Every minute of everyday, somewhere in the world a woman dies of pregnancy or childbirth. Basically in the developing countries, women between 15-49 years of age often face this risk. April 11 is, therefore, observed as the National Safe Motherhood Day in India.
Safe motherhood initiative is a global effort that aims to reduce deaths and illnesses among women and infants, especially in developing countries. This initiative was launched in 1987 to improve maternal health and reduce the number of maternal deaths by half by the year 2000. So, the main objective of the safe motherhood mission should be to increase access to family planning and maternal healthcare services and educate couples to have the best chance for a wanted and safe pregnancy.
These can be done thinking of giving recognition and commitment to the woman's fundamental human right to health. This response is already called for by international treaties, including the International Conference on Population and Development.
It also includes improvement of systems for monitoring maternal and newborn health services, implementation of evidence-based integrated cost-effective reproductive health interventions with a focus on maternal and newborn health within the primary healthcare approach.
Ensuring safe motherhood means ensuring that all women have access to the information and services they need to go safely through pregnancy and childbirth. It includes education on safe motherhood, prenatal care, promotion of maternal nutrition, adequate delivery assistance and provisions for obstetric emergencies including referral services for pregnancy, childbirth and abortion complications and, lastly, postnatal care.
About one lakh deaths occur annually in India from causes related to pregnancy and childbirth. India ranks 127th in the maternal mortality rate (MMR). In Odisha, the MMR was 258 in 2007-09 against the national average of 254, as stated in a new report released by the Deliver Now for Women and Children campaign.The White Ribbon Alliance of India (WRAI) and the Partnership of Maternal, Newborn and Child Health (PMNCH) launched a national campaign last year with special focus on Odisha.
Odisha's MMR continues to remain a cause for big concern despite a steady improvement over the years as per the latest results of the Sample Registration Survey (SRS). As many as 258 women are killed on an average during or after childbirth, per 1 lakh births every year, despite tall claims of the Government to have undertaken numerous measures to improve institutional delivery and reduce maternal mortality. Despite a steady reduction in the MMR, Odisha still remains far from meeting the millennium development goal, which sets a target of reducing the MMR to 109 by 2015.
Neighbouring Andhra Pradesh has an MMR of 134. Odisha can, however, draw comfort from the fact that four other tates, Assam, Bihar, Chhattisgarh and Madhya Pradesh, are worse off in the maternal care index. Maternal mortality continues to be the highest in Assam at 390, though its rate of decline was also the fastest from 480 in 2004-06 to the current level.
The rate of decline of Odisha's MMR by 45 point from 303 in 2004-06 to 258 in 2007-09 was a little more than the national average decline of 42 points from 254 to the current level of 212. The MMR of a population is the number of maternal deaths per one lakh. The world's 20 per cent of maternal deaths are in India.
Infant mortality in India is 63 deaths per 1,000 live births with around 47 per cent of infant deaths occurring in the first week of life. Child marriage, malnutrition, unsafe abortion, and inadequate family planning services continue to fuel the crisis and reveal a widespread gender-inequality.
In January 2004, an expanded Partnership for Safe Motherhood and Newborn Health, which was a consultative process initiated in 2002, was established with an aim of promoting the health of women and newborns, especially the most vulnerable.
Expanding the scope of the global safe motherhood initiative and building on the work of the Safe Motherhood Inter-Agency Group, the Partnership aims to strengthen maternal and newborn health efforts at the global, regional and national levels. Implementing advocacy/media strategy, stimulating national-level commitment and promoting effective interventions should be the guiding
indicators.
Working for survival of mothers is human rights imperative. It also has enormous socioeconomic ramifications and is a crucial international development priority.
In 2005, the Government of India's Ministry of Health and Family Welfare launched the National Rural Health Mission (NRHM) with a strong commitment to reduce maternal and infant mortalities, provide universal access to public health services, prevent and control communicable and non-communicable diseases, ensure population stabilisation, maintain gender balance and revitalise local health traditions.
A core feature of the NRHM is the Janani Suraksha Yojana, a programme which provides financial assistance to poor pregnant women for institutional delivery and post-delivery care. Another important component of the NRHM is to provide improved access to healthcare at the community level through female village health workers known as Accredited Social Health Activists (ASHAs). Discrimination against girls and women that begins in infancy determines the trajectory of their lives. The important issues of education and appropriate healthcare should, therefore, arise in childhood and adolescence.
Health education and services should be reoriented to meet the diverse needs of adolescents. Women should be enabled to exercise their right to control their own fertility and their right to make decisions concerning reproduction, discrimination and violence; because a woman's death is more than a personal tragedy.
It pays an enormous cost to her nation, her community and her family. And all her contributions towards both economic and social development are foregone. If the issue of safe motherhood can't be prioritised then we can't think of building a strong nation. With the loss of a mother, not only a child loses its primary caregiver but also a nation loses the contribution of a mother from inside and outside, in strengthening the position of a nation.
(Dr Subhashree Das is the State Research Coordinator of the National Coalition for Education. She can be mailed at subha.nceindia@gmail.com)