Saturday, February 24, 2007

More than 4 out of 5 children in State are anaemic

by Vikram Jethwani Bhopal. The Pioneer Bhopal Feb 23, 2007

....between the ages of 6 and 35 monthsEighty two of every 100 children, between the ages of six and 35 months, in Madhya Pradesh suffer from anaemia, a serious ailment related to abnormal deficiency of red blood cells. Not only does the report of National Family Health Survey III (NFHS-3) fly in the face of Government claims but it specifically raises a point of concern revealing that the number of children suffering from anaemia increased substantially during 2005-06 in comparison to the previous years.

The NFH Survey (NFHS-2) of 1998-99 had reported that 75 per cent of the children were anaemic. It is alarming to learn that instead of improving rhe situation has deteriorated in Madhya Pradesh over the last seven years. Compare this with Chhattisgarh's example where there has been a decline in the same period from 87.7 percent marked in 1998-99 to 81 per cent in 2005-06. Maharashtra too has improved from 76 to 71.9 per cent.

Pediatricians explained that anaemia makes children more vulnerable to dangerous infectious diseases like tuberculosis, cholera, jaundice, typhoid and also stunts their mental and physical development..
The Women and Child department of Madhya Pradesh has been running the nation-wide Integrated Child Development Services (ICDS) programme in the State. Under it, a sum of Rs 2 per day , shared equally by the Centre and the State Governments , is sanctioned for supplementary nutrition to a child," Principal Secretary of the department and member of the nationwide sub-group on ICDS and nutrition Prashant Mehta told The Pioneer. The scheme applies to children between the ages of six months and six years, he added.

According to the country head of United Nations Children Fund (UNICEF) health division M Babille, Madhya Pradesh is the worst hit by anaemia and compares poorly even with others like Andhra Pradesh and Rajasthan that suffer anaemia rates as high as 79 and 79.8 percent, respectively. Even Bihar, traditionally considered a laggard in civic and health matters is ahead of Madhya Pradesh. Linked to the high incidence of anaemia among children is the appallingly high rate of malnutrition among the young. The recent claim made by the State that only 49.2 percent of the children suffered from malnutrition is in contrast to the finding of the NFHS-2 which had recorded it at 54 per cent.

It is never too late to implement a comprehensive plan to eradicate both anaemia and malnutrition in children of the State after all they represent out tomorrow.

Sunday, February 18, 2007

10 percent of national maternal deaths in Madhya Pradesh: UNICEF

'Civil society is a duty bearer for the rights of women and children and it should help make the system accountable,' Gulati said, expressing concern over the high maternal mortality rate - in the state.

By IANS, [RxPG] Bhopal, Feb 18 - Madhya Pradesh registers 10 percent of the number of women dying at childbirth in India, according to UNICEF, which has called for a sustained commitment towards bettering the health of women and children in the state and the country.'India contributes 20 percent of the maternal deaths in the world which can be reduced only if there is a sustained commitment to deliver for the benefit of women and children,' UNICEF state head Hamid El Bashir said here Friday while addressing NGOs supporting the promotion of safe motherhood. Bashir said civil society needed to engage communities at a high level to push accountabilities within the administrative system.

The state's maternal mortality ratio -, the number of maternal deaths per 100,000 live births, is 379 and is considered to be one of the six worst performing states of India. Around 27-30 women die every day in the state within 42 days of delivery. Pregnancy complications and unsafe abortions are cited as the main reasons for the rising MMR. Appreciating the role of the media in highlighting the issue, Anil Gulati of the UNICEF said the need now was to take this momentum forward through community empowerment and engagement of the civil society.'Civil society is a duty bearer for the rights of women and children and it should help make the system accountable,' Gulati said, expressing concern over the high maternal mortality rate - in the state. Over 60 NGOs participated in the meet from various

Blogs help raise social issues in MP


Bhopal, Feb 17: Blogs are fast catching on in Madhya Pradesh where it provides a platform to activists and officials to voice concern on social issues like safe motherhood and children's plight.
Among the blogs - a user-generated website as is commonly known - is www.safemotherhood. blogspot. com. Managed by 'Campaign to Raise Concern on Maternal Deaths' in the state, it has activists working to help mothers.

There are other blogs too like newswhichmatter., which has news about the state and opinions of people, and, which deals with infant mortality and low nutrition levels among children. Another blog is, which provides news and views on matters concerning the state. The safemotherhood. blogspot. com brings together media reports on maternal mortality in the state.

Maternal mortality at 498 per every 1,000 women is one of state's biggest blights. Most of the deaths occur due to pregnancy-related complications within a fortnight of delivery. 'To raise concern about and bring visibility to the issue of maternal deaths and factors impacting it, the safe motherhood Blog helps to bring out issues at the district level that rarely find a place in the state level media,' said Anil Gulati, a blogger.

The blog, he said, translates the Hindi news into English or adapts it from Hindi and reproduces it on its weblog along with its source. Many a time these news stories from district editions can form a story for the state editions or alternatively can be a pitch for the big story, which also adds to the purpose of the blog, he said.

Blogs also help to give expression to one's creative challenge, added Gulati, who has come to be regarded as blogman of Bhopal. He is a regular contributor to some of the blogs. 'Some blogs have been able to raise concern on issues like maternal and child deaths in Madhya Pradesh,' said Sachin Jain, who heads a media advocacy group, Vikas Samvad, in Bhopal.
For him it is a good advocacy tool. 'Blogs also take up issues which would have remained invisible otherwise. They help to bring the plight of people of the 'other India' into focus,' he claimed.
Blogs and citizen journalists are part of newer trends in engaging people and making their voices heard. But do they make any difference? 'They may not be too effective today but they have the potential to complement other forms of journalism one day,' said PP Singh of Makhanlal Chaturvedi National University of Journalism.

'These new technology tools can play a major role in reaching out to people with more transparency as they are not bound by present day media constraints, and thus serve the purpose more effectively,' he added. Other blogs that have become popular in a short time are and bhopal. There is also a Persecution Blog, which shares news and information about the Christian community.

Friday, February 16, 2007

Health system needs to deliver: A call by civil society

Central Chronicle, Feb 16, 2007

Bhopal, Feb 16: A state level meeting of campaign partners supporting the promotion of safe
motherhood and raising concern on maternal mortality in the state of Madhya Pradesh was held in Bhopal today. More than 60 non governmental organizations from various districts of the state including Panna, Dhar, Jabalpur, Indore, Mandsaur, Sehore, Bhopal, Sagar, Ujjain, Sheopur, Gwalior, Bhind, Barwani, Dewas, Satna, Shivpuri, Rewa, Neemuch, Datia, Ashok Nagar, Tikamgarh, Chhattarpur, Khargone participated in the meeting.

Non governmental organizations representing network organizations like Madhya Pradesh Voluntary Health Association, Madhya Pradesh Samaj Sewa Sanstha, Madhya Pradesh Jan Adhikar Manch, Bharat Gyan Vigyan Samiti, Central Regional Board of Health Services, Mahila Chetna Manch, Vikas Samvad, Department of Journalism, Makhan Lal Chaturvedi National University of Journalism shared their concern and outcomes of their efforts with communities and elected representatives.

Inaugurating the meeting Hamid El Bashir, State Representative, UNICEF office for Madhya Pradesh said that civil society needs to engage communities at high level to push accountabilities within the system to better deliver for women and children. Civil society is a duty bearer for the rights of women and children and it is they who should help make the system accountable. He also raised the issue of violation of rights of women and children and said that there are gaps in the system. He added that state of Madhya Pradesh contributes 10 % of maternal deaths in the country while India contributes 20 % of maternal deaths in the world. It is possible to reduce them but the need is of sustained commitment to deliver for benefit of women and children in the state.

Anil Gulati Communication officer UNICEF spoke on the need of the community empowerment and with civil society their engagement on the issue of women health. Media has helped to bring the issue to forefront but the need is to take this momentum forward.

Manoj Joshi of Madhya Pradesh Voluntary Health Association, P.P. Singh, Department of Journalism Makhan Lal Chaturvedi University of Journalism, Sandesh Bansal State Coordinator Jan Adhikar Manch, Dr Sheela Bhambal of Central Board of Regional Health Services, Sachin Jain of Vikas Samvad, Deep Damani of Mahila Chetna Manch, Fr Mathew and sister Joicy of Madhya Pradesh Samaj Sewa Sanstha made presentation of their efforts in the various parts of the state to help bring the much needed momentum on the issue of maternal deaths and promoting safe motherhood state wide. Their partner organizations were present during the same presentations. A concern was expressed that still a lot needs to be done especially in promoting infrastructure increasing manpower and budget allocations for promoting safe motherhood. Promoting institution delivery alone will not help.

Dr Narayan Goankar Health Officer UNICEF presented the findings of maternal deaths audit in the districts of Guna and Shivpuri. Participations also focused on issue of rights. A need for third party monitoring was expressed in the meeting and for having an Observatory for the rights of women and children. This could be an Observatory which can report on the status of women and children in the state. Veena Bandyopadhyay, Planning officer, UNICEF presented a possible option of setting up of 'Child Rights Observatory' in the state of Madhya Pradesh, which could act as third party for monitoring rights of children and women. Himanshu Sikka of Infrastructure Professional Enterprise also participated in the meeting.

Madhya Pradesh contributes 10 pc MMR: Bashir

Bhopal, Feb 16: Hamid El Bashir, State Representative, UNICEF office for Madhya Pradesh said that Madhya Pradesh contributes 10 percent of maternal deaths in the country while India contributes 20 percent of maternal deaths in the world. It is possible to reduce them but the need is of sustained commitment to deliver for benefit of women and children in the state. He claimed that there are gaps in the system. He was speaking after inaugurating the state level meeting of campaign partners supporting the promotion of safe motherhood and raising concern on maternal mortality in the state of Madhya Pradesh, here on Friday.

He further said that the civil society needs to engage communities at high level to push accountabilities within the system to better deliver for women and children. Civil society is a duty bearer for the rights of women and children and it should help make the system accountable. More than 60 non governmental organizations from various districts of the state including Panna, Dhar, Jabalpur, Indore, Mandsaur, Sehore, Bhopal, Sagar, Ujjain, Sheopur, Gwalior, Bhind, Barwani, Dewas, Satna, Shivpuri, Rewa, Neemuch, Datia, Ashok Nagar, Tikamgarh, Chhattarpur, Khargone participated in the meeting.

NGOs representing network organizations like Madhya Pradesh Voluntary Health Association, Madhya Pradesh Samaj Sewa Sanstha, Madhya Pradesh Jan Adhikar Manch, Bharat Gyan Vigyan Samiti, Mahila Chetna Manch, Vikas Samvad, Department of Journalism, Makhanlal Chaturvedi National University (MCNU) of Journalism shared their concern. Anil Gulati Communication officer UNICEF spoke on the need of the community empowerment and with civil society their engagement on the issue of women health. Media has helped to bring the issue to forefront but the need is to take this momentum forward.

Manoj Joshi of Madhya Pradesh Voluntary Health Association, P.P. Singh, Department of Journalism MCNU, Sandesh Bansal State Coordinator Jan Adhikar Manch, Dr Sheela Bhambal of Central Board of Regional Health Services, Sachin Jain of Vikas Samvad, Deep Damani of Mahila Chetna Manch, Fr Mathew and sister Joicy of Madhya Pradesh Samaj Sewa Sanstha gave presentation in the various parts of the state to help bring the much needed momentum on the issue. Dr Narayan Goankar Health Officer UNICEF presented the findings of maternal deaths audit in the districts of Guna and Shivpuri. Participations also focused on issue of rights.

Published at

Thursday, February 15, 2007

A woman dies every 7 minutes

New Delhi/Gwalior, One woman dies every seven minutes in India due to pregnancy-related complications and these are conservative estimates since more than 30 per cent of maternal mortality cases go unreported, according to estimates. India has one of the worst statistics in the world as far as maternal mortality goes. Even Bangladesh and Sri Lanka have lower maternal mortality ratios than India, according to Unicef.

One of the prime worries in India has been its inability to reduce maternal mortality despite efforts for decades and increased funding and schemes introduced by the government. This has been attributed by Unicef MMR project officer Karuna Bishnoi to a lack of medical facilities in rural areas, lack of trained birth attendants and almost 65 percent of births taking place at homes without assistance from trained attendants.

India at present has an MMR of around 301, which means 301 mothers die during delivery, or within 42 days after delivery, for one lakh live births. At this rate, India will be unable to reach the millennium development goals (MDGs) on MMR where it needs to reach an MMR of 106. But estimates project that India will be only able to achieve an MMR of 240 by 2015, which is by when the MDGs have to be achieved.

Statistics show that MMR is significantly higher amongst SC/ST women as compared to other women in India, whether in urban areas or rural areas. This is also an area of concern for the government of India. In Shivpuri village in Madhya Pradesh, Ram Swarup Batham sits outside his mud hut surrounded by his three young children, all below the age of five.

His wife Veeja died recently in a hospital in Gwalior while giving birth to her ninth child, becoming one more statistic in the long list of maternal mortality deaths in this country. Over the last six years, there has been no significant reduction in maternal mortality deaths.
Describing how he tried to save her, Batham says, “I rushed her to the district hospital in Shivpuri. The doctor there informed me she needed to be taken to Gwalior. I took her to Gwalior Medical College but she died soon after being admitted there.” He passes his fingers through his greying hair. It is obvious he is trying to figure out how to feed, clothe and educate his six young children. His elder three daughters have been married though none of them had crossed 18 when their marriages were negotiated. Batham, a tribal, is fortunate to own 25 bighas of land. “I borrowed Rs 15,000 for her treatment. I’ll sell my land if I cannot repay the loan,” he adds.

The stark reality of his changed circumstances stares him in his face. The death of his wife has plunged their family into chaos. For one, the entire responsibility of feeding six young children has fallen on his aged mother, who admits she simply cannot cope. Sitting on the mud-caked floor in their front courtyard, the old woman mutters, “The doctors were completely callous. Veeja died within five minutes of being given an injection. Now I am supposed to do everything for these children. How much responsibility can I shoulder?” Internal bleeding, eclampsia and obstructed labour are just some of the factors that are responsible for the high number of maternal mortality deaths in Madhya Pradesh. The number of women who die due to pregnancy, childbirth and abortion-related deaths are estimated at 136,000. The maternal mortality ratio (MMR) in Madhya Pradesh at present is 540 deaths per 100,000 live births. Uttar Pradesh alone accounts for close to 40,000 maternal deaths per year. The tragedy of Veeja’s death is that it could have been easily prevented. Mr Hamid al-Bashir, Unicef’s state representative in Bhopal, believes, “Most maternal deaths could be prevented if women had access to appropriate health care during pregnancy, childbirth and immediately after her delivery. When a mother dies during pregnancy, the family suffers a further increase in poverty.” “One of the key methods to improve maternal survival would be to review all maternal deaths at the community level ‘ he added. Dr Aparajita Gogoi, national coordinator for the White Ribbon Alliance, India, described these MMR deaths as a “silent tsunami”. “Over 200,000 families have been devastated by these deaths, which have left 350,000 kids orphaned. Another 600,000 women have been left disabled because of pregnancy-related disorders,” Dr Gogoi said, adding, “We have not been able to stem this tide of maternal deaths despite having 20,000 obstetricians, five lakh trained doctors and 25 lakh nurses and midwives.” Even poor countries like Bangladesh, Bolivia and the Honduras have reduced MMR in similar resource settings. Countries like China, Indonesia and Sri Lanka have built up teams of skilled birth attendants and well-connected frontline providers.

Though India has a large number of medical personnel, 80 per cent of them are concentrated in urban areas, where 25 per cent of the population lives, compared to 20 percent medical personnel in rural areas, where 75 per cent of the population lives, according to estimates given by Dr Hamid al-Bashir. The statistics in Madhya Pradesh are even more alarming because in rural areas, local NGOs point out, for every 5.6 villages (average population of 2,000 in one village) only one hospital bed is available. Over 82 per cent of the children suffer from anaemia while 58 per cent of pregnant women are also found to be anaemic. According to Indian government statistics, 58 percent of pregnant woman are anaemic in India, which compounds all the problems of pregnancies. This is due to poverty amongst many rural women, which makes it impossible for them to eat sufficient amounts of the right kinds of foods, said Dr Aparajita Gogoi.
Unicef believes one of the ways to strengthen community initiatives is by holding maternal death audits. One such audit was recently held in Purulia, West Bengal, between May 2005 and June 2006. It was found that from 55,000 deliveries there were 106 maternal deaths. This figure was arrived at after interviewing family members of the deceased. It was believed that the number of deaths was actually around 140 since most families continue to under-report maternal deaths. The audit brought to light that the average age of marriage for girls in Purulia was 17. None of the girls interviewed had been to school while the average number of years their husbands had spent in school averaged four years. While 61 per cent of deaths occurred in a health facility, 24 per cent died at home and another 13 per cent died en route to a facility. The majority of deaths occurred during labour and in the post-partum period.

India’s inability to reach the millennium development goals are primarily due to its inability to increase institutional births, which Sri Lanka has achieved at above 90 percent; skilled attendants at birth, which has been achieved for a majority of cases by Indonesia; and training of local midwives, which is the way Bangladesh has improved its MMR.

Tuesday, February 13, 2007

India lags far behind in protecting mothers

Azera Rahman (IANS)Gwalior (Madhya Pradesh), February 13, 2007

There has been no appreciable decline in the number of women dying at childbirth in India since 1990, quite unlike other nations like Bangladesh, Gautemala and Morocco that have managed to arrest this trend. India's Maternal Mortality Ratio (MMR), the number of maternal deaths per 100,000 live births, was 301 in 2002 and 2003. According to the Sample Registration Survey (SRS), 70,000 women die every year in India but UNICEF says the number crosses 100,000.
"The real concern for the high MMR in India is not lack of resources but failure in the system," said Aparajita Gogoi, national coordinator of the White Ribbon Alliance (WRA) that works on issues concerning safe motherhood.

Gogoi was speaking at a workshop on maternal mortality organised by UNICEF in Gwalior last week. Talking about the successes in reducing MMR in other countries, Gogoi said there are various facets that have been worked upon in those countries, which if looked into here would bring down the number of maternal deaths to a great extent.

Increasing availability of emergency obstetric care (EmOC) facilities, skilled birth attendants, maternity waiting homes and financial accessibility, which have been adopted in countries like Zimbabwe, Indonesia, Bolivia and Honduras have greatly helped. These nations have been able to reduce their MMR by 52 per cent.

In India, only 40 per cent women have access to skilled birth attendance. And according to the National Family Health Survey (NFHS), only one in six women receive post-natal care when 60 per cent of the maternal deaths occur after the delivery of the child. Promoting accountability is another factor that, when looked into seriously, brought down the number of maternal deaths in China from 1,500 per 100,000 live births to less than 200 in the year 2000. "Accountability is very important. No one is held responsible when a mother dies ... most of the times it's not even registered. It's very important to keep a tab of the health of a pregnant woman". "Only then can the matter be looked into if any complication arises and a similar situation can be prevented in the future," Gogoi said.

Bangladesh has brought down its MMR by 22 per cent, Egypt by 52 per cent, Honduras by 41 per cent, Morocco by eight per cent and Guatemala by 30 per cent. One of the reasons for the high MMR in India country is the ratio of the population to the number of skilled medical staff available. Although 70 per cent of the population resides in rural areas, only 20-30 per cent medical aid is available to them while the ratio is the opposite in urban areas.

Non-functional health centres, scarcity of blood banks, inadequate number of specialists like gynaecologists and anaesthetists in rural areas and the poor condition of the transport system are some of the bottlenecks of the problem. "Seventy per cent of the national budget allocated for health support goes back unutilised. The system is not delivering end results and that's where the problem lies," stated Hamid El-Bashir, Madhya Pradesh state representative of UNICEF. "These deaths are completely preventable and that is the greatest tragedy. It is a silent tsunami," remarked Gogoi.

Monday, February 12, 2007

UNICEF launches new scheme to conduct enquiry on maternal deaths

Aarti Dhar

- Social audit to identify ways to prevent avoidable deaths
- Women have little or no role in decision to seek healthcare
- UNICEF for sustained political commitment for safe motherhood

GWALIOR (M.P.): Concerned over the high maternal mortality ratio (MMR) in the country — 301 per 100,000 live births — the United Nations Children's Fund (UNICEF) has launched a new scheme to conduct maternal death inquiry. The Maternal and Perinatal Death Inquiry (MAPEDI) or the social audit — also known as verbal autopsy — is aimed at providing an understanding of the contributing factors that can be used by decision-makers and stakeholders to address obstacles to quality obstetric care and to identify ways to prevent avoidable deaths.

Survey of healthcare facilities

One such survey was conducted in Purulia district of West Bengal between July 2005 and June 2006 and its findings made the State Government order a review of every maternal death and initiate a survey of the health care facilities. All maternity beds in public sector facilities in the State have now been made non-paying for all and the Government is now working on a cashless referral transport system.

Of the 106 maternal mortalities reported, 62 per cent died during labour or delivery, 26 per cent during pregnancy and 12 per cent during abortion. As many as 61 per cent died at the health facility, 24 per cent died at home, 13 per cent en route to health facility and three per cent due to related causes. Fifty one per cent deaths were due to direct obstetric causes like bleeding, infection, eclampsia, and obstructed labour, 27 per cent due to indirect causes like anaemia, malaria, hepatitis, tuberculosis and cardiac, while 22 per cent died due to other causes.
The women were illiterate, most of them belonged to the Scheduled Castes, followed by the Scheduled Tribes and 42 per cent were below poverty line (BPL) cardholders.

According to Sudha Balakrishnan of UNICEF, husbands played a major role in deciding to seek healthcare and the women themselves had little or no role in this decision. The survey also revealed that 46 per cent sought formal health care after complications arose, 80 per cent sought formal care at some point of time and 20 per cent did not seek any.

Sadly, 16 per cent did not think the woman was sick enough, 8 per cent thought the problem required traditional care, for 23 per cent the cost and transportation was unaffordable. For another 11 per cent transport was not available at all. A similar audit conducted on 104 maternal mortality deaths in Shivpuri and Guna districts of Madhya Pradesh indicated that 83 per cent died after delivery, 5 per cent during delivery, 11 per cent during pregnancy and one per cent after abortion.

The UNICEF has been advocating sustained political commitment and strengthening policies for safe motherhood, ensuring availability of skilled maternal heath care provider and increasing awareness of communities and families for timely recognition of danger signs and deciding for referral besides improving availability of round-the-clock emergency obstetric care services.

Sunday, February 11, 2007

Patients suffer due to lack of drinking water in health centre’s of Madhya Pradesh

Sandhya Prakash, Bhopal (Hindi) Feb 11, 2007

As per reproductive and child health district level household survey (2004) out of the 386 primary health centre where this survey was carried out only 224 had drinking water facility. This means that only 58.3 percent primary health centre’s have drinking water other have no such facility. In case of community health centre’s out of the 46 surveyed only 10 had facility of drinking water.

Similarly out of the 386 primary health centre surveyed only 35 had vehicles which were in running condition. In case of 46 community health centre’s surveyed 31 had vehicles in running condition. (Blog comments - This also means that problem is more acute where it is most needed in the interiors of Madhya Pradesh where accessibility is an issue)

NGOs working in the state question the state policies and say that at one place state is announcing schemes while on other hand state lacks adequate infrastructure to provide health services to its people.

Adapted from the media report published in hindi in Sandhya Prakash.

Saturday, February 10, 2007

Maternal mortality rate high in Madhya Pradesh

Aarti Dhar

The Hindu, Feb 11, 2007

Especially in rural areas where healthcare system is virtually non-existent
Gwalior (M.P.): When Khiloni delivered her second child in her hutment at Duhiya village of Gwalior district in December 2005, the family celebrated.

It was only after a while they realised that her placenta had not come out and she needed immediate medical attention. Her husband, Ashok, a daily wage earner, arranged for a tractor in the middle of the night to take Khiloni (25) to the Civil Hospital at Morar, about 35 km away.
However, little did Ashok realise that the worse was to come at the hospital as the doctors refused to admit Khiloni saying that the hospital was not equipped to handle such a complicated case and asked him to take his wife to a private nursing home reportedly owned by a doctor employed at the Civil Hospital.

Khiloni died a few hours later but the child survived. Ashok took a loan of Rs. 10,000 for the entire exercise and the family is yet to re-pay it.

Tragic tale

Khiloni's two children are being looked after by their maternal and paternal grandmothers.
A few kilometres away in Banjaron ka Dera, a tribal village, young Leela was being treated at the Hastinapur Public Health Centre for complications during her third pregnancy.
During her regular visits to the centre, she was examined by the doctor only once and the rest of the times, it was the health worker who treated her.

A disillusioned Leela was taken to a private doctor when she had a miscarriage in the fifth month of her pregnancy. As there was no sign of improvement even after spending a huge sum, Leela was shifted to the Civil Hospital at Murar on a bullock cart one night when her condition deteriorated, but died the following day.

The family paid Rs. 800 to take back the body. Her husband Mahesh, who took a loan of Rs. 35,000 for this, now works as a bonded labourer while his two children are being looked after by their grandmothers.

Madhya Pradesh figures among the list of States where maternal mortality is high, particularly in rural areas, where the healthcare system is virtually non-existent and awareness on the subject among the people extremely low.

According to UNICEF, Madhya Pradesh along with Assam and Uttar Pradesh has a high Maternal Mortality Rate (MMR) of 700 or more per 100,000 live birth as against the national figure of 407 per 100,000 live births as per the 2001 Census figure. However, regional disparities in maternal mortality are wide with the death ratio being low in Kerala, Tamil Nadu and Punjab and extremely high in most northern States.

Hospitals turning into tombs in rural India

Surpura (Madhya Pradesh), Feb 11 (IANS)

The paint-peeling single-storey building wears a ghostly look. Cobwebs hang from the walls, used syringes and cotton swabs lie on the blood stained floor and the rooms are in darkness. And the doctor is nowhere to be seen.

Welcome to the block level hospital in rural Madhya Pradesh, one of the country's largest states.Catering to emergency situations of a population of nearly 30,000 people, this scene, shocking to a visitor used to tales of booming medical tourism in five-star city hospitals, is an eye opener to the kind of medical aid the villagers in many areas of rural India receive. It's of no surprise then that, among others, the maternal mortality rate here is very high.The delivery room of the hospital couldn't have been worse with a broken sink, no bed and a dirty toilet. "The midwife gets water from outside since there is no running water," says Sumhira Badhoria, an attendant present. "We hardly get electricity for two hours," she adds.But the most surprising fact is that the doctor who is supposed to be on duty for 24 hours was nowhere in sight at 2 o'clock in the afternoon. "The doctor hardly comes here. He comes about twice a week. We have no choice but to go to the private practitioners and pay a hefty sum," lamented one of the villagers.Although the hospital is supposed to have a staff strength of 10, only two attendants were seen. But if this sight is any bad, then the condition of another village about five kilometres away is worse.Kishupura village has a sub health centre, but broken and abandoned. "No one comes here. The nurse comes twice a month and goes around the village," says Sanjay Singh Badhoria, a farmer of the village.The consequences of such negligence in medical facility?

Heart wrenching stories.

Rekha, 22, was pregnant with her third child when she suddenly started bleeding heavily. Alarmed, her husband and a few relatives hired a car and rushed her to the Surpura block level hospital but after getting no medical assistance there, they had to take her to a private practitioner who gave her some medication.Although the bleeding stopped for some time, it resumed soon after at night. With no other option in hand, they rushed her to the district hospital in Bhind, about 35 km from the village.But by the time the hapless husband could stand in the queue to admit her in spite of saying that it was an emergency, she died."It took us more than half an hour to get her admitted. Then we had to look for the doctor. By that time it was too late," lamented her husband, Anil Singh Badhoria, to the visiting IANS correspondent.Survived by two kids, a boy aged four and a girl aged three, Rekha's story is one of the many that remain hidden behind silent cries of the innocent, motherless children.More than 7,000 women die of pregnancy-related issues in Madhya Pradesh every year contributing to 10 percent of the maternal mortality rate in the country. Globally, India accounts for 20 percent of the maternal mortality rate.

By Azera Rahman

Dying to have a baby

Sanchita Sharma
Bhind, Madhya Pradesh, February 10, 2007

Guns have a higher place in society than women in Madhya Pradesh's Bhind district, perhaps best known as the former haunt of bandit queen Phoolan Devi."If a person's gun gets stolen, he loses all respect in society. They say that a man who cannot protect his gun is good for nothing," says Pahalwan Singh Badoria of Hamirapura village in the Ater block of Bhind.This warped logic perhaps explains why men look after their gun more than their wives, who are among the most underweight and anaemic women in India. At 380 deaths per 100,000 live births, Madhya Pradesh has a very high maternal mortality rate (MMR). "Of the 70,000 women who die at childbirth, Madhya Pradesh accounts for 7,000 deaths," says Hamid al-Bashir, state representative, UNICEF.According to the Sample Registration Survey, India's MMR dropped to 301 in 2002-03 from 398 in 1997-98. The Union health ministry widely credits the drop to a rise in the number of hospital deliveries of babies, a fact that is not borne on the ground.

Though the Primary Health Centre (PHC) in Shivpura village in Ater block has medical staff of seven – including two doctors and three Auxiliary Nurse Midwives (ANM) – only one ANM was present on Friday. The PHC, which is the nodal health centre for a population of 30,000, treated only one patient that day. "This PHC faces a cremation ground and the burning corpses scare people away. No one stays overnight because they fear ghosts," says ANM Sumeera Badauri.The cremation ground is the least of the problems. The PHC gets electricity for two hours a day, and has no running water, not even in the delivery room. "The water from the hand-pump is brackish water and unfit for use, so we send the sweeper or the patients' attendants to fetch buckets of water from the village a kilometre away," she says.Villagers claim it is not ghosts but the poor quality of service that keeps them away. "You were lucky you found the PHC open today, they must have known you were coming. It is always locked, so we don't waste time going there. We go to private doctors or the District Hospital in Bhind town 30 kms away," says Sanjay Singh Badauri of the neighbouring Sheopura village.

In Sheopura, the health subcentre functions as the community urinal. "A nurse comes twice a month but now the roof has collapsed, so perhaps she will stop coming," he shrugs.Pregnant women usually walk, bus or pillion-ride on a bicycle on kutcha roads to reach the District Hospital. At times even that does not help. Anil Singh's wife Rekha died of bleeding when pregnant with their third child. "We rushed her in a hired car but she died while we spent half-an-hour getting the paperwork done for hospital admission," says Singh, also of Sheopura village.It is debatable whether Rekha would have lived if she had reached the District Hospital in time. The hospital has no blood bank and there is none in all of Bhind. "We acquired all blood-banking equipment two years but did not get a licence because we do not have the 1,000 sq foot area needed to run a blood bank," says the district chief medical officer SM Ojha.If you are wondering how the hospital functions without blood, here's the answer. "We ask critical patients to go to Gwalior. The city has many hospitals," he says. And those who die trying to reach care become another statistic.

Sunday, February 04, 2007

State rapped on Janani Yojana

Hindustan Times, Bhopal, Feb 3, 2007

Sravani Sarkar

MADHYA PRADESH is among 11 states that were served notice by the Supreme Court for ‘dismal inaction’ in implementation of the Janani Suraksha Yojana – the Centre- sponsored health scheme meant for nutritional assistance to pregnant women.

In order dated February 1, the double bench of Justice Arijit Pasayat and Justice S N Kapoor of the apex court served notice to 11 states and the Union Government to file replies within four weeks and three weeks respectively as to why there was inaction in the scheme’s implementation. The Union Government has also been asked to indicate as to how it proposes to monitor the implementation of the schemes by the state government and in what way there can be more coordinated effort for implementing the schemes.

The other states to get the notice from Supreme Court are Uttar Pradesh, Uttaranchal, Bihar, Delhi, Jharkhand, Chhattisgarh, Assam, Rajasthan, Orissa and Jammu and Kashmir.
The notices have been served in response to a petition filed by civil society organisation, the People’s Union for Civil Liberties (PUCL) and based on an analytical report on the matter compiled and presented to the SC by its permanent commissioners N C Saxena and Harsh Mander.

The State Health Department, however, has outright rejected failure of implementation. Health Commissioner Dr Rajesh Rajora told the Hindustan Times that Madhya Pradesh, at present, is the topmost state in the implementation of the JSY. He said that only recently the state health department made a presentation regarding the scheme before the Union Government’s Joint Review Mission. He added the scenario could be well gauged from fact that as against 68,000 beneficiaries in 2005-06, 1.95 lakh women were benefited by the scheme in 2006-07 (till date).
The Supreme Court, however, has taken a very serious view of the analytical report by its commissioners that incorporates a number of complaints regarding implementation of scheme.
The apex court has asked the Centre to also indicate whether it would be in the interest of the beneficiaries if the funds were directly placed at the disposal of Gram Panchayats.

The funds under the JSY is available with the Chief Medical and Health Officer of the district concerned and the centralised disbursal system makes it difficult for the funds to reach beneficiaries in time. In its order, the Supreme Court also quotes the Commissioners’ report that the non-performance in rural areas is more acute.

“It would be appropriate if the Union of India and the state governments take steps to make the beneficiaries aware of the benefits of the schemes and the entitlements flowing there from’’ observes the Supreme Court order. The senior counsel for the PUCL Colin Gonsalves has been asked to compile the responses (of the union and state governments) and to give his (Gonsalves’s) suggestion as regards the modes to the adopted for better results. The matter would be taken up for hearing again in third week of March.

Friday, February 02, 2007

Paying a steep price for motherhood

Sachin Jain

Even as New Delhi says maternal mortality numbers are falling, tribal women Madhya Pradesh are facing a negligent, cruel and corrupt healthcare system and dying during childbirth. When the conduct of hospital staff is questioned, they face retaliation instead of accountability. Sachin Jain reports.

On 19 November 2006, Newa Bai, a seven month pregnant poor tribal women of Nidanpur village, Ashoknager district, M.P., died at the local government hospital. Her husband Kpoora Adivasi had taken her to the nearest Chanderi government hospital after she complained about nausea and severe abdominal pain. After a primary check-up, the doctor in charge, R P Sharma (the position of gynaecologist, usually a lady doctor, is lying vacant and there is no timeline till when she would be recruited) put Newa on a blood infusion. It was about 1.00 pm which is lunch time for the staff and they left the hospital for extended lunch break, which normally lasts few hours. But only the nurse returned that too after 5 hours. Meanwhile Newa's condition deteriorated and she became critical. Some people who accompanied her alleged that there was even reverse blood flow after the transfusion was over. Newa died.

Sainath, a civil society organization working in the area took up the issue and a concern was raised by them with the district administration. They urged the district to undertake an enquiry. The moment concern was raised and accountability questioned, the district hospital stopped providing any treatment to villagers of Nidanpur. Even if one dares to go to hospital from the village the staff yells at them and even uses bad words.

On 27 December, another pregnant woman Phool Kunwar from the same village in labour pains was taken to Chanderi Hospital. She delivered a girl child on the way. By the time she reached hospital her position got serious. The medical doctor in-charge, that knowing that she is from Nidanpur village, denied any treatment to her. Her husband Uday took her to the Ashoknager district hospital and then to the Guna government hospital. But she could not be saved and died the same day. Her new born baby died on 30 December. The Sarpanch of Nidanpur, Sendra Pal Singh, is in despair. He asks, "where we will go, it seems now that the entire state is against our village. Have we done anything wrong by asking women rights for safe motherhood?"
The deaths come at a time when the state government of Madhya Pradesh is strongly advocating institutional deliveries as the mantra to combat high rates of maternal deaths in the state. Unfortunately in the state the campaign exists in the advertisement hoardings, newspaper advertisements and in media, thanks to efforts of public relation department of the state. Very little effort is being put to strengthen quality of services and hardly any on improving human – human interaction of the health delivery staff.

Village Sarari Khurd, Sheopur has a primary health centre but no doctor. Since when it does not have doctor, even villagers can't remember the same. The centre is opened by hardly fours days a week by local nurse. It neither has any facility nor any equipment and hardly has been cleaned ever. This is not the situation of one health centre, 20 kilometres of Sarari Khurd is Karahal. Karahal has community health centre. Though it opens every day but three positions out of the four to be posted there are vacant. Karahal block officially has a facility of mobile health van to reach out to inaccessible areas. But it has just one mobile health van. If the same works daily it will reach the same village after a gap of 35 days (please note if it works daily). And there is nothing to take care of a pregnant women and children. Even in case of unavailability of medicines, village level health staff is sailing the various kind of medicines to the Villagers.
Janani Suraksha Yojana. On paper, the central government feels that maternal relief and safe delivery does not end with better nutrition, but it involves comprehensive care during pregnancy, child birth and after-delivery support by through quality care in essential and emergency obstetric services.

Ostensibly, the aim seems to be make deliveries safe thereby reducing maternal/infant mortality by providing policy emphasis on institutional deliveries and financial assistance to the pregnant women under the Janani Suraksha Yojana. Previously this scheme used to be known as National Maternity Benefit Scheme.

There are 533 villages in the Saheriya primitive tribe dominated Sheopur district with a population of 5.60 lakhs. The total number of bed available at the one district hospital and other hospitals is only 166, of which 148 beds have not been changed during the last 13 years. During the last two years, several big claims have been made about promoting safe motherhood but just like last six years, three out of four posts of doctors in the Karahal block are still vacant. There was no improvement in the medical facilities during this period and even a single gynaecologist and obstetrician could not be posted.

Bilasi Devi, an anganwadi worker from Gothra Kapura village of the district, speaks from experience and asks as to why should one go to hospital? No one even speaks properly there and everyone right from doctors to nurses to sanitary workers asks for money to take any action. The state government claims that anyone going for institutional childbirth would get Rs.1700 worth financial aid, transport fare and free medicines. The central government sponsored Janani Suraksha Yojana provides Rs.700 and the state government sponsored Vijayaraje Janani Bima Kalyan Yojana provides Rs.1000 for safe deliveries. Despite this, when Babhuti, a Sahariya tribal woman of Gothra Kapura was taken for childbirth to a hospital, her family had to pawn their land for completing her delivery.

In recent years the Sahariya Primitive Tribal Group (PTG) has become a new synonym of acute poverty, chronic hunger and marginalisation but Sahariya women face the double burden of gendered poverty.

In the meantime, the Government of India, on 31 October 2006, released maternal mortality figures for the first time since 1998, which claims that the Maternal Mortality Rate (MMR) has gone down from 498 (per lakh or 100,000 childbirths) to 379 during the period. But the report Maternal Mortality in India: Trends, causes and risk factors - 1997-2003 is itself facing some basic technical questions. The key question is whether the government is trying to veil the adverse ground reality by putting out statistics.

One important point is that this study of MMR has been conducted by considering only a limited number of cases of a particular situation. The survey was conducted over a period of six years and reported low MMR in M.P. and Chhattisgarh (365). But during this period about 103,000 cases of maternal mortality were reported in the two states. The second point is that all these cases (365) are those that have been registered in official records while analyses indicate that only one out of three maternal deaths get officially recorded. The problem is that in the district hospitals, community health centres and the lower level of health set up, the deaths during childbirth are recorded as general mortality. This is to shield hospital staff from being held responsible for negligence and unaccountability.

The next question is that the Madhya Pradesh Government (GoMP) had itself in 2003 pointed out through the State Family Health Evaluation that in the rural areas of the state, the MMR was as high as 763. This study was done on 25 percent populace of each district. Yet the union government is releasing contradictory figures for the same period.

The health facilities in M.P. are in an ugly situation. The analysis of recent efforts of state government does not bring any good news. Only one hospital bed is available per two villages in M.P. A total of 17 lakh childbirths occur in the state every year and 40 percent of state populace is below poverty line, yet the government provides only Rs.150 per person per year as health budget of which Rs.126 is spend on salary-allowances and other infrastructure costs.
Key posts continue to remain vacant. Only 137 posts of gynaecologists and obstetricians are approved in entire state and of these 38 are vacant since several years, according to information unearthed by the Right to Food Campaign in M.P., from Department of Health and Family Welfare, using the national Right to Information law. After a long battle, in early 2005, the state government started the process for filling up 78 posts of gynaecologists and obstetricians but only 31 applications were received. A total 112 posts of anaesthetists were to be filled up but only 12 took up the job. No doctors are willing to take up government jobs owing to lack of facilities including diagnostic implements, medicines and general sanitary facilities. In such situation, doctors often have to face the wrath of the family members of the patient in case of death.

Furthermore, corruption at all levels is making conditions far more dangerous for the pregnant women. Corruption has already seeped in the medicine purchases under the new medicine policy, and the Rs.700 of financial support for mothers under the Janani Suraksha Yojana is spent in giving bribes to the local health staff. Despite unreliable data, statistics say that out of 1.47 lakh maternal deaths in the country every year, 97,000 are contributed by the five BIMARU states and the three newly carved states. The World Health Organisation also accepts this. In fact, half of the maternal deaths in South Asia are contributed by the states of Rajasthan, M.P., Bihar, U.P. and Orissa in India. It is in this light the Government of India's recent attempt to portray low MMR numbers for M.P. must be seen.

MMR is directly related to social disparity, exploitation and poverty. The governments (centre and state) have limited the scope of poverty to hunger and this has limited the rights of the women for safe motherhood. On the one hand, private health services are expanding, and due to poverty, more than 40 percent below poverty line families in M.P, are not able to access them. And on the other hand, the government's accountability to the poorer communities for their access to public health has only fallen.

Sachin Kumar Jain is a development journalist and is associated with the Right to Food Campaign in Madhya Pradesh.

Thursday, February 01, 2007

Reproductive health services: Govt in a dilemma

EDITORIAL by Central Chronicle, MP Edition, Feb 2, 2007

a call of concern by the Chronicle Reproductive health services in Madhya Pradesh

There has not been desired improvement in the condition of pregnant women in Madhya Pradesh. The state is also not left aloof from the revolutionary developments in health services. However, the news of deaths of 13,000 pregnant women, as per a survey, is really shocking. It is a direct slap on the face of our system which proclaims a lot about the progress being achieved in the health sector. This is a bitter truth which needs to be admitted. In Madhya Pradesh, the urban areas are developing well but the condition of people in the rural areas is deteriorating. Even though the government may have made efforts at its level to improve the situation in rural regions but the lacking of facilities is due to laxity and awareness in the implementation of various health schemes. The data of 13,000 deaths of pregnant women pertain mostly to rural areas.

There is shortage of hospitals in villages even today and where hospitals are present, the doctors are not available. There are many hospitals which have not even seen the faces of the doctors who were appointed for them. When the hospitals are sans general physicians then what to talk of specialist gynaecologists. In this context it may be pointed out that even government hospitals in the urban areas are facing shortage of specialist doctors. The government too is in a fix as to how to improve the standard of its hospitals but till today no permanent solution seems to be in sight. The government launched schemes of anganwadis, trained nurses and `trained dais'. Even then it is only a dilemma that the rural hospitals are not getting the services of these trained nurses. There are allegations of women from urban areas reaping the benefit of `dais'. As a result the trained nurses are not available at the time of deliveries of children and in absence of proper care deaths take place. The deaths are not only due to this factor but a host of diseases during pregnancy.

MP needs more medical colleges

View point - Central Chronicle, Bhopal, Feb 2, 2007

The government of Madhya Pradesh has launched many health schemes with a view to check maternal mortality but without much success. Vijay Raje Bima Yojna, taken up by the state government is unable to reach out to each and every woman of the state. The women who live near by towns and districts get medical benefits while women in far-flung areas are still deprived of the same. On the one hand, the government is promoting women for the institutional deliveries while hospitals at districts and tehsils are facing lack of infrastructure and medical staff on the other. There are only five medical colleges, which bring out a limited doctors against six crore people in Madhya Pradesh. Besides, the medical colleges also suffer from lack of medical teachers. The state government recently extended retiring age from 62 to 65 years for the medical teachers. But it cannot be deemed as permanent solution for the government and people. Students who go in for medical degrees opted-some of them-teaching profession while others become medical practitioners. The state needs more medical colleges to meet the health requirement of the people. However, the government has laid a foundation stone for the construction of a medical college at Sagar that will fulfill the medical need to some extent.
Although the state government has come up with a new idea yet it does not get 100% result, due to many impediments; they can be political, social and geographical. Death rate of women who die during prenatal and postnatal is partly because of poverty. Expectant mothers suffer from anemia and partly due to no hospitals in the vicinity.

However, child and women welfare department of state government has announced nutritious meals schemes to the rural expectant and nursing mothers as well as children of 3 to 6 years. They will be given puri, and mix veg, nutritious mathari, wheat soya barfi, laddus of suji and besan, upama of dal and vegetables, laddus of rice and besan, murmura and chana laddu. Besides, poha khamad, rice and dal chila, soya and rice chakki, chawal ka pura, chana chura and mungphali pati, nutritious poha, bajara-besan laddu, bajara mathrai, khasta vegetable curries and so on would be distributed as nutritious food on the basis of local food model to the beneficiaries on the pattern of mid-day meal in schools. It is moot question as to why women in European countries do not die, due to prenatal and postnatal complications? But India, the maternal mortality rate is so high that cannot be controlled only by agency of medical institutions. From the childhood, girls suffer from malnutrition and while reaching on threshold of adolescence and puberty, they become patients of anemia and at the same time they are married off. The pregnancy period becomes a battle field for them to fight between life and death.

The scheme launched by the government can prove as a short in the arm in health improvement movement if it is implemented by the ground level officials and workers.
The government has entrusted collectors to select the items as per protein and calorie quantity and the food grain would be supplied through self-help groups at local level. It is a drawback for the state government that it launches schemes but do not meet to the target, due to apathetic attitude by the field workers and officials.

Sunil Kumar

Govt Schemes : It is same old story

Sonia Khandelwal Indore, January 23, 2007

THE LOFTY schemes of Madhya Pradesh government for promoting institutional deliveries — for bringing down Infant Mortality Rate (IMR) and Maternal Mortality Rate (MMR) — need a reality check at ground level as was highlighted by an incident in a village in Barwani district raising several questions about awareness and implementation of these schemes.s.
Twentyone-year-old Santoshi Raju from Rajpur was referred to the District Hospital at Barwani for delivery, from where she was referred to M Y Hospital here as her blood pressure had increased to a dangerous level. Then started her traumatic journey of running from pillar to post.

“At Barwani, they (the doctors) asked us either to fill a consent form for taking responsibility of complicated delivery (which could mean threat to the lives of either the mother or the child or both) at Barwani or take her to Indore,” Santoshi’s husband Raju, a labourer, told Hindustan Times at the post natal ward.

Not ready to take risk at Barwani, Raju asked Barwani Civil Surgeon Dr B K Sawner to provide him ambulance to take Santoshi to Indore. “But as we did not have Deendayal Antyoday Yojana card, the doctor did not agree for the ambulance,” Raju added.

However, Deendayal Yojana card is not required for ambulance service. Despite repeated requests when the hospital authorities did not agree, an Accredited Social Health Activist (ASHA) from Rajpur Sarika Gopal Mukesh, who had accompanied them to Barwani, suggested taking Santoshi back to Rajpur. By this time, Raju, whose family comes under BPL, was penniless and collected funds from donors to take Santoshi back to Rajpur.

Fortunately, the PHC there provided an ambulance and Santoshi was brought to MY Hospital here on time, where she delivered a girl late Thursday night.The incident has exposed the cracks in the system and brings out the true picture painted by the actual implementation of the various welfare schemes of the state government.

To start with, Sarika, an ASHA, did not have proper information about Janani Suraksha Yojana, wherein she is supposed to get Rs 600 for bringing any expectant mother to a health facility. Not just this one scheme, she was not aware of many other schemes.“I have not heard about Janani Suraksha Yojana but during our training, we were told only about our incentives and basic work. They (trainers) never told us about how to tackle serious situations and also about facilities available like ambulance service for taking expecting women to a health facility,” Sarika told Hindustan Times at MY Hospital here.

When asked why the family had no Deendayal Antyodaya Yojana card, Sarika further said, “Almost 50 per cent of the people in our village (Rajpur) do not have this card as on today. The cards are being prepared for a long time and hence not distributed.”

Higher medical officials do not want to take any responsibility and have been passing the buck when it came to pinning down the person responsible for such an incident. Barwani Chief Medical and Health Officer (CMHO) Dr Lakshmi Baghel, when contacted on telephone about the incident, said, “As far as I am concerned, we had organised fairs and programmes to create awareness about Janani Suraksha Yojana at all the villages under our jurisdiction. If the volunteers are still unaware about it, we will try to create more awareness about it.”
Dr Sawner when contacted over telephone first said “I had given permission for providing ambulance to Santoshi”, only to retract later saying “Santoshi was referred to Indore by Barwani District Hospital gynaecologist Dr Sushila Kumrawat. Santoshi’s relatives did not approach me for ambulance.”

The above incident raises several questions. Like inadequate training of ASHAs, no proper publicity about various schemes of the government amid the target group; officials not bothered about proper implementation of schemes and last but not the least lack of awareness on part of the individual (here both Santoshi and Raju are illiterate) about their rights and the facilities available for them.

Published in HT, Indore Jan 23, 2007