Providing adequate and timely care to pregnant women, should have been a given. In many places in India, it isn’t
last month, an eight-month pregnant woman was forced to carry her dead foetus for 19 hours in her womb in Gurgaon. Doctors at the Government hospital where she went, declared the baby dead, but they refused to operate upon the woman because she had gone to the hospital alone (without any female attendant). She was also reported to be slapped by the hospital staff, underwent physical and emotional pain and faced a severe risk to her life. Finally, she was operated upon in a private hospital in the city with the help of the police.
In the past, multiple incidents have been reported where infants have died in Uttar Pradesh after their mothers were forced to deliver on the floor, even though beds were available at the primary health centres. The attendants reportedly didn’t want to handle soiled sheets. In some hospitals in Uttarrakhand, bed-occupancy rate in the hospitals are close to 200 per cent, indicating the shoddy conditions under which the patients are being kept. Incidents such as these is not restricted to the northern zones but across India, albeit under-reported. It gives us a glimpse into the current status of maternity care in the country.
Surviving child-birth is a basic right of every woman. Yet, in our country, one woman dies every eight minutes from a pregnancy-related cause — almost 45,000 every year. India still continues to contribute almost a quarter of the global estimates of maternal morbidity and mortality. Quality aspects in maternal healthcare have long been ignored in the public health system. The violation of reproductive rights is not yet considered a human rights issue.
During the five-decade old family welfare programme, many interventions have aimed to improve access to skilled care at birth. The quality of care-givers has received less attention. Pregnant women continue to face varying degrees of abuse and ill-treatment by health workers in most state-run healthcare settings. The worst affected are the poor and the most vulnerable population who are unaware about their rights and entitlements. It is made worse by a culture of impunity, where health providers know they will get away with it. Thus, hardly any action is taken.
Mistreatment and abuse of women range from physical abuse (slapping or pinching); sexual abuse; verbal abuse such as harsh or rude language; stigma and discrimination based on age, ethnicity, socio-economic status, or medical conditions; and loss of autonomy. Pregnant women continue to face long delays at over-crowded health facilities where a woman's trauma of losing a foetus is treated as a routine job. The gravity of the situation can be gauged by the fact that the World Health Organisation had to intervene and urge Governments in developing countries to take steps in order to prevent disrespect and abuse during childbirth. But the neglect continues.
Reports of yesteryears suggest women in many rural hospitals are made to leave the hospital soon after delivery or forced to accommodate excess patients on a single bed so that the staff gets rid of work pressure. There is a distinct class bias in how women in labour rooms are treated. There is no sensitisation about gender or imparting of soft skills to public health personnel. Unreasonable use of drugs to speed up the labour and unwanted vaginal surgery with accompanying abdominal pressure, are still rampant. In many primary health centres, especially in rural areas , 24-hour maternal healthcare facilities are still missing.
In rural India, access to healthcare, specifically during delivery, remains a perennial issue. The lack of information makes it all the more difficult to demand high quality healthcare services. Addressing the issues of quality in maternal health service delivery is important not just to decrease the maternal mortality rate and reduce maternal morbidity but also to instill confidence in the public health system amongst end users.
External assessment and certification of the facilities and for building a policy framework that upholds human rights are the key steps towards improving public health facilities. Governments must streamline mechanisms for efficient procurement, management and monitoring of supply chain systems for equipment and drugs for essential maternal care. Standard treatment guidelines also need to be implemented and monitored. Knowing that there are major medical risks in those crucial hours post-delivery, new mothers at any hospital must not be allowed to leave the hospital before 48 hours. Multi-pronged strategies should also be worked out to improve the quality and efficiency of services being delivered by Accredited Social Health Activist (ASHA). This needs immediate attention.
Respectful maternity care (RMC) is a universal human right that is due to every childbearing woman. It is time the universal rights of childbearing women, referred to as the RMC charter that establishes women's right to timely, high-quality, and respectful care in pregnancy, birth, and afterward is adopted in national programs and policies of India.
This year marks an end of Millennium Development Goals and a humble beginning for Sustainable Development Goals (SDGs) to achieve the development agenda over the next 15 years. It is an opportune moment to establish frameworks to accelerate action on maternal, newborn and child health. The health ministry's move to allow ‘birth companions’ during delivery in public hospitals is a commendable move. India is a long way off from the standards practised in developed countries in maternal care. Unless the health system is able to ensure good quality care, the achievement of SDG targets would be incomplete.
(The writer is executive director, Centre for Catalysing Change and national coordinator, White Ribbon Alliance)