India'sreport card on mother'shealth and maternal mortality rate (MMR) once again highlights the gulf that separates India'sreality and aspiration.
The variation of maternal mortality is an indicator of disparity and inequity in access to appropriate health care and nutrition during pregnancy and childbirth in different states. National Population Policy 2000 and National Health Policy 2002 are aimed at reducing the maternal mortality rate to 100 per? 1,00,000 live births by 2010 from the current level of MMR of 400 to 500. Experts feel that at least 40 per cent of all pregnant women experience some type of complication during their pregnancies and about 15 per cent of these complications are potentially life-threatening and require emergency obstetric care. This is the very reason that Indian Medical Association (IMA) wishes institutional deliveries by skilled person (doctor/nurse/ANM) which can be available anywhere in both public or private health centres. The death of a woman during pregnancy and childbirth is not only a health issue but also a matter of social injustice to woman.
Reasons of high mortality
* Still about two-third of all deliveries take place at home in India. The proportion varies from less than 35 per cent in urban areas to more than 75 per cent in rural areas. In states like Uttar Pradesh and Bihar, only about 15 per cent of children are born in medical institutions.
Women not seeking antenatal care
One out of every three women (34 per cent) in India did not receive an antenatal check-up. Only 7 per cent receive antenatal checkup during the last three months of pregnancy. Only one-third women take iron, folic acid supplementation that too markedly inadequate in number. Concept of postnatal care is grossly deficient and almost non-existent.
Teenage pregnancy and their risk of dying
Despite the Child Marriage Restraint Act (1978), 35 per cent of all women are married below the legal minimum age of marriage, which is again higher in rural areas (40 per cent) than in urban areas (18 per cent). The adolescent girls thus face considerable health risks during pregnancy and childbirth. Girls aged 15-19 are twice as likely to die during childbirth as women in their twenties, those underage 15 are five times likely to die. It is estimated that 50 per cent girls are not only married, but also complete their families by 20 years of age.
Though these facts say nothing new, none the less, carries its old power to shake us out of our complacency. Our neighbours, Sri Lanka and China have outstripped India in the race to reduce maternal and child mortality, their figures are one tenth of ours.
The figures of maternal mortality are not to be judged by the same yardsticks as those on education and health. The last two are the state'slow priorities, while maternal mortality is a reflection on social mores and importance/status of women in general. India'sbad record on maternal mortality is actually regarded as part of Asian enigma, locked with wider regional anomaly. But if Gujarat can do it, why not Rajasthan, UP and Bihar follow the same guideline of having more institutional deliveries. Campaign should be launched that ?No woman should be allowed to deliver at home?.
Reasons for under-utilisation
1) Women lack awareness of the importance of delivery taking place in healthcare centre.
2) Lack of decision-making power within the family.
3) Lack of awareness of location of health services.
4) Cost : direct fees as well as the cost of transportation, drugs, etc.
5) The poor quality of services, including poor treatment by health providers also makes some women reluctant to use services.
Interventions and solutions to reduce maternal mortality
1) Women should know that it is their birthright to have quality service.
2) Make the delivery services available to every woman by utilising the potentials of primary health centres.
3) Delivery by skilled attendants, nurses or doctors.
Safe motherhood has placed maternal mortality issue in the context of human rights, urging governments to use their political, legal and health systems to fulfill the obligations imposed by their endorsement of various international human rights instruments. Making motherhood safe, therefore, requires quality health services. The women and adolescent girls must be empowered and made aware of the legal age of marriage and their human rights including their rights to good quality services and information regarding care during pregnancy and after the childbirth.
It is often argued that there is nothing intrinsically wrong about women delivering at home. As a matter of fact, many of our readers have been born at home and are none the worse for it.
Such simplistic reasoning, however, ignores over the fact that there is a huge difference in the situation and prospects of an urban middle-class woman and a woman from a poor family in a village in Uttar Pradesh or Bihar.
The urban woman, probably well-nourished, has been going to a doctor regularly for check-ups, and has been given anti- tetanus injections. She delivers in a clean place with a trained nurse in attendance and a doctor within the reach in case of emergency. For her, delivering at home is a matter of choice.
The village woman on the other hand, has a high chance of being anaemic and underweight, of not having seen a doctor and not being protected from tetanus. She does not have access to a doctor or a hospital in her own village. For her, delivering at home, is an open invitation to possible death.
(The writer is the chairperson, Women Wing of the IMA.) Table : Shows current maternal mortality figures across the country India Rajasthan UP MP Bihar Orissa Kerala AP TN Gujarat 407 670 707 498 454 367 198 159 79 28