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
http://www.bhopal.net/medical/archives/2006/05/arrest_maternal.html

BHOPAL ARCHBISHOP"S CONCERN OVER MATERNAL MORTALITY RATE

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 -
http://www.bhopal.net/medical/archives/2006/05/bhopal_archbish.html

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

http://seafarer.wordpress.com/2006/10/07/miles-to-go-to-reach-the-mdgs-in-madhya-pradesh/

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.