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
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