With the lack of any specific targets, the factors around morbidity are seldom monitored as closely as mortality.
By Neha Chauhan
Mothers are the greatest gift of God. The social media frenzy and similar messages around motherhood and mothers swamped the online portals, with multiple food to jewellery brands doing their best to promote the day in their own way. While it’s heartening to see the recognition of disproportionate burden of caregiver role and as a creator of life, it is also important to see that everyday women are dying creating this miracle. It is not enough to see maternal health from the lenses of ensuring onetime safe delivery, but it’s a journey that starts from making the choices for a wanted pregnancy and continues till post-partum emotional challenges, getting tuned to new roles or re-absorption in the workforce in case of working mothers.
With the lack of any specific targets, the factors around morbidity are seldom monitored as closely as mortality. The huge reliance on maternal mortality as the only determining factor takes away the focus from several preventable causes with inadequate focus of potential cause of lifetime of disability and poor quality of life caused due to maternal morbidity.
It is the most common know fact that India is one of the fastest growing countries and by 2024 India will surpass China to be the world’s most populous country. For the sheer quantum of our number, its high time we start speaking the language of absolute numbers instead of relative percentages and prioritise the existing “population policy” with utmost urgency and bring it to the core of development discourse.
As per the estimates, around 3074 births each hour and 73,787 births per day takes place in India. The data available from NITI Aayog, shows there has been remarkable progress with the Maternal Mortality rates reducing to 130 in 2014-16 from 254 in 2004-06 (per 1,00,000 live births).
The improvement can be attributed to numerous government interventions like Janani Suraksha Yojana (JSY), a conditional cash transfer scheme for pregnant women coming into the institutional fold for delivery and Janani Shishu Suraksha Karyakram (JSSK), an absolutely free delivery, including a Caesarean section, in public health institutions. However, even now around 47,000 mothers continue to die every year due to causes related to pregnancy, childbirth and the post-partum period.
The major medical causes of these deaths, are easily preventable health conditions such as like hemorrhage, sepsis, abortion, hypertensive disorders, obstructed labour and ‘other’ causes including anaemia.
The avoidable life lost on the daily basis while giving birth reflects gross failure of our public health system in identifying young mothers, accessibility of services and information dissemination about the government scheme. The young and adolescent mothers and those faced by the humanitarian situations are especially disadvantaged when it comes to maternal morbidity and mortality.
Despite the falling numbers, India is still home to 1.5 million child brides and as per NFHS 2015-2016 around 7% of female population in India get married before attaining the age of 15, 31.5% of women in rural parts of India are married before they turn 18, followed by 17.5% in the urban areas. It is extremely difficult for child brides to assert their preferences and needs, particularly when it comes to negotiating safe sexual practices and the use of family planning methods, due to which studies show, where girls survive childbirth, they are at an increased risk of pregnancy-related complications and sexually transmitted infections.
About 67% of India still lives in rural areas, and till the time appropriate rural models and localised solutions related to maternal health and information will not reach to these pockets, the women in rural areas will remain deprived of quality services within their vicinity.
Though not related to maternal death but the news of man carrying the body of dead wife on his shoulder for 12 km and other similar stories during that time shook country’s emotions several times. This is a reality that due to lack of available health facilities, transportation and timely reaching to a facility for institutional delivery is a grave challenge for most rural set ups in India.
Another worrying trend is declining rate of contraceptive use and vasectomies in India. It can be largely attributed to reluctance of male involvement for playing the role in Family Planning that in past 8 years (since last NFHS) contraceptive use fell by 52% and vasectomies by around 73%. The decline is being compensated by overt focus on female sterilization, increased use of emergency contraceptives and resort to abortion as a proxy contraceptive.
In addition to the cultural and religious believes that promotes traditional and home delivery methods, substandard treatment facilities and lack of quality parameters at limited privately owned clinics also contribute to the MM rates.
The solution for elimination of maternal deaths cannot be limited to “Safe Delivery” instead there is a dire need to promote holistic focus on sexual and reproductive health services and information in India that includes addressing- mental health issues and maternal morbidity issues such as obstetrics fistula, damage of the reproductive tract, loss of child-bearing ability after the first birth and uterine prolapse, and other preventive measures such as elimination of child marriage and GBV, availability of safe abortion care, access to basket choices, quality counselling services that facilitates negotiation power of women in a relationship and correct and timely information about their bodies.
(Neha Chauhan is Sr. Technical Advisor, Advocacy and Accountability, International Planned Parenthood Federation. Views expressed are personal.)