When Julkiben dai, a traditional birth attendant (TBA), received a call from a pregnant woman, she immediately swung into action. First, she made a call to the 108 number, the state government funded emergency ambulance number. Then, after she reached the pregnant woman’s house, she cut a clean cloth into pieces to be used at the hospital and kept an empty ‘lota’ (water container) ready to fetch and store water.
But when the woman’s labour pains increased and it became impossible for her to climb down the hillock to reach the ambulance, Julkiben summoned young men from the neighbourhood to make a sling from a bed sheet and carry the pregnant women to the ambulance. They had barely reached the hospital labour room when the woman delivered. Although Julkiben received no money for facilitating an institutional delivery, she was happy she saved the lives of both mother and child.
It is not just TBAs like Julkiben but women, their families and community members, who learnt that maternal deaths could be prevented thanks to an intervention by the Centre for Health Education, Training and Nutritional Awareness (CHETNA), the Ahmedabad-based NGO, which has been working on women’s and children’s concerns for over three decades.
“In India, more women die every year during childbirth or pregnancy than in any other country in the world. But it is possible to change this situation when the community is empowered,” says Indu Capoor, Executive Director, CHETNA.
Speaking at recent meeting to share the impact of CHETNA interventions, Capoor revealed that their intervention in 60 villages in Vansada and Chikhali, two tribal blocks of Gujarat’s Navsari district, has shown that it is possible to address the critical three delays causing maternal deaths – delays in seeking emergency care, reaching a health facility and receiving proper care.
Initiated in 2006, this three-year intervention led to remarkable changes in the health indicators in these two tribal blocks. Not only was there was an increase in institutional deliveries from 58 per cent in April 2006-March 2007 to 82 per cent in April 2008-October 2009 in the whole Vansada block, but of the 776 deliveries that took place during June 2008 to March 2009, not a single maternal death was registered in the programme implementation area.
Since poor access to maternal health services and information was causing high maternal mortality, CHETNA decided that it had to adopt a multi-pronged strategy involving the government, community and civil society.
The community learnt that to ensure safe delivery, they need to map facilities that provided safe delivery services and emergency obstetric care. A handy telephone diary with contact number and sticker to be displayed in a prominent corner of the house was developed and distributed to the community.
In fact, CHETNA’s endline (2009) data indicated a significant increase in access to maternal health services from public health sector. In the intervention area, institutional deliveries also increased by 21 per cent. There was also an increase in deliveries in government facilities and private facilities recognised by government under the maternal benefit scheme.
Government data showed that the number of beneficiaries under the Janani Suraksha Yojana (a centrally sponsored scheme aimed at reducing maternal and infant mortality rates) rose from 493 in April 2006-March 2007 to 2113 in April 2008-October 2009 in Vansada block
One in every 48 women in India is at risk of dying during childbirth. The goal of the National Rural Health Mission (NRHM) is to reduce maternal mortality to less than 100 per 100,000 live births by 2012. If affordable interventions like that in Navsari, which costs Rs 33,815 (USD 72) per village per year, could be scaled up and adapted to local conditions in other parts of the country, perhaps this may not be the impossible goal it now seems.