Tuesday, October 31, 2006

Mother, child mortality rate dips

Published in The Pioneer. Nov. 1, 2006

India's aspiration to be the next super-power is sobered by the fact that every fifth woman in the world is dying of poor medical care during the childbirth resides here.

On Tuesday, however, registrar general of India gave reason to hope that the country is pulling itself out of the bottom-of-the-barrel as a survey of infant mortality and death of mothers during childbirth has shown a sharp decline between 1996 and 2003.
In 1997, as many as 400 women died during the childbirth due to non-availability of proper medical facilities. Awareness on better nutrition for the mother, higher age of marriage of girls and availability of better medical facilities in the past decade or so has seen this number dip to about 300 per lakh live birth, according to the recent report.
The number of children dying before attaining one year has also declined from about 70 per lakh children born in 1997 to 58 per lakh children born in 2004.

The latest survey was conducted among 15 million women in the age group of 15 - 49 years. It found a direct correlation between saving mother's lives and deliveries in clinics or nursing homes. However, over three fourth of pregnant women deliver at home partly out of ignorance and rest out of lack of medical facilities in the rural areas. "The survey clearly brings out that to bring down the maternal mortality there is no substitute to women's education, increasing age of marriage and institutional delivery," health secretary Prasanna Hota said.

Worst performers are the so-called BIMARU States comprising Uttar Pradesh (517), Assam (490), Rajasthan (445), Madhya Pradesh (379), Bihar (371) and Orissa (358). Except Assam, these are also the most populous States and outweigh the better performance achieved by Kerala, Tamil Nadu, Maharashtra, Haryana and Gujarat.

The survey identified hemorrhage as the chief cause of mother's death, followed by septicemia and abortion. Women delivering at very young age and a quick second pregnancy are particularly vulnerable, the survey said.

The National Rural Health Mission (NRHM) and States are offering incentive to health workers and expectant mothers to register and deliver at the nearest Government clinic. Under NRHM, the health worker trained in the community is offered financial incentive to encourage the family of expectant mother to visit health clinic at least thrice during the pregnancy. Money is also given to the health workers to meet incidental expenses like transportation costs in case any complication arises. Progressive States are offering additional incentive to encourage institutional deliveries.

An earlier survey by the Health Ministry, National Family Health Survey, found that Dalits were least likely to opt for institutional deliveries while Christians and Muslims were better-off in giving priority to delivery in nursing homes.

Who cares ? 1739 infants died unnoticed in Katni

This was published in Dainik Jagran in Katni. As a part of our endeavour to make the effort visible we are reproducing it here as it is.

Monday, October 30, 2006

IMR on the rise in Burhanpur

Published in The Pioneer on October 31, 2006

Staff Reporter Bhopal
Burhanpur district in Madhya Pradesh has a maternal mortality ratio of 800 per one-lakh live births and an infant mortality rate (IMR) of 96 per 1,000 births, which is higher than the State's average.

In order to combat this, the district administration has been pushing many schemes to promote institutional delivery, immunisation and other schemes, which the State had launched.

District chief medical & health officer has spent Rs 53 lakh in 2005-2006 and Rs 60 lakh in 2006-2007 (till now) from Information Education and Communication (IEF) funds available under RCH II programme for promoting these schemes, which has had a little impact.

On October 19, district secretary in charge Abha Asthana had been to Doifodia primary healthcentre of the Kharnar block and she had expressed her concern on the situation there. Interestingly, the district does not have any figures of the maternal and infant deaths, which took place in the district so how can success of these schemes be evaluated.
Chief medical and health officer Dr GS Awasia said that the transport scheme had started in 2004 and the department doesn't have IMR and MMR figures of the past two years.

Similarly, the situation is grave in Katni district, where Payri Ma scheme was launched by the State in February 2006 with lot of publicity. The purpose was to promote institutional delivery and help combat maternal mortality. The scheme was launched with aim of getting publicity in the name of social service, without any technical inputs.
Within two months of its launch, glitches started pouring in. In the first month, 224 women were awarded as promised in the scheme, the numbers of awards given (not promised) started dropping after two months. The question was how to fund the same, first it was flexible funds available under different heads. Finally, IEF funds came handy for its survival.

Link to the story

Sunday, October 29, 2006

District's beloved mother is on dialysis

Published in Dainik Jagran, Katni as a feature in Hindi. The summary of the same is produced here in English.

Payri Ma is a name of the scheme which was launched by the state in February 2006 with lot of publicity in 6 bocks of Katni district. The purpose was to promote institutional delivery and help combat maternal mortality. Naturally the scheme was launched with aim of getting publicity in the name of social service, without any technical input, into it.

Just within two months if its launch the glitches started coming in. In first month 224 women were given awards as promised in the scheme, the numbers of awards given (not promised) started dropping after two months. Naturally the big question was how to fund the same, first it was flexi funds available under different heads, finally IEC funds came handy for its survival. Though the number of institutional delivery rose in first two months but started giving way, though there is no evaluation why did number increased and how it came down ?

Today scheme is just on dialysis may or may not survive till its first birth day.

Translation by the blog team.

State Schemes for combating MMR face implementation glitches

As published in the Raj Express today October 29, 2006

Schemes initiated by the State of Madhya Pradesh for reducing maternal and infant deaths are not being implemented properly. Maternal and infant deaths continue to happen.

Burhanpur – District Burhanpur in the state of Madhya Pradesh has maternal mortality ratio of 800 per one lakh live births while infant mortality rate of 96 per thousand births, which is quite higher than the state’s average.

In order to combat the district administration by the state’s support has been pushing many schemes to promote institutional delivery, immunization and other schemes which state had launched. Till now district Chief Medical & Health Officer’s office has spend Rs 53 lakh in year 2005 – 2006 and Rs 60 lakhs in te year 2006 – 2007 (till now) from IEC funds available under RCH II programme for promoting these schemes, which has had a little impact.

On October 19 Secretary in charge of the district, namely Abha Asthana had been Doifodia primary health centre of the Kharnar block and she had expressed her concern on the situation there. Interestingly district does not have any figures of the maternal and infant deaths which have happened in the district so how does one evaluate the success of these schemes.
Report in Raj Express has a quote of Dr G S Awasia, Chief Medical and Health officer saying that transport scheme had started in 2004 and we don’t have IMR and MMR figures for last two years.

Comments on the story by the blog

IMR figures and MMR figures no doubt are available at state level, and are not calculate every year. Latest one though old are by sample registration system of GOI which state that IMR Of state is 79 per thousand and MMR is 498 per one lakh live births. It is not easy to calculate figures again and again but nevertheless district should be having the number of maternal and infant deaths in the district, and one can see how the district is progressing, if they do not have the same, then…..

Story translated from Hindi to English

Saturday, October 28, 2006

Government, NGOs stress on safety of mothers

On Mothers Day, the Madhya Pradesh government and NGOs have called on all sections of civil society to ensure safety of mothers and children. Chief Minister Shivraj Singh Chouhan urged women to rise above politics and work towards their welfare by benefiting from government schemes aimed at curbing maternal mortality rate and infant mortality rate in the state. Maternal mortality rate in Madhya Pradesh is as high as 498 whereas the situation in case of infant mortality rate is equally alarming - 83 out of 1,000 children die before their first birthday.

Organisations like Madhya Pradesh Jan Adhikar Manch, Madhya Pradesh Voluntary Health Association, Mahila Chetna Manch and Centre for Advocacy have raised the issue with political leaders and highlighted loopholes in the system.


Cultural determinants of maternal and infant mortality in Madhya Pradesh e concern on maternal deaths in MP

Cultural determinants of maternal and infant mortality in Madhya Pradesh (Déterminants culturels de la mortalité maternelle et infantile au Madhya Pradesh)

Author - SAHAY Sarita

Résumé / Abstract- The maternal and infant mortality rate is very high in Madhya Pradesh. Rampant poverty causing severe malnutrition to all and particularly to pregnant women, low age at marriage, early pregnancy, subordinate status of women and certain old age beliefs related to child bearing and rearing practices are some of the major proximate cultural variables, said to be responsible for this situation.

Unwillingness to avail available immunization courses to protect the children against some of the killing diseases, breast feeding without adding supplementary mash food at proper age and practice of sudden weaning further aggravate the situation. This study reveals many interesting perspectives of these happenings that have been analysed in the light of failed observations in the different districts of Madhya Pradesh.

Journal title - Man in India, Ranchi, INDE (1) (Revue)

Link to the story

Friday, October 27, 2006

Gram sabhas raise issue of maternal mortality

Published in The Pioneer, October 25, 2006, Bhopal Edition

High maternal mortality rate (MMR) in Madhya Pradesh was an issue of debate in the gram sabhas held recently in local panchayats of Gwalior, Chambal, Vindhyachal and Bundelkhand regions of the State. Approximately 50 such special gram sabhas have been organised till now. People who have attended gram sabhas have made out a demand note, which they are sharing with the district administration for implementation.

Jan Adhikar Manch, a network of NGOs working on raising concern over the high maternal mortality in Madhya Pradesh, as a part of their 'save our mothers' campaign in collaboration with local panchayats held various gram sabhas. Sandesh Bansal State coordinator of the Manch told The Pioneer that in these sabhas, the villagers are sensitized about the various schemes available for their benefit being run by the State.Issue of high maternal deaths and lack of adequate facilities in the pancahyat for women health and lack of staff at the primary health centres and anganwadi were the main points. Benefits of the Deen Dayal Antoyadaya Yojana not accruing to all those below the poverty line category, weak village health societies, poor infrastructure and lack of health facilities at the village level were some of the points that came up for discussion.

In Maanpura in Bhind district, more than 200 people had participated wherein issue of the schemes benefit not accruing to all came up in the discussions.During the sabha, people also felt that there was an acute shortage of water in the village and women had to travel long distances to collect water, which impacted on their health especially the pregnant.Bansal also informed, "We have also written to the Chief Minister urging his intervention to help strengthen efforts to combat high maternal deaths.

Link to the story

Rural women demand right to health

Published in The Hindu - October 5, 2006

Maternal mortality rates in rural areas are among the highest in the world

Call to ensure that the dream of safe motherhood becomes a reality

BHOPAL: A large number of women from villages across Madhya Pradesh have joined a signature (or thumbimpression) campaign to press for their right to health and to call upon the Government to ensure that the dream of safe motherhood becomes a reality.

Manoj Joshi of Voluntary Health Association, an NGO working for the cause of women's health, told The Hindu on Wednesday that the maternal mortality rates in rural areas across the country are among the highest in the world. It is estimated that pregnancy-related deaths account for one-quarter of all fatalities among women aged between 15 and 29, with over two-thirds of them considered preventable.With maternal mortality ratio of 498 per one lakh live births, Madhya Pradesh ranks third in the country when it comes to maternal mortality, he said, adding that there are 13,000 maternal deaths in the State every year.

For every maternal death in India, an estimated 20 more women suffer from impaired health, Mr. Joshi said raising the issue of safe delivery.He said that as part of a special drive to raise concern on this crucial issue, more than 20,000 women from different villages of the State are now in the process of signing (or placing their thumb impression) on a banner demanding the right to health and calling upon the State to ensure that the dream of safe motherhood becomes a reality. Mr. Joshi informed that a network of 60 NGOs, linked with the Madhya Pradesh Voluntary Health Association and Madhya Pradesh Samaj Sewa Sanstha were involved in the signature campaign.

The NGOs have been given two banners each to collect signatures/thumb impressions of women after they are adequately sensitised on the issue of maternal mortality and feel that some concrete action is needed to improve the situation. The women plan to present the banners with their signatures to the State Chief Minister.

Link to the story

State of Misery

Published in Frontline (Volume 23 - Issue 21 :: Oct. 21-Nov. 03, 2006)

The Sahariya tribal population in Sheopur district continues to suffer from hunger and malnutrition.LIFE for the Sahariya tribal people in Madhya Pradesh is an unending struggle against hunger, malnutrition, disease and, above all, neglect. In August 2006, Frontline reported hunger-related deaths in Sheopur district, which has a high concentration of Sahariyas. Earlier too, in May 2005, Frontline had reported hunger-related deaths in the district. In another visit in October 2006, Frontline found that not much had changed except in Patalgarh, the village that was in the news so often in the past year, and for all the wrong reasons. In other villages, children continue to slide into the dark folds of hunger, and disappear.

In Ranipura village, about 60 kilometres from the district headquarters, eight children died this year, six of them in August. Right to Food activists had prepared a list of severely malnourished children whose lives were in danger and who needed immediate medical attention. By the time Frontline visited the village in the first week of October, two of the children, both one year old, were dead: Raju, son of Ramdin Sahariya, and Aphim, son of Jasbir Sahariya.Local residents were not sure what went wrong, but they said that the children became weak and looked like they were "drying up from the inside". Imarti, the helper at the anganwadi centre in Ranipura, said: "We did what we could for Raju. I gave him biscuits to eat, but couldn't save his life. What can I do? The jeep [the mobile medical unit] came only twice in the last couple of months. The medicines were not working anyway. If there is no jeep, how am I to take the children to the hospital? Where is the money?"An elderly person of the village, Ramratan Sahariya, put the matter in perspective: "The world dances to the tune of money. That is the trouble." The real trouble is that the Sahariya tribal population in Sheopur district has very little money and therefore limited access to nutrition and health care.

The Sahariyas are one of the three most backward tribes in Madhya Pradesh; they are entitled to BPL (below poverty line) ration cards (which many of them do not have), basic health services and at least 100 days of employment a year. Their children are entitled to mid-day meals in schools. Despite these entitlements, deprivation persists.There is a mobile `medical van' that goes around the district; but it usually visits only 20-25 villages that have been identified as `hotspots' of sickness.Jeevan Devi, who is at least 60 years old, of Gothra village in Karhal block, is suffering from swelling of the stomach, which probably needs surgery. She said she had gone to the district hospital but "the hospital asks for money. They say it will cost at least Rs.4,000-5,000. I do not have that much. Even the nurse asks for money." BPL families are supposed to be given health cards, which entitle them to free treatment up to a certain amount. But residents of this village have never even heard of this.

In Kapura hamlet, at least 13 children have died over the past year. None of their names is to be found in the anganwadi register. The anganwadi worker, Bilasi Devi, cannot write; her husband helps her to maintain the register. She told Frontline: "My superviser came and took down the names of the dead children, but she did not give me a copy." There were other irregularities in the Integrated Child Development Services (ICDS) records. For instance, there were no names of children under one year. In short, there were no records of births or deaths.Recently, a Supreme Court-appointed Joint Commission of Inquiry visited Sheopur district.

The team included activists, doctors and government representatives. P.S. Vijay Shankar, the representative sent by the Supreme Court adviser Dr. Mihir Shah, told Frontline that the commission's report was not yet ready, but that going by first impressions nothing seemed to be working in the district. "Because there was a huge hue and cry, they are doing something for Patalgarh. The Collector often visits the village and activists keep a check too. But elsewhere, curative health in tribal hamlets is almost absent. You cannot even find private hospitals. There are some preventive services, like vaccination. However, in an emergency, the whole structure collapses."The team was witness to some interesting exchanges. In Ranipura, the primary schoolteacher showed up, asking how he was expected to manage alone a school with 108 children. The villagers responded by shouting at him, saying that since he did not "manage" anything at all, he should not talk. The school was open only about once a week, on an average, and that was the only time their children got their mid-day meals.

In another instance, the villagers' job cards were found to be in the custody of the panchayat secretary. After some interrogation by the team, the sarpanch admitted that he and the secretary had split between them the funds meant for wages for work under the National Rural Employment Guarantee Act (NREGA)."Patalgarh was, in fact, the best we could hope to find," Vijay Shankar said. "At least, temporary BPL cards had been issued as an emergency measure after the media reports last year. The villagers were still using them. NREGA schemes were working. Job cards were distributed. A link road is being made. The PDS [public distribution system] supplies are now being sent on a tractor, instead of waiting for the villagers to come to the ration shop." The only problem with this arrangement is that the date of distribution is not a fixed one, and the villagers are never sure when exactly the ration-bearing tractor will show up. If they miss a month's quota of 35 kg of rations, they miss it for good; there is no `carry-over' quota when the rations arrive the following month. Even otherwise, they rarely get more than 30 kg.Vijay Shankar pointed out that in 2004 the apex court ruled that if people could not afford to buy even subsidised grain at one go, they should be able to buy their rations in parts. "This is not happening. If they cannot afford to take it all at once, they can say bye-bye to their rations."An observer present during the court-appointed team's visit said that things have started to change. "There is some social support now, which was missing five years ago.

People are getting work, almost at their doorstep. All of it adds up. That a tractor comes with ration supplies is also a good sign. That way, collecting rations becomes a collective event, and it is harder to turn away people. It is harder to push them around now. Patalgarh is moving in the right direction."Maybe. But Patalgarh is only one of the many tribal villages of Madhya Pradesh that continue to suffer. Jaddapura village, for instance, even more remote than Patalgarh, has recorded at least 10 deaths this year; five of the dead were children. But it gets no attention because, unlike in Patalgarh, no doctor has certified that these deaths were caused by hunger.The administration, of course, denies that there were any starvation deaths in the region. The children who died never got any medical examination, so it is impossible now to prove what killed them. However, Collector M.S. Bhilala admitted that there is widespread malnutrition in the district. "We cannot deny it. It is a perennial problem among the Sahariyas, especially because they are not educated and are very superstitious. But we are also facing a severe shortage of staff. There is approximately a 40 per cent shortage of medical staff, anganwadi workers, teachers and so on. We have written to the State administration and asked for more support. There is one malnutrition rehabilitation centre in Sheopur and we are trying to set up centres in Vijaypur and Karhal."Such centres are needed urgently.

In Sheopur, 57.68 per cent of the children are malnourished, 2.59 per cent of them severely so. Madhya Pradesh has a bad overall record, with 49.2 per cent of the children being malnourished. Compounded by the lack of health services, this translates into a higher death toll. As Vijay Shankar put it - "Hunger is part of the backwardness package, and the Sahariyas are particularly vulnerable. Our aim, during this trip, was not to establish that starvation deaths happen. Those are like the flashpoint at the tip of the volcano. We have to listen to the rumblings beneath the earth.

"link to the article


Birthing Nightmare

by Sachin Kumar Jain

A visit to Balwadi health centre in Badwani district of Madhya Pradesh gives the true picture of the little progress the state has made in the area of health care. This health centre caters to around 30 villages which have around 21,000 people (mostly tribals). Since 2002, the health centre has not had any doctor visit the centre. A compounder does the doctor's job. Medicines and equipment are not available for upto nine months in a year.

In 2004, 13 children died due to malnutrition-related problems and 34 women died while giving birth in Balwadi. This scenario is not restricted to Balwadi. Inadequate basic health care has made many women and children vulnerable to disease and death in Madhya Pradesh.

Recently, in Reethi block of Katni district, at least 20 out of 32 infants died in a government hospital which caters to 56 villages. There are no gynecologists in the hospital; no surgery department or provision for emergency services or medicines. Only one disabled woman doctor tries to reach out to maximum patients here.

Around 700 out of 100,000 women in Madhya Pradesh die every year while giving birth. Over 70 per cent births take place outside hospitals and 53 per cent births are managed by untrained persons. However, despite the increasing number of deaths, neither the local administration nor the state government has taken any notice of the trend. The officials appear preoccupied with serving politicians and have little time to respond to the medical crisis. On paper, there are several attractive government health schemes but lakhs continue to die of curable diseases in Madhya Pradesh.

In 2004, the state government initiated the Deendayal Antyodaya Upchar Yojana, aimed at providing at least 220 million people with better health facilities. This scheme has the provision of free health services up to Rs 20,000 per annum for poor families. However, hardly 14,360 poor people have benefited from the scheme. Critics of the scheme say that only people with some political influence can access the scheme. Again, while the state government made a lot of noise about giving women their maternal health rights, it has not done much to implement the scheme for maternity benefits.
The scheme provides for Rs 150-Rs 300 as transport allowance to pregnant women for travelling to the health centre. But a study conducted by the Centre for Advocacy - a resource centre in Bhopal - reveals that 53.7 per cent actual beneficiaries are not aware of any such scheme and among those who know about it, barley 0.8 per cent have benefited so far. In fact, a few years ago, the Supreme Court (while responding to the Right to Food Public Interest Litigation) directed all the state governments/union territories to implement the National Maternity Benefit Scheme (NMBS). It asked the states to pay all pregnant women, who belong to Below the Poverty Line (BPL) families, Rs 500, 8-12 weeks prior to the delivery, for each of the first two births.

The most important feature of this Supreme Court order was to convert the scheme into a universal entitlement for all BPL pregnant women. The court order was an important step towards looking at maternal relief as a source for ensuring food security for women during the critical months. This, for the first time, also ensured maternity relief as a legal entitlement to women in the unorganized sector.

But the Madhya Pradesh government has done little to take the scheme to the needy women. The government has reached out to only 3.7 per cent of the potential BPL beneficiaries.
Even the Madhya Pradesh Family Welfare Programme Evaluation Survey of 2003 claimed that barely 25 per cent of the rural population is covered by the maternity scheme. Research also indicates that in recent years, over 70 per cent women have died due to excessive bleeding, infections, insecurity and high blood pressure during child birth.
According to one research, only 43 per cent women in the state deliver with the help of a trained midwife; around 77 per cent don't have access to any medical facilities and undergo unsafe deliveries.

Birthing, in Madhya Pradesh is indeed a nightmare for women.

February 5, 2006

Link to this story

Poor pregnant women expect little in Madhya Pradesh: Report

April 15, 2006 Released by IANS

When India celebrated Safe Motherhood Day on Tuesday, the lacuna in proper care for women during pregnancy and childbirth made it less of a celebration this year in the villages of Madhya Pradesh.Poverty and pregnancy form a lethal cocktail that strikes down rural women in the state, denying them basic and antenatal care, nutrition or medical support.

Prema Bai from Hardhot village, over 70 km from Raisen district headquarter in Madhya Pradesh, is four months into her pregnancy. Wife of a daily wager, she and her husband earn a paltry Rs.40 each daily to feed their five-member family. Medical supplies and prescriptions remain a distant dream as Prema struggles to manage one square meal a day.With every meal at stake, visiting a doctor for an antenatal check up is out of the question. Consequently, she is left with no choice but to trudge in her neighbour's bullock cart to the only government clinic in the village for free medical treatment."For an expectant mother in the remote areas of Madhya Pradesh, it is common to travel in bullock carts or cycles over pot-holed roads to distant rural health centres in the hope of getting proper healthcare," health experts say. However, these centres hardly have any bed to offer to the patients, and painkillers are the only medicines available. Of course, they do offer advice to Prema and other pregnant women to visit a gynaecologist.

But no gynaecologists are available in a village like Hardhot.

"The situation is worse in rural areas," says a new Population Council study.The study adds that less than half of the pregnant women, mostly illiterate and socio-economically disadvantaged, don't even seek any care."The women think that check-ups were not necessary (60 percent) or not customary (four percent)," the report reveals.

Lack of knowledge regarding the importance of antenatal care, the long trek to health centres and a lack of cheap transportation are other bottlenecks that pregnant women face."An inability to meet costs related to visiting a health facility prevents 15 percent of the women from undergoing such check-ups."Still, some of the poor women reach the nearest available medical facilities in the hope of getting better care but are mostly left to fend for themselves.Compelled by myriad disadvantages, the women in rural areas opt for home delivery often in dangerously unhygienic conditions, increasing the chances of fatal complications both for the mother and child.A majority of maternal deaths take place after delivery, most of them within 24 hours after childbirth, for want of postpartum care, which allows health workers to detect and manage problems and to make sure that the mother and child are doing well.The state government had came out with a new Reproductive and Child Health Programme in 1990, but its success can be gauged by Prema's trauma.In a state where women on an average have three children, the maternal mortality ratio is one of the highest in the country, said the study.

Madhya Pradesh Health Minister Ajay Vishnoi, however, seems satisfied with the government schemes promoted by the state under the Rural Health Mission.Though he admitted that fighting traditional gaps would take time, he said: "We will soon be appointing lady officers in rural areas to assist pregnant women and ensure safe delivery with post-pregnancy childcare."

The truth is that despite several improved maternal child health services and postpartum programmes aimed at safe motherhood, the lives of many women in the reproductive age group here are still at risk.

The story is available at


Thursday, October 26, 2006

Women died while delivering her baby in the state capital

October 26, 2006 - Published in Rajya ki Nai Dunia and Raj Express, both are published from Bhopal (in Hindi)

Last night a woman died while delivering a baby in the state capital, Bhopal. Child is said to be safe. Nishatura police station sources told media that Makinbai of Chindwara and her husband Budanlal was working as construction labourer at Vishal estate situated at the bypass road. Last night she had labour pains. During delivery she had excessive bleeding, when she was rushed to the DIG bungalow situated hospital, where she breathed her last.

English version - Translated by the blog

Arrest maternal, infant mortality

May 17, 2006 Published in CENTRAL CHRONICLE, Bhopal

Bhopal, May 16 : Chief Minister Shivraj Singh Chouhan has urged people's representatives and NGOs working in health sector to actively participate in the implementation of initiatives devoted to arresting maternal and infant mortality rates in the state.

He said the concrete results could be achieved only by promoting institutional delivery. He was inaugurating Vijaya Raje Janani Kalyan Bima Yojana at the Jai Prakash Hospital premises here today.
The expectant mothers belonging to poor families would be given Rs 1000 for institutional delivery under the scheme. This amount is in addition to the cash amount provided to mothers under Janani Suraksha Yojana or as transportation and treatment expenses for safe delivery.

If a mother dies of delivery-related complications in six weeks of delivery her dependent would be given insurance amount of Rs 50,000. The Chief Minister said that a number of steps have been taken for improving health delivery system such as recruiting doctors, construction of hospital buildings at different levels, creating new posts of paramedical staff, raising the budget for meals to indoor patients. Besides, measures like Dindayal Antyoday Upchar Yojana, round the clock delivery has also been taken.
Expressing concern over death of infants and mothers for want of facilities despite advancements in every sector, the chief minister stressed on making special initiatives for ensuring institutional deliveries of mothers who cant afford expenses in private hospitals. He urged people's representatives to take steps for making poor families aware of the benefits of institutional delivery especially in rural areas. The Chief Minister handed over a cheque for Rs 4.40 crore to the United India Insurance. Minster for Health Ajay Vishnoi said that the Vijaya Raje Janani Kalyan Bima Yojana would have a far-reaching impact. He urged the doctors and paramedical staff to take up extra responsibilities in the interest of poor families and mothers.
Principal Secretary Health Shri Madan Mohan Upadhyay gave details about the scheme and informed that a target has been set for achieving 50 percent institutional delivery this year. At present the percent of institutional delivery is only 33.

Minister for Finance Raghavji, Director Information Communication Bureau Ms Rashmi Arun Shami, United India Insurance General Manger, doctors, paramedical staff were present. Director Health Services Dr Yogiraj Sharma conducted the function.

Link to the story


May 16, 2006 - released by IANS

Expressing concern over the high maternal mortality rate in Madhya Pradesh, Bhopal Archbishop Pascal Topno has called upon self-help groups to help check the menace. With 13,000 reported deaths every year during or post pregnancy, the maternal mortality rate of the state is one of the highest in the country.

Addressing a women's meet at the missionary-run Asha Niketan Welfare Centre here, Topno urged them to tap government programmes and schemes to promote safe motherhood. More than 250 self-help groups from various districts, including Hoshangabad and Sehore, participated in the meet organised by the Madhya Pradesh Samaj Sewa Sanstha.

"The main causes behind the high rate of maternal mortality include delay in recognising complications in the first pregnancy, hindrances in getting pregnant women to hospitals and pregnant women not getting any medical facility at all," other speakers noted.

However, they acknowledged that the government was beginning to tackle the issue of maternal mortality on priority basis ever since activists encouraged by the UNICEF started the issue. While UNICEF communication officer Anil Gulati helped accomplish an action plan to combat maternal deaths, Vandana Agarwal of the same organization elaborated on the causes of such deaths and measures to prevent them.
"Anemia is one of the important factors contributing to maternal deaths," she told the participants and explained how to recognize its symptoms and prevent it early.

Link to the story -

Wednesday, October 25, 2006

Miles to go to reach the MDGs in Madhya Pradesh

Madhya Pradesh’s estimated per capita expenditure per month on food is Rs 128.60 — the lowest in the country. This is a clear indication of the widespread poverty and lack of livelihood security in the state.

The Common Minimum Programme (CMP) of the current United Progressive Alliance (UPA) government and the National Development Goals articulated in the Tenth Five-Year Plan are broadly in agreement with the Millennium Development Goals (agreed upon by 189 countries in 2000) of poverty reduction, achieving universal primary education, promoting gender equality, reducing child mortality, improving maternal health, and ensuring environmental sustainability.

India’s share of the world’s responsibility in meeting the MDGs is phenomenal. It accounts for 25% of global maternal deaths, 34% of the world’s underweight children, 23% of under-5 children deaths, and 28% of the world’s poor living on less than $ 1 a day.

A further disaggregated analysis at the state level brings out different levels of human development and varied performances of state policy in guaranteeing protective and promotive social securities. Inter-state comparisons are important from the perspective of the MDGs, for they identify low-performing states that have to be goaded out of their slumber if the promises made in the Millennium Declaration are to be kept.

Madhya Pradesh and the Millennium Development Goal

Madhya Pradesh is an important Indian state; second largest in terms of area, with around 6% of the country’s population. In 2000, the new state of Chhattisgarh was carved out of Madhya Pradesh’s tribal-dominated regions. In its present form, Madhya Pradesh comprises 9 commissioner divisions, 48 districts, 272 tehsils and 313 community development blocks including 89 tribal development blocks. Its local self-governance structure comprises 45 zilla (district) panchayats, 313 janpad (block) and 22,029 village panchayats. The state comprises five distinct regions — Malwa, Nimar, Bundelkhand, Baghelkhand and Mahakoshal — with great differentials in human development indices.

According to the 2001 census, 20% of Madhya Pradesh’s population is classified as tribal, and 15% of its population belongs to the scheduled castes. Among its districts, Jhabua, Dindora, Barwani, Mandla, Shahdol, Umaria, Betul, Seoni, West Nimar and Sidhi have a tribal population of over 30%. The scheduled caste population is concentrated in the districts of Datia, Chhatarpur, Ujjain, Tikamgarh, Shajapur, Gwalior, Morena, Bhind, Sagar, Vidisha, Sehore, Panna and Damoh. The generic profile of these structurally poor groups is marked by deprivation of even basic services like health, education and sanitation (due to the discriminatory caste system, geographical location and culture), and the state’s denial of land, water and forest rights, resulting in an erosion of livelihood opportunities. The inequality of opportunities faced by scheduled castes and scheduled tribes prompted the third Human Development Report of Madhya Pradesh (2002) to highlight the need for an ST-SC Development Index.

With 37.4% of its population below the poverty line, Madhya Pradesh is one of the poorest states in the country. It ranks third among the traditionally BIMARU states (Bihar, Madhya Pradesh, Rajasthan and Uttar Pradesh) and Orissa. It has an above-all-India average percentage of poor, while the state’s per capita income falls below the national average of Rs 15,626. Madhya Pradesh’s estimated per capita expenditure per month on food is Rs 128.60 — the lowest in the country. This is a clear indication ofwidespread poverty and lack of livelihood security that affects a sizeable population of the state (State HDR, 2002). An estimated 38.2% of women in Madhya Pradesh are undernourished (39.9% of scheduled caste and 49.2% of scheduled tribe women). Around 56% of its children suffer malnutrition. The amount of foodgrain supplied to the state under the public distribution system is extremely low (it constitutes only 2.78% of total cereal consumption by levels of calorie intake), compared to states like Andhra Pradesh, Kerala and Tamil Nadu (Citizen’s Report on MDGs).

Madhya Pradesh’s performance on several human development indicators is dismal. At 85 per 1,000 live births, the state has a high Infant Mortality Rate (IMR), second only to Orissa at 87; the country average is 63 (SRS 2004). Similarly, the Maternal Mortality Rate (MMR) of undivided Madhya Pradesh, at 498, is extremely high, in league with Uttar Pradesh and Rajasthan and the all-India average of 407.
While the state has shown marked improvements in literacy, from 27.90 in 1981 to 64.11 in 2001, only 50% of females, as against 77% of males, are literate.Around 38% of rural households do not have access to safe drinking water. Given the fact that diarrhoea kills 400,000 under-5s each year in the country, and waterborne diseases afflict a sizeable number of poor people, adequate and safe drinking water is necessary to ensure healthy lives and is an important component of public health.

Madhya Pradesh’s overall ranking in the Human Development Index constituted by education (literacy and children’s enrolment in schools), health (life expectancy) and per capita income, is much below the all-India average and very low compared to most states, with the exception of Bihar, Assam and Uttar Pradesh. At the district level, the Human Development Index varies between 0.694 (highest) for Indore and 0.372 (lowest) for Jhabua. Similarly, the Gender Development Index, which disaggregates education, health and income figures in terms of male and female, shows huge variations among the districts, with Dewas leading at 0.634 and Morena, at 0.436, scoring lowest. Interestingly, the poorest performers — Jhabua and Morena — have a high percentage of scheduled tribe (85) and scheduled caste (21) populations. This indicates systemic exclusion of these social groups from access to equal development rights.

Major challenges

Madhya Pradesh is yet to devise a strategy that bails it out of its branded status as a BIMARU state. Although the state finance minister has claimed that, for the first time in 16 years, an overdraft situation did not arise in 2004-05, and that capital consumption had risen by 88%, Madhya Pradesh’s fiscal deficit has been rising for the last 11 years (1993-94 to 2003-04) and the shocks of this fiscal deficit have been primarily borne by the social sector. Expenditure on health as a proportion of total expenditure declined from 5.1% in 2000-01 to 3.4% in 2004-05. Similarly, expenditure on education as a proportion of total expenditure dropped from 16.3% in 2000-01 to 8.7% in 2004-05.

The state’s overall ranking in the Human Development Index is much below the all-India average and is very low compared to most other states, with the exception of Bihar, Assam and Uttar Pradesh. Some striking facts about the state are:

i) 37.4% of its population lives below the poverty line.ii) It has the lowest per capita expenditure per month on food — Rs 128.60.iii) 28.7% of workers eke out a living as agricultural labourers (a sizeable proportion of them belong to scheduled tribes).iv) It has the second highest infant mortality rate in the country, and an above-national-average maternal mortality rate.v) 38% of rural households do not have access to safe drinking water.

There has been a steep fall in the government’s expenditure on education and health in the period between 2000-01 and 2004-05.Together, these provide pointers that if Madhya Pradesh aims to bring itself up to the desired levels of development, as envisioned in the MDGs, the current pace of progress has to be stepped up. There must be a sense of urgency if Madhya Pradesh is to reach the desired outcome.
With respect to poverty alleviation in the state, major challenges relate to decline in employment growth; large size of workforce in the unorganised sector (94%); fragmentation of already small landholdings of small and marginal farmers, making cultivation an unviable livelihood option and causing greater casualisation of the workforce; dealing with land alienation of scheduled tribe cultivators; lessening unemployed person-days for the rural poor; and strengthening non-farm sector employment opportunities. Productive land being an important livelihood asset for the rural poor, the election commitments made to agricultural labourers need to be fulfilled at the earliest. Besides, creation of gainful employment opportunities will become a necessity with further improvements in literacy rates and the outreach of education to remote areas.

In the context of primary education, a major challenge will be to devise strategies to bring out-of-school children (constituting children who have never enrolled in schools, and dropouts) into school. According to the Seventh All India Education Survey for 2002-03, Madhya Pradesh, Andhra Pradesh, Bihar, Rajasthan, Uttar Pradesh and West Bengal accounted for most of India’s out-of-school children in the age-group 6-11 (Class I to V). The state (including Chhattisgarh) had a dropout rate of 30% at the primary level (in 2001-02), which, although better than the northeastern and other BIMARU states, still constitutes a huge challenge if the fundamental right to education for all children in the age-group 6-14 years is to be realised. Quality of education is an important issue, which has particularly arisen from the growing trend in recruiting para-teachers on lower salaries. According to Rajya Shiksha Kendra data (2004), 49% of primary teachers and 43% of upper primary teachers were untrained. The pupil-student ratio in government primary schools is 46. Other issues relate to pedagogy of teaching, attitude of teachers towards scheduled caste and scheduled tribe students or first-generation learners, teacher absenteeism, infrastructure and facilities (drinking water and toilet) available at schools, access in terms of distance, and incentives like midday meals, scholarships, etc.

The scenario in the health sector is even more daunting. Eighty-five out of 1,000 children born in the state die due to lack of health facilities. A sizeable proportion of children are malnourished. Analysis of age-specific death rates for the year 1996 revealed that 37.3% of total deaths in Madhya Pradesh occur within the age-group 0-4. Only 22.4% of children aged 12-24 months receive immunisation against all vaccine-preventable diseases. The maternal mortality rate, at 498, is above the national average. NFHS-2 revealed that only 20.1% of deliveries in the state are conducted at medical institutions. Only 41.7% of pregnant women registered for prenatal care in 1995/96, and only 27% received both required doses of tetanus toxoid; only 40% received IFA tablets. There is a need for a) greater resource allocation by the government, b) monitoring systems at various levels of public healthcare, for proper functioning, c) vacancies for specialised personnel and doctors in tribal areas to be filled up, and d) ensuring that services reaching the needy are not intimidating, and that healthcare providers are sensitive to their needs/problems.

In its election manifesto of 2003, the state Bharatiya Janata Party (BJP) made 371 promises, which have subsequently also been taken up by the present government. But of these not more than 20% are substantive development goals concerning the poorest of the poor and relating to their livelihood, health and primary education needs. As against the social development promises, those relating to infrastructure and energy and catering to the traditional vote-bank of the BJP are more concrete in intent. Of the 102 fulfilled commitments (as stated by the State Planning Board), not more than 5% belong to public health, approximately 6% to primary education, and 6% concern livelihood and food security for the poor.
Some of the achievable commitments relate to the provision of undisputed land to scheduled castes for cultivation; granting permission to forest-dwellers for the use of wood; easy access to credit to promote self-employment; improving implementation of the midday meal scheme; making drinking water and sanitation facilities available at government schools; provision of adequate resources to anganwadi centres; ensuring the availability of nutritious food for pregnant women; and deepening ponds.

The way forward

Strengthening local institutions like panchayats and self-help groups (SHGs) is essential if the health, education and poverty alleviation goals of the Millennium Declaration are to be met within the given timeframe. Nearly six decades of development planning in the country have led to the general consensus that the top-down approach to service delivery has failed, as the benefits continue to be skewed in favour of certain socio-economic groups. As local self-governance institutions such as village panchayats are physically closer to rural communities, the goals of human development in rural areas can be more efficiently realised by nurturing local institutions as vehicles of change. For example, in the area of health, panchayats could provide an institutional base to manage community-based health services (Citizens Report on Governance and Development, 2004). Likewise, in education, they along with PTA and self-help groups could monitor the quality of education, teacher absenteeism and quality of midday meals in schools. Fiscal decentralisation is critical, along with decentralisation of responsibilities, to make village panchayats effective conduits for development.

We need to build a strong public voice on issues of health, education and the livelihoods of marginalised sections of society. In several cases it is seen that when people begin claiming their entitlements the government has passed progressive laws towards protecting the livelihood rights of the rural poor. Campaigns to generate awareness and draw in informed opinion on these issues are critical to build pressure on the government to orient its policies towards performing its welfare functions and to guard against neo-liberal tendencies of leaving the essential needs of citizens to be met by individual efforts in the market.
Jan Swasthya Abhiyan (People’s Health Movement) is one such strong campaign dealing with the right to health and healthcare, and monitoring the implementation of the National Rural Health Mission. It works with public agencies to make the state accountable for ensuring the right to health of all its citizens. The Right to Food Campaign is another strong movement that monitors the implementation of food security programmes across several states of India. Similar campaigns and alliances in the domain of local civil society in Madhya Pradesh need to be nurtured; they could provide an alternative to the government monitoring system of the CMP, NDG, MDG and Madhya Pradesh government’s commitments to the people. Providing an alternative voice on the progress of development goals, civil society, the media and campaigns broadens the scope for introspection by the government on its strategies and resource allocation for human development.

(This article is based on a report prepared for Wada Na Todo Abhiyan/Keep the Promise Campaign, which urges central and state governments to fulfil their welfare duties towards citizens)

Feburary 2006

Link to the story


Tuesday, October 24, 2006

Mother, die who cares

Pregnancy is in itself the most creative characteristic of nature, but in reality it is the most painful for her. Be it physical pain, mental pain or society's doubts, everything is related somehow to pregnancy.

Out of this amount, hardly Rs 32.12 lakhs was spent in Madhya Pradesh although the state stands the most serious threat as far as rate of deaths during and after pregnancy is concerned. A study conducted by the Centre for Advocacy reveals that 53.7 per cent actual beneficiaries are not aware of any such scheme and among those who know, hardly 0.8 per cent have benefited from it. They believe that they cannot obtain any benefits from the scheme because no one can extend help to them as per procedure.

The Commissioners of the Supreme Court ( in the right to Food public interest litigation) in their sixth report clearly questioned the character of the state saying the Supreme Court in its order dt Nov 28, 2001 directed state governments/ Union Territories to implement National Maternity Benefit Scheme (NMBS) by paying all pregnant women RS 500, 8-12 weeks prior to delivery for each of the first two births.

In other words, the most important feature of this Supreme Court of India order was to convert the scheme into a universal entitlement of all BPL pregnant women. The court order was an important step towards looking at material relief as a source for ensuring food security needs of women and her children, during the critical maternity stage, who were hitherto uncovered by any form of social security targeted for this stage. This also for the first time ensured maternity relief as a legal entitlement for women in the unorganized sector, who are glaringly denied the need for special care during this period.

But the reality is too bitter. The analysis establishes that the Government of Madhya Pradesh has played a highly un-accountable role in implementing this scheme. In Madhya Pradesh, the Government provided benefits of this scheme to 22,346 BPL women beneficiaries against the annual target of 5,97,700 to cover BPL pregnant women; it means the state could provide right to health care only to a part of 3.7 per cent of the total entitled women.

Despite a peaceful society, political stability and abundance of natural resources, Madhya Pradesh races ahead in death rate of mothers-to-be and young mothers. At least 498 out of one lakh women die while giving birth. 77pc child births take place outside hospitals and 53pc births are managed by untrained persons in Madhya Pradesh. Although, this data has also been challenged by different studies, even the Govt of MP carried out MP Family Welfare Programme Evaluation Survey (MPFWPES) 2003 throughout the state which covered 25pc of the rural population of the state. This survey provides the estimates of maternal mortality ratio for rural areas of MP, without Chhattisgarh. According to the MPFWPES-2003, the risk of death due to complications of pregnancy and child birth in the rural areas of the state was 763 maternal deaths for every 100,000 live births. The estimates provided by the Rapid House Hold Survey suggest a maternal mortality ratio of 597 maternal deaths for every 100,000 live births for the year 1999. Unfortunately, all these figures present a bleak picture that the women of MP carry both a substantially high risk of death due to complications of pregnancy, delivery and in post partum period and a substantially high life time risk of death due to reproduction associated consequences.
As a result, 70.87 pc women died due to excessive bleeding, infections, insecurity and high blood pressure. A study done by the Bhopal based organization Centre for Advocacy reveals the fact that only 35pcc people know about such schemes and 6 pc have availed of its benefits.
The life of a woman is based on food traditions, other beliefs and age-old traditions which are far from human. Her life shows how she is given leftovers to eat, her nutrition is uncared for, the very social and family atmosphere, in which she lives and breathes, draws outlines of her bleak, unhealthy future. A sick life is nurtured with dearth of proper nutrition, security, entertainment and independence. She has no right to nutrition.

Pregnancy is in itself the most creative characteristic of nature, but in reality it is the most painful for her. Be it physical pain, mental pain or society's doubts, everything is related somehow to pregnancy.

The truth is that while only 43pc of women get their deliveries done under trained `dais', 77pc women do not see the need for medical facilities and undergo unsafe deliveries. Not less than 54 out of every 10,000 women dies during child birth and the reason for the death of one out of 48 women is related to pregnancy or delivery complications.

This argument here that women stay hungry because of dearth of grains because of poverty is wrong. Had this been true, 80 pc women would not have fallen prey to anemia. The bitter truth is that be jit high, middle or lower class, women are not provided with adequate nutritious food.
The MP Human Development Report and National Family Health Survey reveals that only 20.3 pc women consume milk or curd daily whereas hardly 43pc consume `dal'. It also reveals hardly 5pc get to have fruits and .9 pc women consume eggs and just about half a percent women consume other non-vegetarian food. In fact the male dominated patriarchal social system today is weakening the woman physicallly and mentally so that she is not able to contest for political power and challenge male chauvinism.

By Sachin K Jain - published in Central Chronicle Edit page (May 4, 2006)

Concern over high maternal mortality rate in Madhya Pradesh

25 October 2006

The Madhya Pradesh Minister for Health and Family Welfare, Ajay Vishnoi has admitted that the situation on the "safe motherhood" front was far from satisfactory in the State and expressed serious concern over the fact that Madhya Pradesh has a maternal mortality rate of 498 per lakh against a national average of 407. Many callers, who joined the discussion from far off villages in districts like Rewa, Tikamgarh, Sagar and Hoshangabad, brought to Mr. Vishnoi's notice the appalling state of affairs when it came to the functioning of the health delivery system at the primary health centre level. The common grievance was that the doctors and nurses were mostly absent from duty. This was in sharp contrast with the State Health Minister's assertion that across the State there were 500 properly equipped hospitals, each having two doctors and 2 nurses, to attend to delivery cases. Mr. Vishnoi said for safe motherhood, the State Government has launched special schemes for SC/ST women and those below poverty line. More Under a special State Government programme, vehicle hiring charges for rushing SC/ST and BPL women to hospital for delivery was now being reimbursed by the Govt.