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Society
Maternal Mortality: Who Killed My Mummy?
by Swapna Majumdar
When doctors at the local
primary health centre in Banda, Uttar Pradesh, were unable to stop her
bleeding, Phuli, 28, was moved to the Banda district hospital and then
to the hospital in Kanpur. But here she was denied life-saving care and
gave birth outside the hospital gates. While the baby died within an
hour, Phuli died later that night.
Did Phuli need to die? Could she have been saved if she had not been the
wife of a daily wage laborer belonging to a marginalized community?
Would she have survived if she knew that the symptoms of blood loss were
not normal or that she was seriously sick? Why is it that over 75,000
women continue to die from pregnancy-related causes in India each year?
Can the health system be made legally accountable? These were some of
the concerns raised at a recent meeting in New Delhi to discuss Maternal
Health, Human Rights and Law, as a part of the nationwide ICPD +15
(International Conference on Population and Development) Gains and Gaps
review process.
"In India, there is one maternal death every five minutes. These are
preventable deaths. There is no justification for maternal mortality.
India has more than 300 maternal deaths for every 100,000 live births.
In Sri Lanka, the corresponding figure is 56, in China it is 45, in
Namibia, 210 and in Egypt, 130. The biggest cause is discrimination and
the lack of equality that prevents women from accessing information and
services. However, women should not remain objects of interventions but
also be empowered," contends Anand Gover, UN Special Rapporteur on Right
to Health.
Litigation can become a tool to empower women by making maternal health
a right says Jasodhara Dasgupta, member of the steering group for
ICPD+15 review. "Equity has to become a marker for measuring maternal
mortality. Less than 50 per cent of women give birth with the assistance
of a skilled attendant and only 40 per cent of deliveries occur in an
institutional setting. Even access to maternal health varies by state.
So while in West Bengal over 90 per cent receive antenatal care, only 34
per cent receive it in Bihar," she informs.
But maternal health is not only about numbers. It is about a woman's
dignity and her right to health - two reasons why accountability is
needed. Maternal mortality is symptomatic of a deeply ingrained gender
inequality, feels Melissa Upreti, senior legal advisor of the Centre for
Reproductive Rights, an international NGO. "India has taken many steps
to reduce maternal mortality including the National Rural Health Mission
(NRHM), but it lacks effective monitoring and enforcement. This has
undermined the country's efforts. Human rights law and the Constitution
provide a strong basis for lawyers to demand change and hold the
government accountable for maternal deaths," she says.
CRR (Center for Reproductive Rights), which uses the law to underline
reproductive freedom as a fundamental right to all governments, launched
a global initiative in 2004 to promote the use of strategic litigation
for achieving women's reproductive rights worldwide. In 2006, it
organized the first ever training on reproductive rights for lawyers in
India in collaboration with the Human Rights Law Network (HRLN). It was
at this meeting that the potential for developing constitutional
litigation to address maternal mortality through the use of
international norms and comparative law was discussed for the first
time. It also inspired the just-published report, 'Maternal Mortality in
India: Using International and Constitutional Law to Promote
Accountability and Change'.
The report, which assesses the situation in India and recommends
strategies and laws that can be used to tackle the problem, was shared
at the recent meeting, where it was released. "It (the report) is a tool
to establish a protective legal environment to enable women to exercise
their right to survive pregnancy and childbirth and lead healthy and
productive lives. The absence of legal accountability for maternal
deaths and morbidity caused by the health system failures,
socio-economic disparities and discriminatory social practices is a
major impediment to successfully reducing maternal mortality. Law can
help fight maternal mortality," points out Upreti.
This was seen in Madhya Pradesh (MP) last year. A public interest
litigation (PIL) was filed against the state by Jan Adhikar Manch, a
network of local NGOs and the HRLN. The PIL exposed the failure of the
state to implement official policies on maternal health as a result of
which women in the state were not receiving adequate antenatal and
postnatal care. It used data from the National Family Health Survey (NFHS)
to show that less than half of all pregnant women in MP receive
antenatal care and 20 per cent do not receive any care at all. This gap
has contributed to the large number of high-risk pregnancies that go
undetected and lead to a high incidence of maternal mortality and
morbidity. MP has the third highest Maternal Mortality Rate (MMR) in the
country (379 per 100,000 live births).
"Since the filing of the PIL, a blood bank - one of the demands made -
was set up at Bhind Hospital. The case is still being heard. This shows
that courts can be proactive and restore rights of women," contends
Jameen Kaur, HRLN. "It takes courage on the part of the victims to
approach the court and seek redressal and hope. They have a voice in the
form of PILs but it is the government, the upholder of these rights,
which does not have ears."
Disparities in maternal health between north and south India are
striking. According to the CRR report, analysis of government data
reveals that 93 per cent women in south India receive some form of
antenatal care than do a dismal 43 per cent of women in the north. Even
the quality of care received by women in the north is poorer. Only 23
per cent received information of danger signs during pregnancy and
delivery care compared to 44 per cent in south; 60 per cent women were
given iron and folic acid tablets compared to 91 per cent in south.
Despite the fact that eclampsia is the second most common cause of
maternal death, health facilities in many parts do not stock magnesium
sulfate, its standard treatment (NFHS - 1998-99).
Women's groups have begun campaigning for state accountability to ensure
equal rights for women. In Uttar Pradesh, the state with the highest MMR,
'Complete Citizen, Total Rights', a campaign to demand accountability on
the basis of constitutional obligations to protect, promote and fulfill
women's rights has been started by HealthWatch, an NGO working for
women's right to health. HRLN has also filed several PILs seeking
implementation of service guarantees under NRHM.
Three delays that cause women to die - the delay in deciding to seek
care, the delay in reaching the appropriate health facility and the
delay in receiving quality care once inside an institution. It is
evident that these deaths are not random occurrences, but the
foreseeable result of a failure of the health system. Dismissive
attitudes and a lack of basic health facilities in hospitals have
exacerbated the fragile situation. Hopefully, now the courts will step
in to lead the way in upholding a woman's right to health.
August 23, 2009
By arrangement with
WFS
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