Accursed Motherhood

A woman dies every five minutes in India because of pregnancy-related causes, for maladies which are absolutely curable, says a recent report by the United Nations Children's Fund (UNICEF).

The maternal mortality ratio or maternal deaths per 100,000 live births in one year in India is 540 and rises to 619 in rural areas (UNICEF, 1998-1999). Maternal mortality is generally defined as the death of a woman during pregnancy or delivery or within 42 days after the end of pregnancy from a pregnancy-related cause.

Nearly 136,000 maternal deaths occur annually in India, mostly due to anemia and haemorrhage. Studies have found that between 50 and 90 percent of all pregnant women in India suffer from anemia which can be treated relatively simply and inexpensively with the intake of iron tablets.

Dr. Anoop Nangia, who works in a public hospital in Delhi says, "Pregnant women, infants and young children have a high demand but low dietary intake of iron. Poor absorption of iron, or blood loss, from repeated childbirth or heavy menstruation, reduces the iron content in the body causing anemia."

UNICEF report, for 1998-99, states that 47 percent of maternal deaths in rural India are attributed to excessive bleeding and anaemia ensuing from poor nutritional practices. Severe anemia accounts for 20 percent of all maternal deaths in India (The World Bank, 1996). It also increases the chance of dying from a hemorrhage during labour.

Excessive bleeding during delivery, obstructed and prolonged labor, disorders caused by high blood pressure, infections because of unhygienic conditions and occupation-linked ailments because of high pollution and poor sanitation at the workplace also form the prime grounds for the maternal deaths.

Sangeeta Sabharwal, who works for a women's non-governmental organisation in Delhi, says, "With little care and precaution, all these ailments can be prevented with ease. But it is sheer ignorance, especially among the poor, that leads to the maternal deaths."

India is one of the few countries in the world where women have almost the same life expectancy as men. Yet, a woman's health largely depends on her social standing. "It is a shame for India to let its women die when they have a child in their womb," adds Sabharwal.

The reasons for high maternal mortality are not purely medical. The social, cultural and economic barriers in a woman's life stand as a hurdle even before she is born, she fears getting killed in her mother's womb. If born, she is considered an economic burden in the family. Her right to education and nutritious food is seldom given to her and she is confined to the household. The constant subordination by her father, brother, husband and then her son leaves a scarring impact on her overall physical and mental health. Her life is repressed to a continuous struggle for survival.

Dr. K. Nagraj, a development economist says, "Females are the stronger sex, if given a chance to live, they fare much better than men. But unfortunately, the social structures of our society don't give the women the much deserved opportunity to grow."

Poor health of women has repercussions on her family as well. An unhealthy female is more likely to give birth to an unhealthy child. Her potential to productively contribute to the family also reduces.

Feminist writer V Geeta says, "Earlier living within a community used to be the main source of knowledge. Our lifestyle changes have led to more ignorance. The culture of eating healthy food is decaying, especially among working women who have extra responsibility."

Lack of health care, especially in the rural areas, is the leading reason for high maternal mortality ratios in India, reported The World Bank in 1996. Various governments over the years have made efforts to make the health care accessible in all districts but have made slender progress.

The detailed exposure of the sorry state of the Indian Health System in the National Health Policy (NHP) 2002 streamlined the government's goals. Millennium Development Goals (MDGs) replaced Health for All 2000. Simultaneously, the National Rural Health Mission (NRHM) 2005, initiated by the United Progressive Alliance (UPA) government, has gained some mileage recently. The NRHM underlines reducing the infant and maternal mortality rates as their main aim and henceforth, the whole programme is woven around this central idea.

Schemes such as Accredited Social Health Activist (ASHA), where volunteers escort expectant mothers to private or public hospitals and both - the volunteer and the expecting mother - are given incentives, started at the grassroots. Unfortunately, even after crossing three years, the scheme, could not make much headway.

At many places, the volunteers under ASHA were not given either proper training or the drug kits. In the States, the local language version of the NRHM is not available and has not been understood by many. Health problems vary greatly by state but the rigidity of the programme makes it hard for the states to mould it according to their requirements. NRHM's design and budgeting leaves little creative freedom for States.

The entire mission has a provision of Rs 12,000 crore in the 2008-09 national Budget. The funds for the programme move from the Centre to a State and from the State to the district. This gives rise to red-tapism and opens the doors for wide corruption. Corrupt practices under NRHM shake the foundation of an already crippled health system.

Given the wide variation in cultures, religions, and levels of development among the States, women's health also varies from State to State. Rajasthan, Madhya Pradesh, Jharkhand, Orissa, Uttar Pradesh and Bihar have a comparatively high maternal mortality. Madhya Pradesh and Orissa have ratios over 700 when compared with Kerala with the lowest ratio of 87.

A strong behavioral change along with dedicated and persistent efforts by the respective governments is required to combat the problem by ensuring implementation of safeguard measures. Policy measures that guarantee adult female literacy in rural areas, public health clinics in every village, nutritional food for pregnant women and keep a check on female infanticide can keep address the problem and pave way for a healthier environment for women in the country.