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Mothers Need To Quit Dying In India's Heartland

By Subhadra Khaperde, Womens Feature Service

Madhya Pradesh (MP), a state that projects itself as India's heartland, is also the region that witnesses the highest number of maternal deaths in the country. For decades, women here continued to die from pregnancy and childbirth-related causes, with the media and the state government largely ignoring the issue.

In the year 2000 India pledged to bring down its Maternal Mortality Rate (MMR) to 109 per 100,000 live births as part of its Millennium Development Goals. But making maternal mortality a public concern in MP took effort.

Recalls Sachin Jain of the Vikas Samvad, an MP-based advocacy organisation, "Five years ago, when the Maternal Mortality Rate (MMR) was around 498 per 100,000 live births in Madhya Pradesh, it was just a number for many of us. Then some activists, after working it out, put out information that 13,000 women in the state died every year, during and after delivery. That was when the issue began getting public attention. Local organisations and networks like Jan Adhikar Manch and Jan Sangarsh Morcha, Mandla, began raising the concern."

Media tracking done by Vikas Samvad showed the steadily rising graph of news reports: In 2007, there were 654 reports and features on maternal and child mortality in national and regional newspapers. By 2009, the figure had touched 1,256.

This media focus led to two important developments. One, maternal deaths became a political issue. Observes Jain wryly, "Earlier no politician talked about it. Now the state assembly discusses maternal mortality at least three or four times every session! What's more, in the 2008 assembly election, it was an election issue." This unprecedented attention forced the state government to act. Earlier this year, the state government announced that the Janani Express - a free service to transport pregnant women to government health facilities for delivery - would be expanded to cover all 50 districts of the state.

The other impact was at the level of public awareness that brought about significant attitudinal shifts: People's right to proper health care became a community issue. May 2008 saw a campaign led by the Jagrut Adivasi Dalit Sangathan and Cehat, in the predominantly tribal Pati block of Badwani district. Some 1,500 local people - disillusioned with the local health services - undertook a monitoring of the Pati Community Health Centre. They sat in at the premises of the health centre for four days and went through the records. In the end the administration was forced to sign an agreement promising better facilities and care.

"That agreement was put up in the Pati Community Health Centre so that people got to know about it. Information is clearly the key in addressing the big gap between government claims and existing realities," observes Jain. He adds, "When we in Vikas Samvad heard that one Shivkali Baiga in Mandla district had died because of negligence during her delivery, we alerted journalists and widely circulating Hindi newspapers like 'Dainik Bhaskar', 'Dainik Jagran', as well as the English daily, 'The Hindustan Times', covered the story. Shivkali's father has now filed a Public Interest Litigation in the Madhya Pradesh High Court. We hope to keep the pressure on."

If information generation with evidence based social action is a game changer, so also is local expertise. While MP has an estimated 57,000 'dais', or traditional birth attendants, the state government has kept them out of the maternal health delivery regime. But in another region of MP, interesting evidence has surfaced about how, when poor local women are trained and empowered to deliver on maternal and reproductive health, they can make a huge difference.

Suguna Solanki, a Bhil tribal 'anganwadi' helper, lives in Jeet Nagar - a shanty town on the outskirts of Indore, Madhya Pradesh's financial capital. She is a health worker and came into the sector almost by accident. Suguna describes that moment, "Once, a few years ago, I took a 16-year-old unmarried girl from our slum, who was five months' pregnant, to a doctor who was actually a quack. He gave her a potion, pressed hard on her lower abdomen and aborted the foetus. Later, the girl began to bleed profusely. We rushed her to a government hospital where her uterus was removed and she was saved."

The experience helped Suguna understand the obstacles that poor women living in her neighbourhood faced. The problem was two-fold. Not only were women ignorant about their right to health care, they also knew very little about the state of their own bodies.

The first challenge then was to break the culture of silence, whether it was about health entitlements or tabooed topics like sexuality and menstruation. Suguna joined an initiative undertaken by the Urban Health Resource Centre (UHRC), New Delhi, in 75 slums in Indore, in collaboration with five local NGOs, with funding from USAID. The programme, which began in 2003, focused on assisting local communities to gain access to the government's reproductive and child health services.

Suguna, along with a few other 'anganwadi' workers from adjoining slums like Rajeev Gandhi Nagar, Bhavana Nagar and Pavanpuri, were trained as community workers in reproductive and child health. They were also given the task of mobilising local communities to seek better health services. The women organised monthly health camps in which doctors conducted regular check ups and provided free medicines.

In time the women realised they needed to do more if their work was to have an impact. Says Rekha Patode of the Rajeev Gandhi Nagar slum, "Menstrual hygiene is a big problem here, for instance. In most cases women use the same pieces of cloth after washing them, and since the rags are not dried properly because their public display is tabooed, women end up suffering from various infections, including pelvic inflammation."

At this point, the UHRC decided these field health workers should be made to form their own organisation, so that they would be able to carry on working for the community even after the project ended. Recalls Urmila Javre, a field worker from Pavanpuri slum, "Seven women field workers came together and helped to form and register an NGO by the name of Parivar Sahayog Samiti (PSS) under the Madhya Pradesh Societies Act. We were given training on how to run it and we told the trainer about our desire to work on women's reproductive rights."

Soon, the monthly health camps began to be reoriented towards treating gynaecological infections. The local women welcomed these initiatives. For the first time, they were being properly examined in privacy by trained doctors, given appropriate medication and sanitary napkins. The results were heartening. Incidence of pelvic inflammation came down markedly, and there was also a reduction in anaemia levels. This led, in turn, to the better health profile of the pregnant women.

In 2009, the funding for the project ended. But Suguna and her colleagues are determined to carry on. The PSS is a remarkable example of how local expertise can make a real difference on the ground. They also understood intuitively the connections between maternal and reproductive health. Millennium Development Goal 5 - that seeks to improve maternal health - recognises this very link.

According to 'The Millennium Development Goals Report 2009', brought out by the United Nations, maternal mortality levels in South Asia are among the highest in the world, next only to sub-Saharan Africa. If this has to change, India would have to do better, and for India to do better a state like Madhya Pradesh would have to bring down drastically its MMR, currently at 335 deaths per 100,000.

The information driven campaign of the Vikas Samvad, and the local expertise inherent in the PSS model could be important pointers to the way forward in a state that has long neglected its expectant mothers.

Womens Feature Service covers developmental, political, social and economic issues in India and around the globe. To get these articles for your publication, contact WFS at the www.wfsnews.org website.