The risk of a woman dying as a result of pregnancy or child birth in her lifetime is 1 in 43 in India while it is 1 in 30,000 in Sweden.
According to the series on Maternal health and mortality trends, published in one of the most influential scientific journals in the world, “The Lancet”, one third of total maternal deaths in the year 2015 happened in India. This means an estimated 45,000 maternal deaths (death of a woman during pregnancy or within 42 days of delivery or termination of pregnancy) occured in the country in 2015.
A total of 189 countries endorsed the Millennium Declaration and signed up to meet eight goals. India is one of the signatories. One of these Millennium Development Goal (MDG- 5) is to improve maternal health. The target set for MDG-5 was a 75% reduction in the maternal mortality rate(MMR) between 1990 and 2015,in a span of 25 years. Under MDG 5, the target is to reduce MMR by 75 per cent between 1990 and 2015, India’s target for MMR is 140 per 100,000 live births by 2015, taking a baseline of 560 per 100,000 live births in 1990.
India was slowly showing a decline in maternal mortality rate.According to the latest 2015 report of the Registrar General of India’s Sample Registration System, the maternal mortality ratio (MMR) in India had registered a decline from 212 per 100,000 live births in the period 2007-09 to 178 in 2010-12. It had declined further to 167 per 100,000 live births in the period 2011-13 but has reached a stalemate since 2-3 years. SRS data shows that that so far only three states—Kerala with an MMR of 66 per 100,000 live births, Tamil Nadu with an MMR of 90 and Maharashtra with an MMR of 87—have been able to achieve the millennium development goal.
The government’s accountability
The most vulnerable are the rural populations and the poor. The MMR has reached a stalemate since 2-3 years. Why?
On paper we have many schemes for the pregnant poor. The Janani suraksha yojana gives cash of Rs 1,000 to them and this mainly goes to the family. Children are the main concern of the pregnant woman who may go hungry to feed her young child. By further decreasing the ICDS (which is the main Child nutrition program) in the current budget, the government has not only washed its hands of meeting the millennium goals but has directly made itself the cause for the failure. National Urban Health Mission also has budget crunches. Remember that a malnourished child becomes a malnourished and anaemic mother with higher chances of dying due to pregnancy, later on in life. Things always go round and round.
This photograph taken by one of the leading newspapers in Orissa tribal region tells us the story of India’s skewed development. A tribal woman who developed premature pains was carried to the nearest ambulance, and reached the nearest District hospital to finally die due to severe bleeding after delivering a stillborn baby. The ASHA worker accompanied her.
The fact remains that this is not restricted to India’s remote tribal areas. It can happen anywhere. Many birth facilities lack basic resources like water, electricity and sanitation.
The series author Professor Wendy Graham and Professor Oona Campbell, London School of Hygiene & Tropical Medicine raise many pertinent issues. Measuring progress via the current indicator of skilled birth attendant coverage is insufficient and fails to reflect the complexity of circumstances. “It is unethical to encourage women to give birth in places with low facility capability, no referral mechanism, with unskilled providers, or where content of care is not evidence-based. This failing should be remedied as a matter of priority.”
Are we the super power that our politicians tell us we are ? They tell us that the whole world is now looking at us for leadership. Will the world not see our disproportionate development?