In the name of maternal health - unravelling untold stories from India

Initially I gave birth to three daughters....We had lost all hope and villagers said that I would never be able to give birth to a son. I had nothing to eat and even my husband was not there with me. Moreover, I fell ill. Then there was blood clotting in my womb. But finally I gave birth to twin sons and a daughter. (Nisha from Bihar, India)

Yes, we live in a country where the son preference far exceeds concerns over the health of the mother. Though this particular story pertains to a middle aged woman in Amgachi (Bihar, India), it surely echoes voices of a million in the nooks and corners of India. Thousands of women in the world die during child birth.

Added to this, bearing multiple children with little time between pregnancies makes them and their children physically vulnerable to several kinds of diseases and ailments. Hence it is clear that maternal health (i.e. health of the woman during pregnancy, child birth and the post-partum period), is not a women-only concern, but rather it has wider implications for communities and societies whose future prospects depend to a great extent on the health status of its child-bearers.

Addressing the need of the hour, Sustainable Development Goals aim to reduce the global maternal mortality ratio to less than 70 per 100, 000 live births by 2030. In India both at the national and regional level policies like Nation Health Mission, Janani Sishu Surakshya Karyakram, Janani Suraksha Yojana, Pradhan Mantri Surakshit Matritva Abhiyan, Mamata Yojana have created some positive impact on the Infant Mortality Rate (IMR), Total Fertility Rate (TFR) and Maternal Mortality Rate (MMR). Yet the concern lies in exploring the extent to which the beneficiaries and the benefactors of such programmes have been able to meet each others’ requirements. It is also necessary to explore other factors which operate under-wraps in determining the state of maternal health in rural India. This piece collates some of the good and the not-so-good experiences of mothers drawing from field experiences in Bihar and Odisha.

It is beyond doubt that the coverage of health care facilities have improved over the years in India. A young woman from Kandhamal, Odisha, recalls: As soon as my sister started experiencing the delivery pain, we contacted the ASHA. She came with an auto rickshaw and we took my sister to hospital in Jagannathpur.
This also brings forth the practice of institutional delivery in conservative rural areas in recent times and in support a lady explains how her elder two daughters were born at her mother’s place while the younger ones were born in Jagannath prasad medical.

Success stories also echo through the experiences shared by a woman in Siriguda, Odisha, saying:
They pay Rs. 1000 in the first and last instalments and twice Rs. 1500 ....(and) if we call them over the phone, they come and take the patient to the hospital.

In the Berhampur district of Odisha, a middle aged woman in her advanced pregnancy shares her experience saying: ASHAdidi took me to the medical and my pregnancy test was done on computer. Now I am taking medicines. Anganwadi workers give me egg and nutritious powder (Chatua) twice a month.
Indeed these are changes, ones which we all would love to hear, see and be a part of.

However, the experience has been a bit different in Bihar, where health facilities do not reach all equally. A young woman reveals her experience during pregnancy: All they (anganwadi workers) used to give me was 1 kg of rice and 250 gms of pulse once in a month and the remaining they kept for themselves. The nurse charges 10-20 rupees unnecessarily.
For families who struggle to make ends meet and take loans to meet emergencies, bearing these extra costs widens the gap between the means and the end.

Apart from institutional coverage, social norms and family structures play a decisive role in the state of maternal health. Keeping in mind the fact that in rural India mothers are often very young the care they receive from elders in the family and neighbourhood (especially women) during pregnancy is reflected in the health condition of both the mother and the child born to her. While there are stories in Odisha which read: My mother in law gave me everything to eat, whatever she grows in her kitchen garden, on the flip side there are instances where a woman in Bihar reminisces: (despite) continuous vomiting, my mother in law would always create conflict if I did not go out for wage work.....Only after 12 days after the delivery I started cooking.
Alcoholism adds to the problem and husbands beat up their wives for things like deciding on the number of children and demands for a boy child.

Keeping oneself active during pregnancy is a good thing, to the extent that such an activity is not forced on the pregnant woman. Being forced to work sometimes results in unintended emergencies. A woman in Kandhamal recollects: Once I was climbing a ladder with a head-load of rice during pregnancy. There were some complications. My neighbours took me to Mahipur hospital in an auto rickshaw.

Those living in Odisha are additionally burdened by frequent cyclones and floods and one of the interviewees’ shares how troubled her third pregnancy was when during one such occasion she went to bed on an empty stomach for days or was only consuming some locally available gruel. Explaining her situation, a mother in Jagathpalli, Odisha, recollected: I had no substitute for doing labour work and earning a wage (and she left her newborn with neighbours to continue earning her living).

If indeed policy measures are to improve maternal health, a lot needs to be done to address issues of working mothers within rural informal work setups, the type of work and work load etc. Battling with poverty within the household, lack of resources or agency to choose from the resources available, women in rural settings often fall prey to stringent socio-cultural norms and practices, which in turn degrade their overall health. All these together worsen the health condition of pregnant women as well. However, it would not be an overestimation to say that with time the maternal health care system will find a greater and far reaching coverage, ensuring safer environments for expecting mothers. It is noteworthy that positive impacts of improving maternal health have already started getting reflected in health statistics captured from the length and breadth of the country. Yet, concerns around the current state of maternal health lie in a turbid state and one needs to find ways out.

Contributed by Dr. Sweta Bhusan, Senior Researcher with Collaborative Research and Dissemination (CORD), New Delhi. Sweta is working on an IMMANA funded project ‘The Women’s Empowerment in Nutrition Index (WENI): Measuring nutritional empowerment to better link agriculture to nutrition’.




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