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.