AIR’s 14 radio stations in Madhya Pradesh ran a 15 to 20 minute episode daily on the issue of women's health.
Anil Gulati in Bhopal
Ten percent of maternal deaths in India take place in the state of Madhya Pradesh. Maternal death audits as undertaken by the state reveal that how timely medical attention still is a challenge for many pregnant women. Lack of awareness on recognition of danger signs, issue of transport, access to proper medical facilities, poverty are still some of the many challenges which needed to be overcome. Though the Government of Madhya Pradesh has launched many schemes to promote institutional deliveries and to combat maternal mortality, with special focus for below the poverty line and those belonging to scheduled castes and tribes, but a lot remains to be done.
Media and civil society are helping to raise concern and create awareness on the issue. All India Radio with its vast network in the state particularly in rural Madhya Pradesh contributed its bit by using air waves for the cause by addressing issues of immediate concern to its audiences.
All India Radio in collaboration with the state government and UNICEF, supported by Department of International Development (DFID), strategically used its programme options to engage communities on the issue of safe motherhood and help voice their concern by its people - policy interface. It also used its news network to give voice to state and civil society on the issue. Content analysis of last few months i.e. June 2006 - Feb 2007 AIR news reports tell us that the issue has been in focus and is spread evenly. News pertaining to government proclamations, schemes, and events took the major share but the news network also relayed statements of various experts and people working on the issue, which is a positive trend.
AIR has a strong presence especially in rural areas vide its fourteen radio stations across the state. It ran a 15 to 20 minute episode daily in form of a series from its network of radio stations on the issue of women's health. 35 such programmes were aired. Each programme had a local expert, often a medical professional to answer the questions and issues that were raised by the people from the district. It also provided information on how to recognize danger signs in pregnancy, stressed on the need of institutional delivery, care including nutrition of women during pregnancy, and issues related to anaemia. The purpose was to provide information and answers to the questions to the community by a local expert.
In addition to the same, the radio network also aired a series of seven one-hour live-phone in programmes on its afternoon prime time slot each month. It was a 'people - policy maker interface'. As part of the same programme a political representative or a representative from the state department was present in the studio to answer questions raised by callers on the issue. For the first time the issue of maternal health was addressed in this forum. The initiative by its very nature strengthened the community - system interface.
In the first programme the State Health & Family Welfare Minister answered questions from various rural parts of the state. Callers from far off villages in districts like Rewa, Tikamgarh, Sagar and Hoshangabad, brought to the notice of Health Minister the problems they face when it comes to the functioning of the health delivery system at the primary health centre level. The common grievance was that the doctors and nurses were absent from the duty. Questions were also raised the benefits of schemes not accruing and the types of health schemes available. On similar lines representatives from State's Women Commission, Human Rights Commission, Women and Child development department, Rural Development and Public Relations department were involved. Fifteen to twenty questions were asked in each programme.
In the last of the series the Chief Minister of the state answered queries of people in the state on the issue. Though the programme focused on women's health and safe motherhood, issues of education especially of girls, grant of scholarships to girls as provided by the state and violence against women also came up. In turn the programme offered an opportunity for people to get answers to their grievances by their elected representative on issues which many times get neglected in the political process.
Friday, May 25, 2007
Sunday, May 06, 2007
A comment on two years of NHRM
Dr Sanjit Nayak at One World South Asia
Health being a state subject, states have used their own discretion to interpret and implement the National Rural Health Mission (NRHM). While this has resulted in some activities being implemented the broader goal of the NHRM to empower local communities has been lost. This has lead to the dilution of the agenda of placing people's health in people's hands. The current government approach is to mandate community participation by issuing government orders to its functionaries at the district level. In rural areas, village and district action plans based on community need assessment have remained a non starter and in urban areas the poor remain marginalized from this process. The NRHM talks about health sector reforms but the specific objectives of the reforms appear unrealistic and unlikely to result in the improvement of the health status of the individual or the community. In effect the Mission remains more target oriented with a disproportionate emphasis on inputs rather than focused on output or performance. The concept of Accredited Social Health Activist (ASHA), which forms the core through which the NRHM will be operationalised, cannot be described as being an innovation but rather is old wine in a new bottle. In earlier versions of the health programme similar human resource mechanisms have been proposed - for example the community health worker, link worker, multi- purpose worker amongst other things. In India, the polices, plans and schemes have often been comprehensive but the implementation has remained poor and as a result the desired result as envisaged by policies and programmes has never been actualised. The ASHA as has been mentioned earlier forms the core implementation mechanism for NRHM, who will undertake the bulk of the activities at the community level.
Inspite of playing this critical role, women who are selected are seen to be volunteers and the programme itself does not define any type of financial compensation for the work they will undertake. Recent findings show that it is proving to be extremely difficult to motivate individuals to undertake the work where no remuneration is forthcoming. As part of the ASHA scheme an incentive system has been proposed under the supervision of Sarpanch and Auxiliary Nurse Midwife. This has lead to non-integration (architectural correction) of all the other health programmes at the community level. Furthermore, there is an extremely high expectation from ASHA whose envisaged work profile does little justice as a part time worker.
The ASHA work under severe constraints with regard to infrastructure as a result ASHAs often have to resort to referring their patients to private service providers. In addition, ASHA has replaced the male health worker. ASHA's work profile is different and primarily to support the ANM. The numbers of male MPWs is already reduced and it is likely that their role will soon be written out of health programmes. It is important to point out that MPWs have a key role to play in other programmes e.g. prevention of communicable diseases and undertaking surveillance, none of which can be undertaken by ASHA. As part of the reform process of the health sector, which remains an important component of NRHM, the strengthening of public-private partnership has been mooted.
However, many health activists feel this is the governments' way of shirking responsibility to provide health services in particular primary health care as has been envisaged in the Constitution. The government is now trying to even privatize primary health care and does not want to invest in improving the public health sector. Upgrading infrastructure, especially PHC to FRU/ UPHC in un- served and underserved areas with doctors unwilling to provide service will further privatise primary health care. Contracts to private practitioners will be the only solution to man these PHC. Indian Public Health Standards (IPHS) to provide quality health care in the public health system by ensuring minimum requirements of infrastructure, accountability of doctors, the need for standard treatment protocols and social audit through rogi kalyan samiti (RKS) has been a non- starter. This has been the scenario previously as such policy directions have not translated into action. T
he guidelines for IPHS do not address the real issue which requires an analysis of failure of previous schemes. An attempt was made by the National Commission of Health and Macro-economics but its recommendations are gathering dust. NRHM aim is to reduce infant mortality and maternal mortality by improving access through the ASHA and the Janani Suraksha Yojana (JSY) scheme by strengthening Community Health Centres. The emphasis is on technology alone. It has failed to address the correlates to nutrition and thus to poverty. The belief that reducing total fertility will reduce infant mortality ignores the links between the socio-economic status of the community especially that of women and health of an infant. It is important to note that access to care is also linked to discrimination as well. Additionally unskilled human resource and poor infrastructure in un-served and under-served areas compound the problem. Targets to reduce infant mortality rate (IMR) and maternal mortality ratio (MMR) by only increasing health sector expenditure needs to address issues of equitable distribution and resource allocation. Conceptual problems do exits in NRHM. Much of NRHM today depends on public- private partnership and not on strengthening the public health system. By outsourcing and contracting we have subscribed to privatisation of the health care delivery system. It is also difficult to comprehend how ASHA can bring about inter- sectoral coordination. In conclusion the link between poverty and ill-health are cursorily mentioned and are ignored in the actual implementation plan laid out as part of the NRHM. Based on the above analysis it might be fair to say that attainment of the goals envisaged by NRHM by 2012 remains wishful thinking.
The author is a public health specialist with the Population Foundation of India New Delhi. The views expressed are that of his owns as an activist and not that of the foundation
Health being a state subject, states have used their own discretion to interpret and implement the National Rural Health Mission (NRHM). While this has resulted in some activities being implemented the broader goal of the NHRM to empower local communities has been lost. This has lead to the dilution of the agenda of placing people's health in people's hands. The current government approach is to mandate community participation by issuing government orders to its functionaries at the district level. In rural areas, village and district action plans based on community need assessment have remained a non starter and in urban areas the poor remain marginalized from this process. The NRHM talks about health sector reforms but the specific objectives of the reforms appear unrealistic and unlikely to result in the improvement of the health status of the individual or the community. In effect the Mission remains more target oriented with a disproportionate emphasis on inputs rather than focused on output or performance. The concept of Accredited Social Health Activist (ASHA), which forms the core through which the NRHM will be operationalised, cannot be described as being an innovation but rather is old wine in a new bottle. In earlier versions of the health programme similar human resource mechanisms have been proposed - for example the community health worker, link worker, multi- purpose worker amongst other things. In India, the polices, plans and schemes have often been comprehensive but the implementation has remained poor and as a result the desired result as envisaged by policies and programmes has never been actualised. The ASHA as has been mentioned earlier forms the core implementation mechanism for NRHM, who will undertake the bulk of the activities at the community level.
Inspite of playing this critical role, women who are selected are seen to be volunteers and the programme itself does not define any type of financial compensation for the work they will undertake. Recent findings show that it is proving to be extremely difficult to motivate individuals to undertake the work where no remuneration is forthcoming. As part of the ASHA scheme an incentive system has been proposed under the supervision of Sarpanch and Auxiliary Nurse Midwife. This has lead to non-integration (architectural correction) of all the other health programmes at the community level. Furthermore, there is an extremely high expectation from ASHA whose envisaged work profile does little justice as a part time worker.
The ASHA work under severe constraints with regard to infrastructure as a result ASHAs often have to resort to referring their patients to private service providers. In addition, ASHA has replaced the male health worker. ASHA's work profile is different and primarily to support the ANM. The numbers of male MPWs is already reduced and it is likely that their role will soon be written out of health programmes. It is important to point out that MPWs have a key role to play in other programmes e.g. prevention of communicable diseases and undertaking surveillance, none of which can be undertaken by ASHA. As part of the reform process of the health sector, which remains an important component of NRHM, the strengthening of public-private partnership has been mooted.
However, many health activists feel this is the governments' way of shirking responsibility to provide health services in particular primary health care as has been envisaged in the Constitution. The government is now trying to even privatize primary health care and does not want to invest in improving the public health sector. Upgrading infrastructure, especially PHC to FRU/ UPHC in un- served and underserved areas with doctors unwilling to provide service will further privatise primary health care. Contracts to private practitioners will be the only solution to man these PHC. Indian Public Health Standards (IPHS) to provide quality health care in the public health system by ensuring minimum requirements of infrastructure, accountability of doctors, the need for standard treatment protocols and social audit through rogi kalyan samiti (RKS) has been a non- starter. This has been the scenario previously as such policy directions have not translated into action. T
he guidelines for IPHS do not address the real issue which requires an analysis of failure of previous schemes. An attempt was made by the National Commission of Health and Macro-economics but its recommendations are gathering dust. NRHM aim is to reduce infant mortality and maternal mortality by improving access through the ASHA and the Janani Suraksha Yojana (JSY) scheme by strengthening Community Health Centres. The emphasis is on technology alone. It has failed to address the correlates to nutrition and thus to poverty. The belief that reducing total fertility will reduce infant mortality ignores the links between the socio-economic status of the community especially that of women and health of an infant. It is important to note that access to care is also linked to discrimination as well. Additionally unskilled human resource and poor infrastructure in un-served and under-served areas compound the problem. Targets to reduce infant mortality rate (IMR) and maternal mortality ratio (MMR) by only increasing health sector expenditure needs to address issues of equitable distribution and resource allocation. Conceptual problems do exits in NRHM. Much of NRHM today depends on public- private partnership and not on strengthening the public health system. By outsourcing and contracting we have subscribed to privatisation of the health care delivery system. It is also difficult to comprehend how ASHA can bring about inter- sectoral coordination. In conclusion the link between poverty and ill-health are cursorily mentioned and are ignored in the actual implementation plan laid out as part of the NRHM. Based on the above analysis it might be fair to say that attainment of the goals envisaged by NRHM by 2012 remains wishful thinking.
The author is a public health specialist with the Population Foundation of India New Delhi. The views expressed are that of his owns as an activist and not that of the foundation
Maternal Deaths In Madhya Pradesh Denial Is The Best Policy
by Sachin Kumar Jain
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 equipments and hardly has been cleaned ever. This is not the situation of one health centre, 20 kilometers 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.
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 gynecologist and obstetrician could not be posted.
Anganbadi worker from Gothra Kapura village of the district, Bilasi Devi 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. Government claims that anyone going for institutional childbirth would get Rs 1700 worth financial aid, transport fare and free medicines, but Babhuti was taken for childbirth to a hospital and her family had to pawn their land for completing the process.
In such situation, the Government of India has recently released figures related to maternal mortality for the first time since 1998, which claims that the Maternal Mortality Rate (MMR) has gone down from 498 (per lakh childbirth) to 379 during the period. But the report of the GoI (Maternal Mortality in India: Trends, causes and risk factors - 1997-2003) is itself facing some basic technical questions. The biggest question is as to whether the government is trying to veil the ground situation by some statistics under some pressure.
One important point is that this study of MMR has been conducted by considering only limited number of cases in specific situation. The survey was conducted over a period of six years and the low MMR is reported in MP and Chhattisgarh (365) although during this period about 103000 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 tell that only one out of three maternal deaths get officially recorded. The problem is that in the district hospitals, community health centers and the lower level of health set up, the deaths during childbirth are recorded as general mortality.
The next question is that the Madhya Pradesh Government (GoMP) had in 2003 pointed out through the State Family Health Evaluation made it clear that in the rural areas of the state, the MMR is as high as 763, which clearly tells that the situation is far graver than the analysis by the union government. This study by the GoMP was done on 25 percent populace of each district and not only a selected group yet the union government is releasing contradictory figures for the same period.
The controversy should not remain limited to statistics because the health facility condition in state clearly brings forth the ugly face of the situation. The analysis of recent efforts of state government does not bring any good news.
In the state, only one hospital bed is available per two villages. Total 17 lakh childbirth 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. Only 137 posts of gynecologists and obstetricians are approved in entire state and of these 38 are vacant since several years. After a long battle, the government started the process of filling up the vacancies last year but 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.
Government started the process for filling up 78 posts of gynecologists and obstetricians but only 31 applications were received. A total 112 posts of anesthetists were to be filled up but only 12 took up the job. Corruption at all levels is making conditions far more dangerous for the pregnant women. Corruption has begun in the medicine purchase under the new medicine policy, as now in the new medicine policy all the purchase will be done centrally and the Rs 700 of financial support under Janani Suraksha Yojana is all spent in giving bribe to the local health staff.
Despite unreliable data, statistics say that out of 1.47 lakh maternal deaths in the country every year, 97000 are contributed by the five BIMARU states and the three newly carved states. The World Health Organization also accepts this. The half of the maternal deaths in South Asia are contributed by the states of Rajasthan, MP, Bihar, UP and Orissa in India.
In such situation the statistics need to be manipulated to show lower MMP so that the policies foreign investments and privatization of services could be justified. MMR is directly related to social disparity, exploitation and poverty. The government has limited the scope of poverty around hunger and this has limited the rights of the women for safe motherhood. On one had health services have been hugely privatized and on other government's accountability for rights of community to health has reduced. Due to poverty, more than 40 percent below poverty line families are not able to seek benefit of private health services.
Actually this is the time to sincerely implement the efforts for safe motherhood. A political debate has started on the issue but lack of commitment is easily perceptible. The fear is that the rights of women might get entangles into a web of schemes. Government provides cheaper food grains but it is ironic that a women suffering from childbirth pains has to prove that she is poor as per government guidelines to get free medical care and medicines. The government needs to chalk out a comprehensive policy and coordinated effort for child and maternal health and not keep churning out irresponsible and discrepant schemes just to please some political leaders.
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 equipments and hardly has been cleaned ever. This is not the situation of one health centre, 20 kilometers 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.
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 gynecologist and obstetrician could not be posted.
Anganbadi worker from Gothra Kapura village of the district, Bilasi Devi 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. Government claims that anyone going for institutional childbirth would get Rs 1700 worth financial aid, transport fare and free medicines, but Babhuti was taken for childbirth to a hospital and her family had to pawn their land for completing the process.
In such situation, the Government of India has recently released figures related to maternal mortality for the first time since 1998, which claims that the Maternal Mortality Rate (MMR) has gone down from 498 (per lakh childbirth) to 379 during the period. But the report of the GoI (Maternal Mortality in India: Trends, causes and risk factors - 1997-2003) is itself facing some basic technical questions. The biggest question is as to whether the government is trying to veil the ground situation by some statistics under some pressure.
One important point is that this study of MMR has been conducted by considering only limited number of cases in specific situation. The survey was conducted over a period of six years and the low MMR is reported in MP and Chhattisgarh (365) although during this period about 103000 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 tell that only one out of three maternal deaths get officially recorded. The problem is that in the district hospitals, community health centers and the lower level of health set up, the deaths during childbirth are recorded as general mortality.
The next question is that the Madhya Pradesh Government (GoMP) had in 2003 pointed out through the State Family Health Evaluation made it clear that in the rural areas of the state, the MMR is as high as 763, which clearly tells that the situation is far graver than the analysis by the union government. This study by the GoMP was done on 25 percent populace of each district and not only a selected group yet the union government is releasing contradictory figures for the same period.
The controversy should not remain limited to statistics because the health facility condition in state clearly brings forth the ugly face of the situation. The analysis of recent efforts of state government does not bring any good news.
In the state, only one hospital bed is available per two villages. Total 17 lakh childbirth 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. Only 137 posts of gynecologists and obstetricians are approved in entire state and of these 38 are vacant since several years. After a long battle, the government started the process of filling up the vacancies last year but 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.
Government started the process for filling up 78 posts of gynecologists and obstetricians but only 31 applications were received. A total 112 posts of anesthetists were to be filled up but only 12 took up the job. Corruption at all levels is making conditions far more dangerous for the pregnant women. Corruption has begun in the medicine purchase under the new medicine policy, as now in the new medicine policy all the purchase will be done centrally and the Rs 700 of financial support under Janani Suraksha Yojana is all spent in giving bribe to the local health staff.
Despite unreliable data, statistics say that out of 1.47 lakh maternal deaths in the country every year, 97000 are contributed by the five BIMARU states and the three newly carved states. The World Health Organization also accepts this. The half of the maternal deaths in South Asia are contributed by the states of Rajasthan, MP, Bihar, UP and Orissa in India.
In such situation the statistics need to be manipulated to show lower MMP so that the policies foreign investments and privatization of services could be justified. MMR is directly related to social disparity, exploitation and poverty. The government has limited the scope of poverty around hunger and this has limited the rights of the women for safe motherhood. On one had health services have been hugely privatized and on other government's accountability for rights of community to health has reduced. Due to poverty, more than 40 percent below poverty line families are not able to seek benefit of private health services.
Actually this is the time to sincerely implement the efforts for safe motherhood. A political debate has started on the issue but lack of commitment is easily perceptible. The fear is that the rights of women might get entangles into a web of schemes. Government provides cheaper food grains but it is ironic that a women suffering from childbirth pains has to prove that she is poor as per government guidelines to get free medical care and medicines. The government needs to chalk out a comprehensive policy and coordinated effort for child and maternal health and not keep churning out irresponsible and discrepant schemes just to please some political leaders.
Saturday, May 05, 2007
Hospital negligence claims woman's life in Bhopal
Story on NDTV.com
Salamat Ali is inconsolable. His 25-year-old wife Tajbunissa died at the Indira Gandhi Gas Relief hospital in Bhopal on Thursday afternoon and he wasn't even told until the evening.
Tajbunissa, two and a half months pregnant, had gone for an abortion and a tubectomy. But after the surgery, she never regained consciousness.
Salamat is sure his wife died due to negligence of the doctors.
''After the tubectomy operation, she never gained consciousness and when she started bleeding form her nose and mouth, I desperately tried to call the doctors but there was no one,'' said Salamat Ali, victim's husband.
Hospital authorities claim Tajbunissa died of pulmonary oedema or fluid in the lungs, followed by a cardiac arrest.
Callous attitude
An FIR has been filed and the police are investigating the death. Salamat also says he was asked to take his wife's body away without making a fuss. He says the hospital even offered him a compensation of Rs three lakh.
Other patients at the hospital say the incident has exposed the irregularities at the hospital where the staff is greedy and careless.
''Over here even the guards ask for money. Nurses say 'Give me Rs 500 only then I will change the bottle,'' said Avinash Jain, patient.
There are six hospitals in Bhopal to cater to all those affected by the Bhopal gas tragedy. There are also seven mini dispensaries.
But patients say most of them are severely understaffed and lack even the basic amenities.
''The gas relief hospitals are going form bad to worse. This is not simply a case of negligence or even criminal negligence, it's a case of criminal offence,'' said Abdul Jabber, Convener, Bhopal Gas Victims Organisation.
Already suffering from the after-effects of a disaster, these people seem to get little but apathy at these hospitals set up to help them.
Salamat Ali is inconsolable. His 25-year-old wife Tajbunissa died at the Indira Gandhi Gas Relief hospital in Bhopal on Thursday afternoon and he wasn't even told until the evening.
Tajbunissa, two and a half months pregnant, had gone for an abortion and a tubectomy. But after the surgery, she never regained consciousness.
Salamat is sure his wife died due to negligence of the doctors.
''After the tubectomy operation, she never gained consciousness and when she started bleeding form her nose and mouth, I desperately tried to call the doctors but there was no one,'' said Salamat Ali, victim's husband.
Hospital authorities claim Tajbunissa died of pulmonary oedema or fluid in the lungs, followed by a cardiac arrest.
Callous attitude
An FIR has been filed and the police are investigating the death. Salamat also says he was asked to take his wife's body away without making a fuss. He says the hospital even offered him a compensation of Rs three lakh.
Other patients at the hospital say the incident has exposed the irregularities at the hospital where the staff is greedy and careless.
''Over here even the guards ask for money. Nurses say 'Give me Rs 500 only then I will change the bottle,'' said Avinash Jain, patient.
There are six hospitals in Bhopal to cater to all those affected by the Bhopal gas tragedy. There are also seven mini dispensaries.
But patients say most of them are severely understaffed and lack even the basic amenities.
''The gas relief hospitals are going form bad to worse. This is not simply a case of negligence or even criminal negligence, it's a case of criminal offence,'' said Abdul Jabber, Convener, Bhopal Gas Victims Organisation.
Already suffering from the after-effects of a disaster, these people seem to get little but apathy at these hospitals set up to help them.
Wednesday, April 11, 2007
Madhya Pradesh Needs to Invest in Health
www.boloji.com
The theme of World Health Day on 7 April was 'Invest in Health – Build a Safe Future'. The above theme is more relevant in Madhya Pradesh, central part of India. The State urgently needs to invest in health to help save lives of its own people especially women and children.
The State of Madhya Pradesh has the highest rates of malnutrition among the children in India. As per the latest National Family Health Survey 60 % of its children in age group of 0 – 3 years are under nourished. Similarly as per the growth monitoring drive undertaken by the state 78,000 children in the state are severely malnourished, meaning they need immediate care. Though the state has set up nutritional rehabilitation centers in some of its districts to provide for medical and nutritional care and support to the parents of severely malnourished children but need is of more efforts in this direction or else many may die.
Madhya Pradesh has the highest infant mortality rate and 3rd highest maternal mortality ratio in the country. 76 out of every 1000 children born in the state die before their first birthday and approximately 24 women die everyday in the state. Though the state has introduced many schemes to help combat the same, but due to bureaucratic hassles and corruption the schemes are not yielding the desired results for children and women. As per state's health department web site Madhya Pradesh for its population of 60.38 million (as per 2001 census) has the following health infrastructure:
- District hospitals 48
- Civil hospitals 54
- Community health centers 270
- Primary health centers 1149
- Sub health centers 8834
- Sanctioned beds in district hospitals 8945
- Sanctioned beds in civil hospitals 2775
- Total licensed blood banks by state 41
A NGO namely Collective of Advocacy research and training which advocates on the issues of maternal and infant survival has been calling the issue to attention. They had undertaken an analysis of rural health infrastructure versus the population in the state. As per their statement there is just 'one bed per 5.6 villages' in the state which is alarming!. It is not only the issue of beds or buildings. Even where there are structures or health centers they lack basic minimum facilities as needed and defined by rules and are not sufficient enough to save lives or provide for better health care to its people.
As per Reproductive and Child Health District level household survey (2004) data, out of the 386 primary health centre's surveyed in the state only 224 had drinking water facility. This means that only 58.3 percent primary health centre's had drinking water while others have no such facility. Similarly in case of community health centre's out of the 46 surveyed only 10 had facility of drinking water. In case of vehicles like ambulances out of the 386 primary health centers surveyed only 35 had vehicles which were in running condition and out of 46 community health centre's surveyed 31 had vehicles in the running condition.
Infrastructure investment does not only mean building equipments etc. Human resource which is core in health needs to be focused upon. Not only to fulfill the vacancies of doctors, para-medics, nurses but also providing them with facilities to provide care for the people. When one raises concern on the issue of health there are numbers of different issues which impact lives of people including women and children in the state which needs attention. Probably state needs to revamp and transform its health system and look at the whole issue more holistically. The State needs to peg health of its people as priority number one, transform on immediate basis which is not only limited to public proclamations and announcing schemes but also delivering results at ground level.
anil gulati
(All views expressed in this piece are personal opinions of the writer)
The theme of World Health Day on 7 April was 'Invest in Health – Build a Safe Future'. The above theme is more relevant in Madhya Pradesh, central part of India. The State urgently needs to invest in health to help save lives of its own people especially women and children.
The State of Madhya Pradesh has the highest rates of malnutrition among the children in India. As per the latest National Family Health Survey 60 % of its children in age group of 0 – 3 years are under nourished. Similarly as per the growth monitoring drive undertaken by the state 78,000 children in the state are severely malnourished, meaning they need immediate care. Though the state has set up nutritional rehabilitation centers in some of its districts to provide for medical and nutritional care and support to the parents of severely malnourished children but need is of more efforts in this direction or else many may die.
Madhya Pradesh has the highest infant mortality rate and 3rd highest maternal mortality ratio in the country. 76 out of every 1000 children born in the state die before their first birthday and approximately 24 women die everyday in the state. Though the state has introduced many schemes to help combat the same, but due to bureaucratic hassles and corruption the schemes are not yielding the desired results for children and women. As per state's health department web site Madhya Pradesh for its population of 60.38 million (as per 2001 census) has the following health infrastructure:
- District hospitals 48
- Civil hospitals 54
- Community health centers 270
- Primary health centers 1149
- Sub health centers 8834
- Sanctioned beds in district hospitals 8945
- Sanctioned beds in civil hospitals 2775
- Total licensed blood banks by state 41
A NGO namely Collective of Advocacy research and training which advocates on the issues of maternal and infant survival has been calling the issue to attention. They had undertaken an analysis of rural health infrastructure versus the population in the state. As per their statement there is just 'one bed per 5.6 villages' in the state which is alarming!. It is not only the issue of beds or buildings. Even where there are structures or health centers they lack basic minimum facilities as needed and defined by rules and are not sufficient enough to save lives or provide for better health care to its people.
As per Reproductive and Child Health District level household survey (2004) data, out of the 386 primary health centre's surveyed in the state only 224 had drinking water facility. This means that only 58.3 percent primary health centre's had drinking water while others have no such facility. Similarly in case of community health centre's out of the 46 surveyed only 10 had facility of drinking water. In case of vehicles like ambulances out of the 386 primary health centers surveyed only 35 had vehicles which were in running condition and out of 46 community health centre's surveyed 31 had vehicles in the running condition.
Infrastructure investment does not only mean building equipments etc. Human resource which is core in health needs to be focused upon. Not only to fulfill the vacancies of doctors, para-medics, nurses but also providing them with facilities to provide care for the people. When one raises concern on the issue of health there are numbers of different issues which impact lives of people including women and children in the state which needs attention. Probably state needs to revamp and transform its health system and look at the whole issue more holistically. The State needs to peg health of its people as priority number one, transform on immediate basis which is not only limited to public proclamations and announcing schemes but also delivering results at ground level.
anil gulati
(All views expressed in this piece are personal opinions of the writer)
Friday, April 06, 2007
MP Convention on safemotherhood
The Hindu, Staff Correspondent
- Govt. to address women, child-related issues with urgency
- Meeting organised along with UNICEF to make the rural women aware of various schemes
`Govt. is determined to ensure that not a single woman dies due to delivery related complications'
Majhauli (Madhya Pradesh): Thousands of women braved the afternoon sun on Sunday and attended a huge women's convention organised here by the Madhya Pradesh Department of Public Health and Family Welfare and UNICEF to make the rural women aware of various schemes aimed at addressing the problem of maternal and infant mortality and other women and child related issues.
Addressing the convention on safe motherhood at this development block in Jabalpur district, the State health Minister, Ajay Vishnoi said that it is very important to save the life of every woman and child. He said that the State Government is determined to ensure that not a single woman died due to delivery related complications. The Government is committed and policies were being implemented with total urgency for the benefit of every mother and child in the State, he added. The women attending the convention clapped in approval when the Minister informed them about the incentives being given to women in Madhya Pradesh to promote institutionalised delivery and schemes like Bal Shakti and Ladli Lakshmi Yojna. Speaking on this occasion, UNICEF's State Representative, Hamid El-Bashir said that his organization would always work closely with the State Health Administration and other Government departments. He went on to observe: "We are proud of this partnership and were prepared to take it further". He added, "We are ready to work with every agency and organization tackling women and child related issues on priority". He also advised the women to raise their demands saying: "We are ready to listen" and further said: "We want to ensure that maternal and infant mortality is reduced in Madhya Pradesh. We also want to reduce levels of malnutrition and anaemia among infants, girls and women."
The State Director Public Health and Family Welfare, Yogiraj Sharma said in his speech that maternal mortality is very high in Madhya Pradesh and every hour one mother dies in the State. He said that every one was responsible for this grim scenario and that women would have to come forward and take the benefits of various schemes being implemented by the Government for their welfare, particularly the incentives being offered for institutionalised delivery. The Jabalpur Collector, Sanjay Dubey emphasised that all steps should be taken to protect the newly born and to combat the problem of infant mortality. He said that children should be protected from malnutrition and women should not be allowed to go through pregnancy related complications.
Ms. Alka Vishnoi, the State Health Minister' wife set the tone for the women's convention named as the "Saas-Bahu Sammelan" (convention of mothers-in-law and daughters-in-law).
- Govt. to address women, child-related issues with urgency
- Meeting organised along with UNICEF to make the rural women aware of various schemes
`Govt. is determined to ensure that not a single woman dies due to delivery related complications'
Majhauli (Madhya Pradesh): Thousands of women braved the afternoon sun on Sunday and attended a huge women's convention organised here by the Madhya Pradesh Department of Public Health and Family Welfare and UNICEF to make the rural women aware of various schemes aimed at addressing the problem of maternal and infant mortality and other women and child related issues.
Addressing the convention on safe motherhood at this development block in Jabalpur district, the State health Minister, Ajay Vishnoi said that it is very important to save the life of every woman and child. He said that the State Government is determined to ensure that not a single woman died due to delivery related complications. The Government is committed and policies were being implemented with total urgency for the benefit of every mother and child in the State, he added. The women attending the convention clapped in approval when the Minister informed them about the incentives being given to women in Madhya Pradesh to promote institutionalised delivery and schemes like Bal Shakti and Ladli Lakshmi Yojna. Speaking on this occasion, UNICEF's State Representative, Hamid El-Bashir said that his organization would always work closely with the State Health Administration and other Government departments. He went on to observe: "We are proud of this partnership and were prepared to take it further". He added, "We are ready to work with every agency and organization tackling women and child related issues on priority". He also advised the women to raise their demands saying: "We are ready to listen" and further said: "We want to ensure that maternal and infant mortality is reduced in Madhya Pradesh. We also want to reduce levels of malnutrition and anaemia among infants, girls and women."
The State Director Public Health and Family Welfare, Yogiraj Sharma said in his speech that maternal mortality is very high in Madhya Pradesh and every hour one mother dies in the State. He said that every one was responsible for this grim scenario and that women would have to come forward and take the benefits of various schemes being implemented by the Government for their welfare, particularly the incentives being offered for institutionalised delivery. The Jabalpur Collector, Sanjay Dubey emphasised that all steps should be taken to protect the newly born and to combat the problem of infant mortality. He said that children should be protected from malnutrition and women should not be allowed to go through pregnancy related complications.
Ms. Alka Vishnoi, the State Health Minister' wife set the tone for the women's convention named as the "Saas-Bahu Sammelan" (convention of mothers-in-law and daughters-in-law).
Tackling maternal mortality in MP
By Rashme Sehgal
Shivpuri and Guna districts in Madhya Pradesh have one of the highest maternal mortality rates in India. But in a PHC in Satanvara block, two young doctors have ensured not a single maternal death in 257 deliveries they’ve handled over one year
The ravines of Chambal have given birth to many legends woven around the lives of notorious dacoits. One such legend is being woven around Ram Babu Gadaria, a shepherd by profession, who became a dacoit after his wife was raped by upper-caste landlords.
What has Gadaria got to do with the pressing issue of maternal mortality in a backward state like Madhya Pradesh? He has almost brought the tottering health system to a halt with his Phoolan Devi-like antics. He is said to kidnap doctors and health workers for ransom, releasing them after receiving hefty amounts from their families. Recently he kidnapped two private doctors with sizeable practises and released them after being paid astronomical sums of money.
Two young women doctors in their mid-20s, Manisha Yadav and Sandhya Gupta, working at a primary health centre (PHC) in the Satanvara block of Shivpuri district, adjacent to the Chambal valley, are terrified of Gadaria and his gun-toting gang. Both Manisha and Sandhya have been working at this PHC for over a year and have already handled more than 257 deliveries. But since many of these deliveries take place at night, these young women have to make their way from their rented accommodation to the PHC in the dead of night.
“It's very scary. Both of us have studied in Gwalior and the very thought of coming face-to-face with a member of this gang is alarming. The local villagers have told us that the Gadaria gang are quite active here,” said Manisha.
Both these doctors decided to accept this challenging assignment because they would receive a starting salary of Rs 15,000 per month. Salaries of doctors willing to accept field postings were recently hiked by the state government which realised that several PHCs and district hospitals were inadequately staffed. These two doctors claim credit for not having had a single maternal death so far. “Of the 257 deliveries we have conducted so far, we have not had a single maternal death,” they say.
The birth of two female children the night before by two tribal women has boosted their confidence further. Both the mothers and their babies are sleeping in a room adjacent to the makeshift operation theatre. One of the reasons for the absence of maternal deaths could be that caesarean and other complicated delivery cases are directed from here to the district hospital. “We have had three cases of stillborn babies. One case was of a mother running continuous high-grade fever giving birth to seven-month-old twins. Fortunately, the mother survived,” Manisha pointed out.
The district of Shivpuri, which falls in the Gwalior-Chambal zone, has one of the highest maternal mortality rates in India . A maternal death audit conducted by Unicef and local NGOs has brought to light that while 50 maternal deaths took place in Shivpuri in 2006, the figure in Guna district was 56. Guna is the parliamentary constituency of the high-profile Congress MP Jyotiraditya Scindia. The deaths were reported by the ANMs (auxiliary nurse midwives) and by local NGOs.
Dr Ramani Atkuri, of Unicef, Bhopal , pointed out, “This is the tip of the iceberg. We believe many more women have died from childbirth but their deaths go unreported.”
“The majority of deaths take place because of haemorrhage, severe anaemia, eclampsia, malaria and sepsis,” Atkuri added.
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. Every five minutes, India suffers one maternal death. The number of women who die due to pregnancy, childbirth and abortion-related complications is estimated at 60,630. The maternal mortality ratio (MMR) for India presently is 301 deaths per 100,000 live births. Uttar Pradesh alone accounts for close to 21,450 maternal deaths per year.
The maternal audit also highlighted that less than 25% of babies born to women who died have a chance of surviving. This was borne out in Guna district. Ram Swarup Batham sits outside his mud hut in Shivpuri village 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.
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.”
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. One RNTCP official says: “The lack of integration between the TB programme and the general healthcare system is the main reason why the programme has not attained its goals. The PHC health staff do not support the TB programme because it does not offer cash incentives. These vertical programmes are creating distortions, and there is no collaboration in the implementation of programmes.”
The death of his wife has plunged their family into chaos. For one, the entire responsibility of looking after the 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.”
The tragedy of Veeja's death is that it could have been easily prevented. Hamid al-Bashir, Unicef's state representative in Bhopal , believes, “Most maternal deaths could be prevented if women had access to appropriate healthcare during pregnancy, childbirth and immediately after 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,” al-Bashir adds. The official explains that the situation has been repeatedly highlighted before RNTCP officials in Delhi. “But,” he says, “they are avoiding the issue and tell us to try solving the problem locally.”
Dr Aparajita Gogoi, National Coordinator for the White Ribbon Alliance India , describes 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.”
Gogoi says, “We have not been able to stem this tide of maternal deaths despite having 20,000 obstetricians, 5 lakh trained doctors and 25 lakh nurses and midwives.” Even poor countries like Bangladesh , Bolivia and 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.
The statistics in Madhya Pradesh are more alarming because in rural areas, local NGOs point out, for every 5.6 villages (average population of 2,000 per village) only one hospital bed is available. Over 82% of the children suffer from anaemia while 58% of pregnant women are also found to be anaemic.
Unicef believes one of the ways to strengthen community initiatives is by holding maternal death audits. Another such audit was recently held in Purulia in West Bengal between May 2005 and June 2006. It was found that of 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 revealed 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 was four years. While 61% of deaths occurred in a health facility, 24% died at home and another 13% died en route to a health facility. The majority of deaths occurred during labour and in the post-partum period.
InfoChange News & Features, March 2007
Shivpuri and Guna districts in Madhya Pradesh have one of the highest maternal mortality rates in India. But in a PHC in Satanvara block, two young doctors have ensured not a single maternal death in 257 deliveries they’ve handled over one year
The ravines of Chambal have given birth to many legends woven around the lives of notorious dacoits. One such legend is being woven around Ram Babu Gadaria, a shepherd by profession, who became a dacoit after his wife was raped by upper-caste landlords.
What has Gadaria got to do with the pressing issue of maternal mortality in a backward state like Madhya Pradesh? He has almost brought the tottering health system to a halt with his Phoolan Devi-like antics. He is said to kidnap doctors and health workers for ransom, releasing them after receiving hefty amounts from their families. Recently he kidnapped two private doctors with sizeable practises and released them after being paid astronomical sums of money.
Two young women doctors in their mid-20s, Manisha Yadav and Sandhya Gupta, working at a primary health centre (PHC) in the Satanvara block of Shivpuri district, adjacent to the Chambal valley, are terrified of Gadaria and his gun-toting gang. Both Manisha and Sandhya have been working at this PHC for over a year and have already handled more than 257 deliveries. But since many of these deliveries take place at night, these young women have to make their way from their rented accommodation to the PHC in the dead of night.
“It's very scary. Both of us have studied in Gwalior and the very thought of coming face-to-face with a member of this gang is alarming. The local villagers have told us that the Gadaria gang are quite active here,” said Manisha.
Both these doctors decided to accept this challenging assignment because they would receive a starting salary of Rs 15,000 per month. Salaries of doctors willing to accept field postings were recently hiked by the state government which realised that several PHCs and district hospitals were inadequately staffed. These two doctors claim credit for not having had a single maternal death so far. “Of the 257 deliveries we have conducted so far, we have not had a single maternal death,” they say.
The birth of two female children the night before by two tribal women has boosted their confidence further. Both the mothers and their babies are sleeping in a room adjacent to the makeshift operation theatre. One of the reasons for the absence of maternal deaths could be that caesarean and other complicated delivery cases are directed from here to the district hospital. “We have had three cases of stillborn babies. One case was of a mother running continuous high-grade fever giving birth to seven-month-old twins. Fortunately, the mother survived,” Manisha pointed out.
The district of Shivpuri, which falls in the Gwalior-Chambal zone, has one of the highest maternal mortality rates in India . A maternal death audit conducted by Unicef and local NGOs has brought to light that while 50 maternal deaths took place in Shivpuri in 2006, the figure in Guna district was 56. Guna is the parliamentary constituency of the high-profile Congress MP Jyotiraditya Scindia. The deaths were reported by the ANMs (auxiliary nurse midwives) and by local NGOs.
Dr Ramani Atkuri, of Unicef, Bhopal , pointed out, “This is the tip of the iceberg. We believe many more women have died from childbirth but their deaths go unreported.”
“The majority of deaths take place because of haemorrhage, severe anaemia, eclampsia, malaria and sepsis,” Atkuri added.
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. Every five minutes, India suffers one maternal death. The number of women who die due to pregnancy, childbirth and abortion-related complications is estimated at 60,630. The maternal mortality ratio (MMR) for India presently is 301 deaths per 100,000 live births. Uttar Pradesh alone accounts for close to 21,450 maternal deaths per year.
The maternal audit also highlighted that less than 25% of babies born to women who died have a chance of surviving. This was borne out in Guna district. Ram Swarup Batham sits outside his mud hut in Shivpuri village 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.
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.”
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. One RNTCP official says: “The lack of integration between the TB programme and the general healthcare system is the main reason why the programme has not attained its goals. The PHC health staff do not support the TB programme because it does not offer cash incentives. These vertical programmes are creating distortions, and there is no collaboration in the implementation of programmes.”
The death of his wife has plunged their family into chaos. For one, the entire responsibility of looking after the 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.”
The tragedy of Veeja's death is that it could have been easily prevented. Hamid al-Bashir, Unicef's state representative in Bhopal , believes, “Most maternal deaths could be prevented if women had access to appropriate healthcare during pregnancy, childbirth and immediately after 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,” al-Bashir adds. The official explains that the situation has been repeatedly highlighted before RNTCP officials in Delhi. “But,” he says, “they are avoiding the issue and tell us to try solving the problem locally.”
Dr Aparajita Gogoi, National Coordinator for the White Ribbon Alliance India , describes 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.”
Gogoi says, “We have not been able to stem this tide of maternal deaths despite having 20,000 obstetricians, 5 lakh trained doctors and 25 lakh nurses and midwives.” Even poor countries like Bangladesh , Bolivia and 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.
The statistics in Madhya Pradesh are more alarming because in rural areas, local NGOs point out, for every 5.6 villages (average population of 2,000 per village) only one hospital bed is available. Over 82% of the children suffer from anaemia while 58% of pregnant women are also found to be anaemic.
Unicef believes one of the ways to strengthen community initiatives is by holding maternal death audits. Another such audit was recently held in Purulia in West Bengal between May 2005 and June 2006. It was found that of 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 revealed 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 was four years. While 61% of deaths occurred in a health facility, 24% died at home and another 13% died en route to a health facility. The majority of deaths occurred during labour and in the post-partum period.
InfoChange News & Features, March 2007
Tuesday, March 13, 2007
Fragile Lives
FRONTLINE- Volume 24 - Issue 5 :: Mar. 10-23, 2007
By T.K. RAJALAKSHMI
The fundamental causes leading to high maternal mortality are yet to be addressed.
Mamta Bahelia, A tribal woman in Pathadeori village of Madhya Pradesh's Seoni district. Weighing 52 kg into the eighth month of her pregnancy, she continues to do laborious work.
ACCORDING to the Sample Registration Survey for 2001-03, around 78,050 pregnant women die in India every year. For every hundred thousand live births, there are 301 maternal deaths, the survey says. According to the White Ribbon Alliance of India (WRAI), a nationwide initiative that promotes safe motherhood, there has been no significant decline in India's maternal mortality rate (MMR) since the 1990s. Surveys of the causes of the high MMR show how inaccessible timely medical attention still is to many pregnant women. An inadequate health care system, lack of awareness, bad roads and, of course, poverty are some of the major factors that come in the way of safe deliveries for pregnant women. Surveys have also found that the maximum number of maternal deaths is recorded among the Scheduled Castes, the Scheduled Tribes and Other Backward Classes.
Bimla of Duhiya village in Murar block of Madhya Pradesh's Gwalior district is an Accredited Social Health Activist (ASHA). Madhya Pradesh is one of the 18 Empowered Action Group States covered under the National Rural Health Mission (NRHM); it is one of the "low-performing" States in terms of institutional deliveries, along with Uttar Pradesh, Uttarakhand, Bihar, Jharkhand, Chhattisgarh, Rajasthan, Orissa and Jammu and Kashmir. As an ASHA, Bimla gets Rs.600 for every pregnant woman she is able to take to a government hospital for delivery. Indeed, all she can remember of her "training" is that she, and others like her, were told that they would be paid if they took pregnant women to hospital.
But Bimla could not save the life of her own sister-in-law, Khiloni. The family says she died because there was no trained "birth attendant" in the village and the government hospital where they took her would not accept the case because it was complicated. Bimla's is a family of landless farm hands. Duhiya is a village of mainly Jatavs, though there are a few landed, upper-caste families too. Only a kutccha road links Duhiya to Gwalior city. Bimla does not seem fully aware of the provisions of the Janani Suraksha Yojana (JSY), operational since April 12, 2005, under which pregnant women get Rs.1,400 if they give birth in a government hospital and are also compensated if they give birth at home or in accredited private hospitals. Only two of the 25 women she took to a government hospital for delivery got paid under the JSY. Her own payment is often not on time and she is not paid for conveyance any way. She is supposed to serve a `population area' of 1,000, but she serves two panchayat areas with a total population of 2,000. Sometimes, she says, Auxiliary Nurse Midwives (ANMs) refuse even to "touch" pregnant women of lower castes, let alone attending to their needs. Vinita Kalra, an auxiliary nurse midwife, has been working for eight years in Mamodhan village of Rajasthan's Dholpur district. In this photograph, making a home visit for an antenatal check-up.
According to an activist from a rights organisation in Murar, there have been several cases in Duhiya where pregnant women were turned away from the government hospital and forced to spend small fortunes on treatment at private hospitals. "This also means that the ASHA does not get paid," she said. In an area where maternal mortality obviously needs more attention than it gets, priorities sometimes seem strangely misplaced. The medical officer in charge of the primary health centre (PHC) in Hastinapur town of Murar block, for instance, could only think of the missing boundary wall at his PHC when asked what problems he faced at work. The centre he runs has no blood bank or ambulance services, no female doctors, and its nurses are not trained in Emergency Obstetric Care Services (EmOC). It has a proper building but is understaffed. Local people say there is no one at the centre after evening though it has been converted into a 24-hour First Referral Unit under the NRHM. He denied that there had been any cases of maternal mortality at his PHC. But he added that the families of pregnant women were usually to blame for pregnancy-related deaths because they did not organise timely medical attention. By the time a pregnant woman was taken to a doctor, he said, it was usually too late. He also said that anaemia was a major cause of maternal mortality. At least on this last point, the National Family Health Survey III would agree with him. The survey data, released recently, show that nearly 82.6 per cent of the children in the age group of six to 35 months are anaemic; 40.1 per cent of women have a body mass index (BMI) below normal; 57.9 per cent of pregnant women and 57.6 per cent of women who were ever married are anaemic.
The Economic Survey (2005-06) says the NRHM is the chief vehicle for making good the promises made on health care in the National Common Minimum Programme. Commenting on the implementation of the NRHM so far, WRAI spokesperson Aparajita Gogoi said there was no arrangement for training midwives under the Mission. Most ANMs are at present involved with family planning and health care for children. Skilled assistance at childbirth is not easily available. Much of what happens in communities and in the hospitals goes unreported and there is little accountability for maternal deaths. Doctors are often not trained in emergency obstetric care services and nurses and midwives are not encouraged to carry out life-saving procedures. Gogoi also said that panchayats were entitled to Rs.5,000 from the Health Department for emergency obstetric care services, but most of them were not aware of it and did not use the money.
Lack of nutrition is also a problem. The Integrated Child Development Services centre at Duhiya functions from the home of an Anganwadi worker. The only diet supplement that children and pregnant and lactating mothers receive here is soya puffs.
EVEN A BASIC labour room like this one is not something women have easy access to in rural India. The government now offers cash incentives to encourage women to go to hospitals for delivery. The story is the same everywhere. Banjara Ka Pura, also in Murar, is a village dominated by Banjaras, a Scheduled Tribe. All families in the village are landless and daily wages do not exceed Rs.40. The entire village should have been categorised as Below Poverty Line, yet few residents hold BPL cards. Even the grain allotted for the BPL category is not sold at BPL prices. There are young widows and old destitute women in the village who are not covered under the Antyodaya scheme for foodgrain entitlement. Expenditure on health leads to bondage in the village.
One woman, Lakshmi, narrated how her pregnant daughter-in-law died of haemorrhage after a miscarriage because she did not get timely treatment. "We used to take her in a bullock cart every day to the PHC. But the centre refused to admit her. We spent Rs.800 on a jeep to bring her body back," she said. She added that the entire family now worked as bonded labourers for the local temple priest, who had lent them Rs.35,000. Lakshmi's second daughter-in-law was luckier; she delivered her child in a tractor.
A recent Maternal and Perinatal Death Inquiry (MAPEDI) study by the United Nations Children's Fund (UNICEF), in Guna and Shivpuri districts of Madhya Pradesh and Purulia district in West Bengal, says most maternal deaths occur within six to 24 hours of delivery, the immediate cause being hemorrhage. In most of the cases surveyed, the women were found to be severely anaemic, and had been so from adolescence. The MAPEDI study, based on interviews with families that had lost pregnant mothers, highlighted that the majority of the deaths were preventable and that people would access services if they could. Financial constraints and bad roads are among the factors that prevent pregnant women and their families from accessing medical attention during and after pregnancy. The fact that trained nurses and midwives are not available round the clock also pushes up maternal mortality.
In the Purulia study of nearly 106 maternal deaths, it was found that nearly 80 per cent of the women had sought formal care at some point of their illness and nearly 46 per cent had sought formal care after complications arose. Among the reasons for not seeking formal care, 23 per cent of the respondents (family members) felt that transportation was a leading cause. While 16 per cent felt that the person herself did not perceive she was sick enough, only a meagre 8 per cent felt that the problem required traditional care. Nine per cent could not pay for transport, while 10 per cent said transport was not available.
The study, presented by Sudha Balakrishan, indicated there was an awareness of the need to seek health care, just as there was in Madhya Pradesh. But while most respondents in Purulia could afford transport to hospitals and health centres, very few in the Madhya Pradesh case study said they could do so. Shahikala Nageshwar of Jawarkothi village in Seoni district belongs to a Scheduled Caste. Pregnant and underweight (43 kg) at 19, she was taken to hospital for her delivery on a bullock cart by a midwife.
Following the UNICEF study, the Government of West Bengal decided to review every maternal death. It also issued an order making all maternity beds in government hospitals free of cost. The problem is that despite heightened allocations for health care, the Central government continues to view health care as important "not only for reaping the demographic dividend, having a healthy productive workforce and general welfare, but also for attaining the goal of population stabilisation. Population stabilisation is proposed to be achieved by addressing issues like that of child survival, safe motherhood and contraception" (Economic Survey 2006-2007). Health activists have increasingly begun to de-link the goals of population stabilisation from MMR and infant mortality rate (IMR), the government's approach remains much the same.
The NFHS-III interviewed 230,000 women in the 15-49 age group and men in the 15-54 age group. It found that 44.5 per cent of the women were married before the age of 18. Jharkhand recorded most of the cases (61.2 per cent), followed by Bihar (60.3 per cent) Andhra Pradesh (54.7 per cent) and Rajasthan (57.1 per cent); the lowest numbers were reported from Himachal Pradesh (12.3 per cent), Jammu and Kashmir (14 per cent), Kerala (15.4 per cent) and Punjab (19.4 per cent).
The NFHS-III interviewed 230,000 women in the 15-49 age group and men in the 15-54 age group. It found that 44.5 per cent of the women were married before the age of 18. Jharkhand recorded most of the cases (61.2 per cent), followed by Bihar (60.3 per cent) Andhra Pradesh (54.7 per cent) and Rajasthan (57.1 per cent); the lowest numbers were reported from Himachal Pradesh (12.3 per cent), Jammu and Kashmir (14 per cent), Kerala (15.4 per cent) and Punjab (19.4 per cent).
There seems to have been a shift from a vertical approach to health care to a more decentralised one and the 2007-08 Budget proposals include higher allocations for health care. But there needs to be a greater emphasis on an inter-sectoral approach, especially on food security. It is not only a question of meeting the Millennium Development Goals any more, it is about being accountable and sensitive to the needs of one half of the nation's population.
Kudos to frontline on picking up this issue...
Monday, March 12, 2007
Anaemia a huge problem in India: NFHS-3
One World SouthAsia
82 % children anaemic in MP
India has among the highest number of cases of anaemia in the world, according to the National Family Health Survey recently undertaken. The reasons range from high cost of healthcare facilities, poor food quality and the low status of women As many as 79.1% of India’s children between the ages of three and six, and 56.2% of married women in the age-group 15-49 were found to be anaemic in 2006. The figure for the latter was 51.8% in 1999.
Releasing the official figures of the National Family Health Survey-3, Werner Schultink, chief of Unicef India, child health and nutrition, said, on February 21, that there were a number of reasons for India having the largest number of anaemic married women and children in the world. He cited the low social status of women, poor food quality, high cost of healthcare, and genetic problems as being responsible for the problem. NFHS-3 is published jointly by Unicef, the United Nations Population Fund, Britain’s Department for International Development (DFID) and Avahan, an initiative of the Bill and Melinda Gates Foundation. Schultink explained that about 20% of pregnant women in the US and Europe are anaemic. “Even in Indonesia the anaemia rate among women is 30-40%. The NFHS data suggests the rate of anaemia has gone up since 1999 in India.” The survey revealed that among the states, Assam is the worst affected with 72% of married women being anaemic, followed by Haryana (69.7%) and Jharkhand (68.4%). The prevalence of malaria in states like Assam was cited as one of the chief reasons for this sorry state of affairs.
Talking about the condition of children, M Babille, who heads the health division of Unicef India, said that the situation had worsened in 16 Indian states over the last seven years. Among the states worst hit, 79% of children in Andhra Pradesh suffer from anaemia. Rajasthan has a figure of 79.8% and Karnataka and Madhya Pradesh over 82%. Portraying a negative image of India’s growth trajectory in the health sector, Babille added that 33% of women in the 15-49 age-group were underweight. Among the states, 43% of women in Bihar are underweight, followed by Jharkhand (42.6%) and Chhattisgarh (41%). “Nearly 40% of children below the age of three in Maharashtra are underweight too,” he said. This latest National Family Health Survey, conducted in 2005-06, shows that the number of anaemia cases has increased among women, while there has been a slight decline in the case of children. Shockingly, even in the nation’s capital, Delhi, as many as 63.2% of children in the 3-6 age-group, and 43.4% of women between the ages of 15 and 49 years are anaemic, according to the survey. The last survey in 1998-99 showed 69% of children and 40.5% of women were anaemic in Delhi. According to Sharda Jain, chairperson of the women doctor’s wing of the Indian Medical Association (IMA), India has one of the highest numbers of anaemia cases in the world, with nearly 90% of women and children anaemic. Narender Saini of IMA explained that the normal haemoglobin level in the blood, according to Indian standards, is 12.5 g/dl and that if the number falls below 10 g/dl, the person is considered anaemic. In Delhi, about 30% of people from affluent families, who have access to good nutritional food, are anaemic. The third in a series of surveys, NFHS-3 is based on a sample of households at the national and state levels, with the basic goal of providing data on health and family welfare.
82 % children anaemic in MP
India has among the highest number of cases of anaemia in the world, according to the National Family Health Survey recently undertaken. The reasons range from high cost of healthcare facilities, poor food quality and the low status of women As many as 79.1% of India’s children between the ages of three and six, and 56.2% of married women in the age-group 15-49 were found to be anaemic in 2006. The figure for the latter was 51.8% in 1999.
Releasing the official figures of the National Family Health Survey-3, Werner Schultink, chief of Unicef India, child health and nutrition, said, on February 21, that there were a number of reasons for India having the largest number of anaemic married women and children in the world. He cited the low social status of women, poor food quality, high cost of healthcare, and genetic problems as being responsible for the problem. NFHS-3 is published jointly by Unicef, the United Nations Population Fund, Britain’s Department for International Development (DFID) and Avahan, an initiative of the Bill and Melinda Gates Foundation. Schultink explained that about 20% of pregnant women in the US and Europe are anaemic. “Even in Indonesia the anaemia rate among women is 30-40%. The NFHS data suggests the rate of anaemia has gone up since 1999 in India.” The survey revealed that among the states, Assam is the worst affected with 72% of married women being anaemic, followed by Haryana (69.7%) and Jharkhand (68.4%). The prevalence of malaria in states like Assam was cited as one of the chief reasons for this sorry state of affairs.
Talking about the condition of children, M Babille, who heads the health division of Unicef India, said that the situation had worsened in 16 Indian states over the last seven years. Among the states worst hit, 79% of children in Andhra Pradesh suffer from anaemia. Rajasthan has a figure of 79.8% and Karnataka and Madhya Pradesh over 82%. Portraying a negative image of India’s growth trajectory in the health sector, Babille added that 33% of women in the 15-49 age-group were underweight. Among the states, 43% of women in Bihar are underweight, followed by Jharkhand (42.6%) and Chhattisgarh (41%). “Nearly 40% of children below the age of three in Maharashtra are underweight too,” he said. This latest National Family Health Survey, conducted in 2005-06, shows that the number of anaemia cases has increased among women, while there has been a slight decline in the case of children. Shockingly, even in the nation’s capital, Delhi, as many as 63.2% of children in the 3-6 age-group, and 43.4% of women between the ages of 15 and 49 years are anaemic, according to the survey. The last survey in 1998-99 showed 69% of children and 40.5% of women were anaemic in Delhi. According to Sharda Jain, chairperson of the women doctor’s wing of the Indian Medical Association (IMA), India has one of the highest numbers of anaemia cases in the world, with nearly 90% of women and children anaemic. Narender Saini of IMA explained that the normal haemoglobin level in the blood, according to Indian standards, is 12.5 g/dl and that if the number falls below 10 g/dl, the person is considered anaemic. In Delhi, about 30% of people from affluent families, who have access to good nutritional food, are anaemic. The third in a series of surveys, NFHS-3 is based on a sample of households at the national and state levels, with the basic goal of providing data on health and family welfare.
Thursday, March 08, 2007
Madhya Pradesh women still have long way to go
By Sanjay Sharma
Bhopal, March 8 (IANS) Women in Madhya Pradesh lag behind their counterparts in most part of the country on almost every front - from health, education, liberty to rights - a sad statement on their condition as the world marks International Women's Day Thursday. With regard to their participation in governance, while the Constitutional 73rd Amendment has reserved one-third of seats for women and enabled their presence in panchayat (village council) bodies, they continue to be under male dominance.
"Women panchayat members continue to suffer from gender bias," says a worker of Mahila Chetna Manch (MCM), an NGO working in the field of women empowerment. Despite the seats reserved for women, it is men, who dominate the proceedings in the panchayat - through the women members, who happen to be wives, mothers or daughters.
In the case of women sarpanchs (heads) of Salkhera and Barbel gram panchayats, in Khargone district, 44 percent women do not go alone to attend meetings, some are accompanied by their husbands or adult male members of the family, while the rest said their husbands actually represent them, said Abha Chauhan, of the Institute of Social Sciences in her observation on women's participation in panchayat in Scheduled Areas with special reference to Madhya Pradesh.
There have been cases when women representatives signed documents while totally ignorant of the contents due to illiteracy. More than 1,300 women sarpanchs have been slapped with false corruption charges. Some 50 of them have been removed from office through forced no-confidence motions. They have also been threatened and humiliated.
Domestic violence against women in the state has increased three times in the last five years, police records say. From 7,283 cases in 2001, the figure went up to 23,215 in 2005. The 2006 figures are yet to be computed. The new National Family Health Survey-III data reveals that 45 percent women in the state have never heard of HIV/AIDS. The state has a Maternal Mortality Ratio of 379 (maternal deaths per 100,000 live births) - one of the six highest in the country. Approximately 27-30 women die every day in the state within 42 days of delivery due to complications and unsafe abortions.
According to the survey, the state contributes 7,000 maternal mortality cases every year to the figure of 70,000 for the country as a whole. The sex ratio is 829 females for every 1,000 males.
Lack of transport and access to proper medical facilities as well as the absence of planning for delivery are major impediments to safe motherhood coupled with shortage of medicines.
"Though the state has launched schemes - like promoting institutional deliveries - to arrest maternal mortality, specially among those below the poverty line and those belonging to scheduled castes and tribes, much still needs to be done," say activists working in the field.
While institutional deliveries have risen from 27 percent in 2004-2005 to 35 percent in 2005-2006, it is faced by impediments like low awareness about various schemes for pregnant women, lack of planning for delivery and shortage of medicines and health facilities, the study points out.
Around 40.11 percent of women have a body-mass weight index below normal or are under nourished, says the survey undertaken by the union government. "About 57.9 percent pregnant women, between 15-49 years of age, are anaemic while only 46.7 percent women participate in household decisions and 45.8 percent have experienced spousal violence," it says.
Bhopal, March 8 (IANS) Women in Madhya Pradesh lag behind their counterparts in most part of the country on almost every front - from health, education, liberty to rights - a sad statement on their condition as the world marks International Women's Day Thursday. With regard to their participation in governance, while the Constitutional 73rd Amendment has reserved one-third of seats for women and enabled their presence in panchayat (village council) bodies, they continue to be under male dominance.
"Women panchayat members continue to suffer from gender bias," says a worker of Mahila Chetna Manch (MCM), an NGO working in the field of women empowerment. Despite the seats reserved for women, it is men, who dominate the proceedings in the panchayat - through the women members, who happen to be wives, mothers or daughters.
In the case of women sarpanchs (heads) of Salkhera and Barbel gram panchayats, in Khargone district, 44 percent women do not go alone to attend meetings, some are accompanied by their husbands or adult male members of the family, while the rest said their husbands actually represent them, said Abha Chauhan, of the Institute of Social Sciences in her observation on women's participation in panchayat in Scheduled Areas with special reference to Madhya Pradesh.
There have been cases when women representatives signed documents while totally ignorant of the contents due to illiteracy. More than 1,300 women sarpanchs have been slapped with false corruption charges. Some 50 of them have been removed from office through forced no-confidence motions. They have also been threatened and humiliated.
Domestic violence against women in the state has increased three times in the last five years, police records say. From 7,283 cases in 2001, the figure went up to 23,215 in 2005. The 2006 figures are yet to be computed. The new National Family Health Survey-III data reveals that 45 percent women in the state have never heard of HIV/AIDS. The state has a Maternal Mortality Ratio of 379 (maternal deaths per 100,000 live births) - one of the six highest in the country. Approximately 27-30 women die every day in the state within 42 days of delivery due to complications and unsafe abortions.
According to the survey, the state contributes 7,000 maternal mortality cases every year to the figure of 70,000 for the country as a whole. The sex ratio is 829 females for every 1,000 males.
Lack of transport and access to proper medical facilities as well as the absence of planning for delivery are major impediments to safe motherhood coupled with shortage of medicines.
"Though the state has launched schemes - like promoting institutional deliveries - to arrest maternal mortality, specially among those below the poverty line and those belonging to scheduled castes and tribes, much still needs to be done," say activists working in the field.
While institutional deliveries have risen from 27 percent in 2004-2005 to 35 percent in 2005-2006, it is faced by impediments like low awareness about various schemes for pregnant women, lack of planning for delivery and shortage of medicines and health facilities, the study points out.
Around 40.11 percent of women have a body-mass weight index below normal or are under nourished, says the survey undertaken by the union government. "About 57.9 percent pregnant women, between 15-49 years of age, are anaemic while only 46.7 percent women participate in household decisions and 45.8 percent have experienced spousal violence," it says.
Wednesday, March 07, 2007
77,000 maternal deaths per year in India
A woman dies every seven minutes in India due to complications related to pregnancy, the Lok Sabha (Lower House of Indian Parliament) was informed today. "There are approximately 77,000 maternal deaths per year, which in other words mean one women dies every seven minutes due to complications related to pregnancy and child birth," said Minister of State for Health and Family Welfare Panabaka Lakshmi in a written reply in Lok Sabha.
She said these findings were based on the official estimates of Registrar General of India (RGI). The Maternal Mortality Ratio (MMR) for India (2001-03) is 301 per 100,000 live births.
Lakshmi informed the House that as per the latest survey reports, the reasons for high Maternal Mortality in the country are--Hemorrhage (38 percent), Sepsis (11 percent), Abortion (eight percent), Obstructed Labor (five percent), Hypertensive Disorders (five percent) and other reasons (34 percent). "To provide basic facilities in rural areas including those at the time of delivery, the government has launched the National Rural Health Mission (NRHM) in the year 2005 with special emphasis on improving the health status of rural population throughout the country," she said.
The mission will operate over a period of seven years from 2005 to 2012 with the goal of achieving reduction of Maternal Mortality Ratio to 100 per 100,000 live births, she added.
She said these findings were based on the official estimates of Registrar General of India (RGI). The Maternal Mortality Ratio (MMR) for India (2001-03) is 301 per 100,000 live births.
Lakshmi informed the House that as per the latest survey reports, the reasons for high Maternal Mortality in the country are--Hemorrhage (38 percent), Sepsis (11 percent), Abortion (eight percent), Obstructed Labor (five percent), Hypertensive Disorders (five percent) and other reasons (34 percent). "To provide basic facilities in rural areas including those at the time of delivery, the government has launched the National Rural Health Mission (NRHM) in the year 2005 with special emphasis on improving the health status of rural population throughout the country," she said.
The mission will operate over a period of seven years from 2005 to 2012 with the goal of achieving reduction of Maternal Mortality Ratio to 100 per 100,000 live births, she added.
Saturday, March 03, 2007
A 10th of Indian maternity deaths in Madhya Pradesh
Bhopal, March 2 Madhya Pradesh accounts for 10 percent of all maternity related deaths in India, says a new study. The reasons for this are many including lack of transport or access to proper medical facilities as well as absence of planning for delivering babies.
So says a UNICEF facilitated study by the state's health department. 'Shortage of medicines at health centres and the disinterested attitude of the medical staff also add to the problem,' adds the study. 'Madhya Pradesh reports 10 percent of maternal deaths in the country while India reports 20 percent of maternal deaths in the world,' said UNICEF state head Hamid El Bashir, speaking to IANS. Though the state has launched many schemes, such as promoting institutional deliveries, to arrest maternal mortality especially among the poor and those belonging to Dalits and tribals, a sustained commitment was required, say experts and activists working in the field.
The study was carried out in August 2006 in seven districts with high institutional child delivery rates and seven with low rates. It covered 1,705 women, of whom 934 had institutional deliveries. The rest had home delivery. The districts covered under the first category were Indore, Ujjain, Bhopal, Japalpur, Panna, Umaria and Gwalior and those under the second included West Nimar, Ratlam, Betul, Chhattarpur, Sidhi and Bhind.
With a maternal mortality rate (MMR) of 379, Madhya Pradesh is among the six worst affected states in the country. Approximately 27 to 30 women die every day in the state within 42 days of delivery. Complications during pregnancy and unsafe abortions are among the main reasons for the rising MMR. While institutional deliveries rose from 27 percent in 2004-05 to 35 percent in 2005-06, low awareness about various schemes for pregnant women, lack of planning for deliveries and unavailability of medicines at health centers were some of the impediments that still needed to be tackled on a priority basis. Only eight percent women interviewed had planned where to go for delivery and over 75 percent women had to buy medicines. 'Fifty percent women cited transport problems and cost of hospital delivery as reasons for preferring home delivery,' the study pointed out.
Bashir told IANS that the civil society needed to engage communities at a high level to push accountability within the system to help women and children get a better deal.
So says a UNICEF facilitated study by the state's health department. 'Shortage of medicines at health centres and the disinterested attitude of the medical staff also add to the problem,' adds the study. 'Madhya Pradesh reports 10 percent of maternal deaths in the country while India reports 20 percent of maternal deaths in the world,' said UNICEF state head Hamid El Bashir, speaking to IANS. Though the state has launched many schemes, such as promoting institutional deliveries, to arrest maternal mortality especially among the poor and those belonging to Dalits and tribals, a sustained commitment was required, say experts and activists working in the field.
The study was carried out in August 2006 in seven districts with high institutional child delivery rates and seven with low rates. It covered 1,705 women, of whom 934 had institutional deliveries. The rest had home delivery. The districts covered under the first category were Indore, Ujjain, Bhopal, Japalpur, Panna, Umaria and Gwalior and those under the second included West Nimar, Ratlam, Betul, Chhattarpur, Sidhi and Bhind.
With a maternal mortality rate (MMR) of 379, Madhya Pradesh is among the six worst affected states in the country. Approximately 27 to 30 women die every day in the state within 42 days of delivery. Complications during pregnancy and unsafe abortions are among the main reasons for the rising MMR. While institutional deliveries rose from 27 percent in 2004-05 to 35 percent in 2005-06, low awareness about various schemes for pregnant women, lack of planning for deliveries and unavailability of medicines at health centers were some of the impediments that still needed to be tackled on a priority basis. Only eight percent women interviewed had planned where to go for delivery and over 75 percent women had to buy medicines. 'Fifty percent women cited transport problems and cost of hospital delivery as reasons for preferring home delivery,' the study pointed out.
Bashir told IANS that the civil society needed to engage communities at a high level to push accountability within the system to help women and children get a better deal.
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.
....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
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
by IANS
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. blogspot.com, which has news about the state and opinions of people, and mpchildinfo.blogspot.com, which deals with infant mortality and low nutrition levels among children. Another blog is madhyapradesh.blogspot.com, 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 bhopal.blogspot.com and bhopal. wordpress.com. There is also a Persecution Blog, which shares news and information about the Christian community.
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. blogspot.com, which has news about the state and opinions of people, and mpchildinfo.blogspot.com, which deals with infant mortality and low nutrition levels among children. Another blog is madhyapradesh.blogspot.com, 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 bhopal.blogspot.com and bhopal. wordpress.com. 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.
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 www.mpnewsonline.com
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 www.mpnewsonline.com
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.
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.
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.
- 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.
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.
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
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.
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.
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