India’s dying mothers

Hansa, a 22-year-old mother of two, living in Matel village in district Rajkot, Gujarat is yet another victim. Her fate was like thousands of pregnant women in India who die because of poor health care facilities.

“This was her third pregnancy”, relates her husband’s aunt. “Hansa developed some problem in the fifth month of her pregnancy and her husband came to me late in the evening asking me to come to their home.”

She says that Hansa had been bleeding for 4 days and they put her in a ‘Chakda’ (make shift three wheeler) having no other means of transportation and took her to a nearby doctor. He gave her some medicine and told them to take her to the district hospital in the morning. They did as they were told but Hansa failed to survive the trip. She died within the first few hours of the journey.

Early marriages and poor planning

Many women in rural India face problems when they marry early. Hansa had two children already, a son and daughter, aged 2 and 1 years and 3 months respectively. Poor family planning methods often lead to families having children one after another, allowing the woman barely any time to recover from her previous pregnancy. An almost non-existent healthcare and counseling system ultimately contributes towards the death of these women.

Although several policies and initiatives have improved pre-natal health care, India will probably not be able to achieve its Millenium Development Goal of reducing maternal mortality by 75 percent since 1991. Back then, it was 523 deaths per 100,000 live births. Today the figure stands at 254 per 100,000 live births.

Gitanjali Chaturvedi, who has worked in the areas of child development with UNICEF and has been closely associated with the maternal mortality problems in India says, “There are three essential problems; the problems that are clearly political, the problems that are clearly social and we have economic problems as well.” Social problems like getting women married early brings down the average age of females who give birth in their teenage years, which is a potential health hazard.

Sri Lanka conquers maternal mortality

India’s neighbour Sri Lanka has been able to get its maternal mortality rate down drastically and according to the latest data, the maternal mortality rate stands at a mere 32 deaths per 100,000 live births. The Sri Lankan Ambassador in Germany, Sarrath Kongahage says that the country has been able to achieve this feat through education of the female population and a properly managed health care system: “Almost 95% of out female population is school going and the average age of females giving birth is more than 18 years.”

Chaturvedi believes that traditional methods in India may provide some solutions. “Traditionally our system was such that every village had its own midwives (Dayees) and there were proper birth attendants who even gave advice to the women and even looked after them.” she says.

But now the concept is obsolete in the country. “In India the technical model of service delivery is obstetrician based”, according to Smita Bajpai who works in the Ahmedabad based NGO, Chetna that works extensively in the field of female health. This means that the women are encouraged more to go to the hospitals which may be a long way away rather then finding someone to help them at home.

The concept of midwives

Meanwhile, the concept of midwives and delivery at homes is getting more and more popular in countries like Germany. “In Germany a midwife can actually perform a delivery without a doctor whereas a doctor needs to have a midwife at the time of delivering a child”, says Kirstin Mainz-Riehl, a counselor at Profamilia, a non-governmental organization that offers counseling on family issues to women.

The MMR of Germany is one of the best is the world at 7 deaths per 100,000 live births. This shows that simple methods can work wonders if used properly. Mainz-Riehl says that the profession is now so much in demand that it is hard to get a place in the midwife training schools..

Safer deliveries at home might also be a better idea for women in India. “Healthcare should be available at the doorstep level especially for pregnant women. By the time they reach hospitals, which sometimes are hundreds of kilometers away, they develop a lot of complications and many die en route to the hospitals”, says Dr. Chandreshekhar, who works as a consultant gynecologist and obstetrician back in India. Steps are being taken in this direction and Chaturvedi says that UNICEF has trained many women in Uttar Pradesh to conduct safe deliveries at home.

Women need to be aware

The Sri Lankan ambassador to Germany talked of education and awareness as a very important component of the process of getting the birth rate down. In India the official NRHM (National Rural Health Mission) trains women called ‘Ashas’ to visit every home in the village and find pregnant women and get them to hospitals. There are no indications on how effective the system has proven for pregnant women, also because the process does not focus on creating awareness.

In Germany a lot of stress is on counseling. Mainz-Riehl says that, “Every woman of Germany has access to free counselling if she wants to take it”. She also adds that involving the male partner in counselling is also getting more and more popular. Doctors in Germany prefer the father of the child to be present at the time of delivery. He may also be asked to perform vital tasks like cutting the umbilical cord or giving the baby its first bath.This is contrary to the system in traditional societies in India where males are hardly involved in prenatal care or delivery.

The use of simple techniques in a practical way and the proper management of policies is all that is required in India. As Chaturvedi puts it, “A kind of health revolution is basically what we need, where every women gets counseling and goes to a primary health centre sure to find a doctor."

Author: Benish Ali Bhat
Editor: Manasi Gopalakrishnan