, no treatment or follow up was done,” she points out. 

Khanna, critical of the shoddy healthcare facilities at health centres across the country, points out how women with life-threatening complications were often shunted from facility to facility without any appropriate treatment. “Even where the basic, lower level facilities could have been provided, it was not done. Thirty-six women visited three or more facilities seeking care when they were faced with an obstetric emergency,” highlights Khanna.

Since post-partum is the most crucial period where mortality occurs, proper facilities were unavailable. Of the 124 deaths, 82 deaths took place in the post-partum period with 52 deaths happening in the first 24 hours of delivery. 

Dr Subha Sri of Common Health condemns Janani Suraksha Yojana, central government’s national rural health mission, for the poor situation. 

“The approach to addressing maternal health in India is fragmented and focused on promoting institutional deliveries alone, while overlooking the broader framework of sexual and reproductive rights.

The maternal health policy in the country needs to move away from the paradigm of institutional deliveries to safe deliveries. Several issues that affect maternal health – such as access to safe abortion services, access to choice of contraception, proper childbirth, poverty, nutrition – remain the blind spot in policy,” says Dr Subha.

According to Dr Subha gender-based violence is another factor which is known to have an impact on woman’s control over their fertility, other than unsafe abortion, which is a major cause of maternal mortality and is not adequately addressed in maternal health programmes.   

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