Maternal Mortality and Morbidity

A few days ago, the media reported an incident about a woman who lay dead on a pavement in Shankar Market, at Connaught Place, the heart of the Capital. The story illustrated the pain of a woman who went into labour and gave unassisted childbirth on a sidewalk, proving to be fatal. Prior to her tragic death, she was found by the owner of a nearby shop, who, having heard the wails of the newborn, came forward to help. Lying unkempt on a watered down, slimy pavement, the woman was hardly aware of the rainwater and the stray dogs lurking about her. She lay prostrate in a sordid state, with her baby girl pressed to her chest. As the story unfolded, the mother died four days later owing to severe weakness. Reportedly, the Police removed the body and took away the baby to a foster home.

In another such case, that surfaced a year ago, Fatima, a 24-year-old destitute girl delivered a baby girl under a tree in full public view. A patient of epilepsy, she simultaneously suffered severe fits at the time of delivery, making her condition critical. Frantic calls of help by her mother and repeated visits to MCD maternity home were not paid heed by the officers. The delivery took place unassisted and miraculously Fatima survived the ordeal. Fortunately for her, an NGO came to know about her and helped file a case in the High Court citing gross violation of human rights. It was through the medium of court and lengthy litigation that Fatima was awarded due compensation. If you happen to go past Nizamuddin Basti, you will still find her inhabiting under a lone tree with her mother Jaitun (Amma) and the daughter she calls Alisha. That tree is her only roof and it is her walls.

Such cases of maternal mortality and morbidity make one's insides churn, not only because these are outrageous and gross, but also because the same could have been averted and many lives saved. Maternal Mortality originally stems from social injustice obliterating access to right to survive pregnancy and child birth. Such deaths are rooted in women's subjugation, unequal status in society and lack of decision-making power. These women die, not because of some incurable illness, disease or heredity but of neglect and absence of health care amenities. In a country where childbearing is feted as 'taking forward of the family legacy', the mother herself is exposed to a risk to her life. When it comes to the duty of the family and the State towards making sure she lives through and after childbirth, the entire palaver fast loses steam.

We still record 63,000 maternal deaths every year, making India home to highest number of women dying during childbirth across the world. If launching of government sponsored schemes were the panacea, then India would have certainly reached the annihilation of maternal mortality by now. The reality is however, that despite the laws and the plethora of schemes, we remain a country where economic boom has left out and overshadowed the plight of its women.

The Central government launched the Janani Suraksha Yojna (JSY) under the National Rural Health Mission (NRHM) in 2005 which was introduced to cater safe delivery with the help of Accredited Social Health Activist (ASHA) and Auxiliary Nurse Midwife (ANM). The scheme aimed at providing cash assistance (ranging between `600-`1400) to all BPL women opting for institutional deliveries.

The service guarantees, as per the NHRM framework, promise minimum four antenatal check ups, iron and folic acid supplementation, tetanus toxoid injection, treatment of anaemia, minimum four post-natal checkups, transport and 24-hour access to emergency obstetric care. The National Maternity Benefit Scheme, Integrated Child Development Scheme (ICDS) and Antyodaya Anna Yojana (AAY) are other such schemes sponsored by the state to cater the nutritional, health and food-based assistance to destitute households.

The Constitution of India guarantees the right to life to the citizens of India under Article 21. In the landmark case of Paschim Banga Khet Mazdoor Samity & amp; ors v State of West Bengal & anr (AIR 1996 SC 2426) the Supreme Court held that the right to life includes the right to adequate medical facilities for preserving human life as well as the right to timely treatment in Government hospital. Article 42 (d) of the Directive Principles of State Policy guarantees the right to just and humane conditions of work and maternity relief. Article 14 (right to equality), Article-15 (freedom from discrimination) and Article 51(c) (respect for international law and treaty obligations) are further torchbearers of the right of a woman to a safe delivery as well as pre and post check up and assistance. Shockingly, 1,000 women are still dying daily from pregnancy-related causes in the country.

It is clear from above that there is no dearth of schemes or laws when it comes to maternal mortality and morbidity, but the implementation of the same is despondent. Most maternal deaths are caused by severe bleeding after childbirth, infections soon after delivery, blood-pressure disorders during pregnancy, and obstructed labour. Apart from these medical conditions, in many areas, health workers are not present or vaccines and medicines are not available. Patients are asked to purchase medicine from private chemists, which they cannot afford. The treatment of doctors and nurses is so harsh and insulting that women prefer unassisted childbirth with the help of dai (unqualified midwife) or quacks instead of qualified medical practitioners. Denial of pregnancy related entitlements, financial as well as medical, is quite common. In the absence of regular check-ups and physical examination, a pregnant woman's health deteriorates and chances of her and the baby's survival become slimmer. Reports of misrepresentation of facts and figures as well as corruption, when it comes to vaccine and medicine delivery, have further raised a question mark over state sponsored schemes and their implementation.

Though India has seen a fall in maternal mortality rate (MMR) by 59% between 1990 and 2008, the country is still grappling with one of the highest maternal death rates globally. According to the latest report, "Trends in Maternal Mortality", released jointly by WHO, UNICEF, UNFPA and the World Bank, India's MMR stood at 570 in 1990, which fell to 470 per 100,000 live births in 1995, 390 in 2000, 280 in 2005 and 230 in 2008 (see table). In contrast, the MMR of China is 37 per 100,000 live births.

There is a need for accountability and periodic assessment of facts at the ground level with strict scrutiny and a dedicated National Health Law. As per the Millennium Development Goals of 2015, India should bring down its MMR to 109 by the year 2015. If we are to reach anywhere near the promised target, the implementers need to pull up their socks and make sure the benefits of these schemes tenaciously percolate into the bottom of the social hierarchy, so that birth of a child continues to be a celebration and not a funeral.

Table:

Year	MMR (per 100000 live births)
1990	570
1995	470
2000	390
2005	280
2008	230

Neha Rathi

16.09.2010