[women-rights] Better data needed to address maternal mortality
HREA
Human Rights Watch Press release
by Aruna Kashyap
March 24,
2009
Moving from guesstimates to information about
maternal mortality
When 20-year-old Ranibai, from a
poor family in Uttarakhand, began haemorrhaging during pregnancy, the path
to treatment was not easy. Her family carried her on a charpai down hilly
terrains to a health facility, but she bled to death before they got there.
No health worker was nearby.
Ranibai's case is not an
aberration. Tens of thousands of women are known to die of pregnancy and
childbirth complications in India every year, but the actual number remains
a mystery. For every woman who dies, another 20 to 30 suffer illnesses
arising out of delivery or abortions.
An Indian Government
estimate says the annual number of maternal deaths (deaths caused by
pregnancy, delivery, or abortion) is 78,000, but a 2007 UN estimate puts
the number at roughly 117,000, the highest number of maternal deaths in the
world. But these are merely estimates with huge error margins. Women's
health experts across the country agree that lack of accurate data is a big
part of the problem.
Nine years ago, 189 countries came
together and endorsed the United Nations General Assembly Millennium
Declaration outlining eight millennium development goals (MDGs).
Governments and donors have devoted intensive research, resources, and
services to achieving these shared global priorities, but India is falling
behind.
One of these goals, MDG-5, aims to reduce maternal
mortality by 75 percent by 2015 from its 1990 levels. Even though about a
fifth of maternal deaths worldwide are estimated to be in India, the
government has not compiled up-to-date data on these often preventable
tragedies.
The Indian government itself acknowledged that the
"absence of reliable estimates" of maternal mortality makes the
process of reducing it "both difficult and complex." The last
nationwide study, which found that hemorrhage, infections, and unsafe
abortions were the top three direct causes of maternal deaths, was for the
period 1997 to 2003. There has been no reliable government study of
maternal mortality since. For a country famed worldwide for its prowess in
research, technology, and medical sophistication, this shows not a lack of
capacity but a lack of political will.
Studies, such as the
National Family and Health Survey and the District Level Household and
Facility Survey, present useful information about access to antenatal and
postnatal care, and whether women deliver at health institutions. But they
do not tell us how many women die, where, and why, making it difficult to
assess the impact of government's schemes and the progress on reducing
maternal mortality.
Analysing maternal deaths, severe
complications, and the medical, socio-economic, and cultural factors that
contribute to them is critical to understanding and reducing maternal
mortality. In Ranibai's case, hemorrhage was the direct cause of death. But
a lack of transportation was a crucial contributing factor that denied her
access to timely emergency obstetric care. There may have been other
factors like poor nutrition, but no one will learn of them. The government,
health-care workers, and women themselves will be unable to take more
effective measures to prevent these deaths unless they have more and better
information.
The most common method of monitoring adverse
pregnancy outcomes is through confidential inquiries and reviews. The
success of such techniques has been illustrated not only by various local
nongovernmental and international organisations, but also by the Tamil Nadu
state government.
Confidential inquiries empower women, their
families, and health workers with a chance to be heard. Women in India not
only suffer and die in alarming numbers, but they also suffer and die
silently. Health workers strive in unenviable and harsh circumstances but
are expected to churn out miraculous results. And bereaved families are
often left with questions and complaints, but no realistic avenue for
sharing them.
The disparities between those who can get luxury
health care and those who struggle for the most basic care will not be
resolved overnight. But tracking maternal deaths, severe complications, and
their causes, and culling out lessons for change are essential first steps
toward reducing that gap, and promoting the right to health, and life, for
all Indian women.
Let us hope that someday very soon pregnant
women in India no longer will die unseen, uncounted, and unheard. In the
words of Renuka Chowdhury, the minister for women and child development, it
would be a shame if in 2015 India presented itself on the global stage as
"a country which can put Chandrayaan into orbit cannot have women
delivering babies (safely)."
HREA - www.hrea.org
Human Rights Education Associates (HREA) is an international non-governmental organisation that supports human rights learning; the training of activists and professionals; the development of educational materials and programming; and community-building through on-line technologies.
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