Maternal
Deaths In Madhya Pradesh Denial Is The Best Policy
By Sachin Kumar Jain
27 February, 2007
Countercurrents.org
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.
About the author - Sachin
Kumar Jain is a Bhopal based freelance journalist and coordinating a
development media advocacy institution for last 7 years. He has also
written several books on Malnutrition, Matrnal health, Hunger and poverty
He is also closely associated with National Right to Food Campaign.
Contact - Vikas Samvad and
Right to Food Campaign, E-7/226, Ist Floor, Arera Colony, Opp. Dhanvantri
Complex, Shahpura, Bhopal, Madhya Pradesh
0755-4252789, 09827361019,
[email protected]