India Faces Reminders of Failing Maternal Safety

NEW DELHI (WOMENSENEWS)–Pregnant with her first child, 17-year-old Guna did not know she was anemic. Nor was she aware of the complications this could cause because no government female health worker or nurse ever visited her village, located in an inaccessible part of the central Indian state of Chhattisgarh.

When she began to hemorrhage after delivering her child at home last year, her family tried to arrange for a vehicle to take her to a health facility. But Guna died before they could do so.

Guna’s death in September 2014 became known through an investigation by an alliance of nongovernmental organizations. It is among the roughly 44,000 preventable maternal deaths that occur in India every year.

It’s also a reminder of the country’s conspicuous failure to meet Millennium Development Goal No. 5, under which countries, 15 years ago, pledged to cut their maternal deaths by one-third between 1990 and the end of 2015.

The White Ribbon Alliance in India, a coalition of individuals and organizations, is working with International Planned Parenthood Federation, Plan India, Family Planning Association of India and Save the Children to keep the problem on the international radar. It joins a 30-country global campaign gathering steam ahead of the annual World Health Assembly, the legislative body of the World Health Organization, which convenes in Geneva from May 18-26.

At that assembly, recommendations from all the 30 countries will be heard in a global citizens hearing and the White Ribbon Alliance wants to be sure recommendations are made to improve India‘s maternal survival statistics.

Anemia, hemorrhage, high blood pressure, infection, unsafe abortion and obstructed labor continue to kill women during pregnancy and childbirth, making India the country with the largest number of maternal deaths in the world.

Drop in Maternal Death Rate

The maternal mortality ratio in India has declined in recent years. Government figures show it at 167 for every 100,000 live births for the two-year period of 2011 to 2013, down from 178 for the previous two-year period.

But the country is still way off target for Millennium Development Goal 5, which requires that the key figure be 109 by the end of this year.

"It is not just a question of how many women are dying but also who these women are," Laxmi Lingam, deputy director of the Tata Institute of Social Sciences in Hyderabad, said in a recent phone interview. "It is the poor and marginalized women who continue to die of preventable causes."

Lingam blames the way health services, including antenatal and post-partum care, are structured and delivered. She says they are failing disadvantaged women, especially those living in geographically remote areas.

She is currently helping the government of the southern Indian state of Andhra Pradesh formulate a roadmap to improve maternal health and safe deliveries with a focus on marginalized communities.

Ekjut, a nonprofit working in some parts of Jharkhand and Odisha, two tribal dominated Indian states with high maternal and infant mortality, has shown that it is possible to prevent maternal deaths among tribal and underserved communities living in remote areas.

Their targeted intervention uses a participatory approach in which local women’s groups discuss problems related to pregnancy and childbirth and find solutions. It has helped reduce the maternal mortality rate in two districts of the two states by up to 70 percent over a period of three years. The Jharkhand government has now adopted this approach and has scaled it up in 12 blocks in the state. It is also being introduced in three districts of Western Odisha.

Indian women die needlessly because of a delay in emergency transport, inappropriate and unavailable emergency obstetric care and a lack of abortion services, finds a 2014 fact finding study by CommonHealth and Jan Swasthya Abhiyan, an alliance of 21 community and civil society organizations. Gaps in antenatal and post-partum care, which overlook the high prevalence of anemia, also contribute to high maternal deaths, authors of the study find.

Traditional Midwives Needed Back

"The gradual sidelining of traditional midwives is a major reason why women still die while giving birth," AR Nanda, former secretary of the government’s Ministry of Health and Family Welfare, said in a recent interview held in Delhi. "These midwives would be able to ensure appropriate health services for the women since most of them live in the same villages and know them intimately. They should have been trained and integrated within the health system. This would have brought down preventable maternal deaths, particularly among the rural poor women."

India should be ashamed of its high maternal mortality rate, said Syeda Hameed, a former member of the country’s Planning Commission, the Delhi-based government body now renamed Niti Ayog, which formulates five-year plans for the most effective and balanced utilization of resources and determining development priorities.

Hameed, in an interview held in Delhi, said that while she was on the Planning Commission she was unable to persuade other policymakers that more institutional deliveries would not be enough to lower maternal mortality.

Now she says local politicians should be confronted with the facts about constituents dying from causes related to pregnancy and childbirth. "Political accountability is needed," she said. "The local elected representative must know how many maternal deaths have taken place and what action has taken place."

April 11 was National Safe Motherhood Day in India, intended by organizers to reiterate every woman’s right to live and survive pregnancy and childbirth.

In observance, the Municipal Corporation of Delhi launched an e-governance project for all maternity homes. Under it, all vital information pertaining to a patient –dates of admission, disease history, treatment, date of discharge and referral– will be filed electronically and used to track patients for their antenatal check-ups and ensure follow-up.

The White Ribbon Alliance in India marked Safe Motherhood Day by launching a campaign called Nothing About Us Without Us to build public pressure on health authorities to improve the safety of childbearing.

Campaigners with Nothing About Us Without Us also have their eyes on the U.N.’s adoption of the Sustainable Development Goals in September 2015. They want to be sure that these goals include mechanisms to monitor government promises and programs on maternal and newborn health.