High
Maternal Mortality
In The Heart Of India
By Anil Gulati
21 December,2006
Countercurrents.org
Munna
was nine months pregnant. She did experience pains few days back, when
her husband and mother-in-law rushed her to the nearest primary health
centre in Kushwai of the District Shahdol in the State of Madhya Pradesh
in India. They had to make her travel by bus from their village, and
then in pain Munna had to walk, which she could barely to reach the
health centre.
But unfortunately the kushwai
health centre, where they had come with lot of hopes, did not had a
medical doctor for last one and half years. One male health worker mans
the centre. Though, he puts in his best but that may not be enough for
women like Munna and others who need medical support.
Inspite of reaching the primary
health centre, she did not get any help. She has to travel another eight
kilometers to Burhar, the place where there is a community health centre.
The centre is fortunately newly built and has facilities for delivery.
Munna did develop some complications during the delivery but fortunately
survived to see her new born.
She was lucky but thousands
of women which die in the state are not. App 10,000 women die every
year in Madhya Pradesh during pregnancy or within 42 days after pregnancy.
Majority of these could be prevented. Medically these deaths may be
due to hemorrhage, infection, eclampsia or unsafe abortion or any of
three delays. But fact is there exists a yawning gap in our health system
which stands in between life and death of women in the state. This gap
has linkage to availability and access to health services, infrastructure,
awareness among communities of not only the services but even recognizing
danger signs, issue of how where they can access the services etc. Studies
also tells us that for every maternal death in India, 20 more women
suffer from the impaired health.
But if the situation at ground
is like this, and has been there. What is the state’s response
to an issue like this? Does it impact the political leaders, their discourse?
Does issue of women dying in the state is debated in discussions where
funds are allocated or decisions are made? Does state’s machinery
care for it? Does civil society raise its concern?
The year 2004
To answer some of these questions
a dip stick assessment was done in year 2004 at various levels within
civil society, debates in the state assembly, media analysis. Outcomes
were revealing. First of all the issue concerned only few in health
department. There were only handful of civil society partners, and their
major role was to support service delivery system. As such there was
no push or urgency to bring change. Interestingly, the issue had never
being debated on the floor of the state assembly, a place where elected
representatives ‘of the people, for the people and by the people’
decide. It did not impact them, many of them were not even aware of
the fact that state has this high number of maternal deaths? An issue
like this was never raised by the political leaders in the debates which
happen there – an issue of total neglect at the highest political
body. Media covered ‘event news’ around the safe motherhood
day, probably they never got the right information too.
Present
That was a starting point,
but nevertheless situation has changed today. Today state recognizes
it as a major issue when it comes to women and children. State calls
for an action. It is on high priority list of the political head of
the state, state party is being questioned on the number of deaths,
gaps on the infrastructure and many related points. Today more than
150 civil society organizations are raising concern on the issue and
demanding urgency and urgency of action in the state.
How it happened and what
does it impact and what strengths does it generate? Movements don't
just happen; the energy that underlies them must be marshaled, channeled,
and focused. The principal means by which this is achieved in our society,
and within our political tradition, is through advocacy networks and
coalitions.
Networks like Madhya Pradesh
Voluntary Health Association, Madhya Pradesh Jan Adhikar Manch and Collective
for advocacy, resource and training, Madhya Pradesh Samaj Sewa Sanstha,
Mahila Chetna Manch, and many others have not only contributed to help
bring the issue at an individual level but as a part of informal collation
added to that force which helped bringing the agenda on political normative
framework. Some of the strengths which this informal network helped
bring were the numbers of civil society partners raising concern on
the issue spread across different regions of the state. From a handful
few now it is more than 150 civil society partners in the state working
in all divisions to bring the issue to forefront. The turn around is
also in their way of working from being a service delivery partners
or a social mobilization partners in supportive and submissive role
in a new avatar of advocacy partner. In this new role civil society
speaks on the issue of right to health, its violation, demands state’s
accountability to provide for safemotherhood. In this new business influencing
people who make decisions which impact human lives is the key.
The primary target of the
civil society was to bring the issues which impact lives of women at
the villages, blocks and districts to the agenda of the people who make
or influence decisions, i.e. state assembly debates, political leaders,
members of legislative assembly, ministers, media, rights commission
etc. They had been to some part successful. ex-pression of this concern
was undertaken by directly meeting and sensitizing political leaders.
The evidences highlighting gap were shared with political leaders, urging
them to rise above politics and give a strong call for action. These
non governmental organizations wrote memorandums, shared information
and collected evidences for the same purpose. Media engagement also
supported by providing an enabling environment for change. Strong evidences
i.e. case of maternal deaths which can be presented, health system gaps
were highlighted which added pressure on the state and the leaders to
react. Resultant of this solid gains achieved. Today questions on maternal
mortality are being raised in the state assembly, the highest policy
making body of the state. It is not just few many voices are being publicly
heard on the issue. There is a increased concern within media.
From nowhere it came to a
point where state publicly acknowledge the problem, and its commitment
to act. Many new polices and schemes have been announced and that too
in the rapid succession. This amount of concern and even expressed publicly
by leaders had never been seen earlier in the state on the issue of
maternal mortality. But that is not enough today empowered civil society
and media is always looking with eagle’s eye on the new measures
of the state and vocally points out the gaps This is a positive sign,
where people are voicing their opinion. But it is not easy as said.
Political leaders have started picking up real cases of deaths, gaps
in infrastructure in the state, violation of rights, gaps in policies
and seeking answers to what is being done by the state to response to
the situation.
Advocacy experts tell us
that ‘people centered advocacy’ is the best, i.e. position
when people who suffer can speak for themselves. A step has been taken
in the same direction by the engaged networks. Madhya Pradesh Jan Adhikar
Manch in their work with communities helped to bring the issue to debate
in various gram sabhas which were held by panchayats in Gwalior –
Chambal division. Similarly women who had participated in various women
conventions hosted by Madhya Pradesh Samaj Sewa Sanstha came forward
and wrote about the problems women face in rural areas when it comes
to issue of safemotherhood and why do women die in their villages while
giving birth. As per sources of Madhya Pradesh Samaj Sewa Sanstha more
than 200 women have written to the Chief Minister. On a simple fifty
paise post card, they wrote by theselves and it was send to the Chief
Minister. It looks simple but powerful, if it gets to his eyes. Recently
a large number of women from villages across Madhya Pradesh have joined
a signature (or thumb-impression) campaign to press for their right
to health and to call upon the Government to ensure that the dream of
safe motherhood becomes a reality. As a part of a special drive to raise
concern on this crucial issue, more than 20,000 women from different
villages of the State are now in the process of signing (or placing
their thumb impression) on a various banners demanding the right to
health and calling upon the State to ensure that the dream of safe motherhood
becomes a reality. Madhya Pradesh Voluntary Health Association, Madhya
Pradesh Samaj Sewa Sanstha are the civil society partners who are collecting
these signatures/thumb impressions of women. They say that they do so
after they are adequately sensitizing them on the issue of maternal
mortality. Then if they feel that some concrete action is needed to
improve the situation, they come and sign. Plan is to present the banners
with their signatures to policy makers.
One might say that this is
good effort, which indeed it is to bring the agenda of maternal mortality
on to the political and action framework but it is still a long way
to go. This is true. But if one looks back one and half years where
there was hardly any concern, hardly anyone called for action, except
few that too ‘within the box’. The focus was limited. From
nowhere it has come somewhere, which is an important achievement by
any means. Need of the day is to provide possible answers to the state,
which is willing to listen. Answers which can help deliver results,
within the context of the field realties and socio – cultural
aspects – a new call to many !
Contact
Anil Gulati
E mail – [email protected]
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