Biswajit Padhi
Khariar (Orissa)
SEVEN women die every day in Orissa due
to pregnancy-related causes. The Union
government's Janani Surakshya Yojana
(JSY) is a scheme which seeks to prevent
maternal mortality, but it is feeble. Despite an incentive of Rs 1,400 in rural areas
and Rs1,000 in urban areas for an institutional
delivery, more than 50 per cent of women
in Orissa still deliver in their homes – a pointer
to serious flaws in the programme. The
state government has hired the services of an
additional workforce of 35,000 ASHAs
(Accredited Social Health Activists) to facilitate
JSY. An ASHA is supposed
to link the government
health centres
with her village. Yet, the
allegation here is that
the JSY has only succeeded
in raising the "fees" of
doctors and nurses in
government hospitals.
While the maternal mortality ratio, on the whole, has come down from 401 per 100,000 live births to 301 per 100,000, Orissa continues to lag behind at 358 per 100,000. Maternal mortality ratios are indicators that no country can overlook as they indicate the well-being of its citizens.
The recent Maternal and Perinatal Death Inquiry in eight districts of Orissa validates the claims of local NGOs that the poor are facing lack of access to services. About 10.46 per cent of deaths of women between 15 to 49 years are maternal deaths. Nuapada tops the list with 17.17 per cent and Rayagada has an unbelievably low figure of 6.62 per cent.
The problem is many deaths are not being recorded. The system of recording maternal deaths is done by lower-rung health service providers whose primary job is to provide services. Since health data is a barometer of service delivery, health service providers tend to suppress figures to avoid reprimand by their superiors.
Around 57.13 per cent of maternal deaths
occurred within six weeks of childbirth. About
44.2 per cent of women died within 24 hours
of giving birth. Although the JSY package
includes a three- day stay in the hospital, post
delivery, the insufficient number of beds and
inadequacies in the referral transport system
doesn't encourage the women to stay on. The
increase in the percentage of post delivery
deaths in hospital institutions proves this.
The JSY obsession with numbers has blinded
them to the fact that infrastructure and personnel
have to match enhanced demand for
services.
Most deaths occur between July and September. Apart from medical reasons, geographical barriers during the rainy season and the preoccupation of patients and their families in agricultural operations limit their access to services. The efforts of the government to train all health workers in Skilled Attendance at Birth (SAB), is welcome. But it has to walk a mile further. It has to equip smaller sub-centres with these trained health workers, so that women can overcome geographical barriers. Such initiatives need to be matched with a strong referral system to avoid mortality.
One-fourth of maternal deaths are due to haemorrhage, before and after delivery. Sixty-nine per cent of pregnant women are anaemic in Orissa. Though there are 84 First Referral Units (FRUs) in the state, most don't have blood transfusion facilities. Voluntary blood donation is not a reality here. Since time is of essence, every block hospital must provide blood transfusion facilities to avoid needless deaths.
A profile of 800 families where a female member had died due to childbirth underlines the need for a much more proactive role of the community. Around 46 per cent of women who died had been married before they were 18, despite a law against child marriages. It is also clear that socio- economic conditions are responsible for delays in seeking healthcare. About 67 per cent of women who died in childbirth were either Scheduled Caste or Scheduled Tribe and 65 per cent were below the poverty line (BPL). Around 53.8 per cent of the women and 40 per cent of their spouses were illiterate.
Awareness levels too are low. About 66.2 per
cent of spouses didn't think the women were
so unwell as to be in need of medical help.
Another 39 per cent couldn't get transport to
hospitals. While governments need to put in
place adequate infrastructure, the community
too needs to address social barriers.
Biswajit Padhi Secretary, SRUSTI At/Po: Khariar - 766107,
Nuapada,
Orissa , INDIA phone: 91 6671 232110 , 232433( fax) Cell:
9437072910
Web: srusti.org
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