Religion and governance: strange bedfellows #Vaw #womenrights


BMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f3715 (Published 7 June 2013)

Cite this as: BMJ 2013;346:f3715
  1. Anita Jain, India editor, BMJ

Author Affiliations

  1. ajain@bmj.com

An unexpected turn of events saw a woman referred to as Beatriz get a life saving caesarean section, thanks to doctors in El Salvador who supported her cause, and a rousing international movement. She was earlier denied an abortion, it being criminalised in predominantly Catholic El Salvador, with the ensuing imprisonment of women and doctors (doi:10.1136/bmj.f3612). Timely intervention prevented Beatriz going the same way as Savita Halappanavar did a few months back in Ireland. Savita died after being denied an abortion on the grounds that “it [Ireland] is a Catholic country” (doi:10.1136/bmj.f2208). Her death and Beatriz’s struggle for life raise the question: Why does religion interfere?

A parallel conflict between religion and governance is taking place in the Philippines. At the Women Deliver conference I attended last week, it pained me to hear Filipino women with 16 and 22 children talk of how they were tired of having children, of having to provide for them under conditions of extreme poverty, and fearful of dying in the process of childbirth. Senator Pia Cayetano provided an inspirational narrative of having the reproductive health bill passed last year after five congresses and nearly 15 years. Recognised by President Aquino as a “matter of urgency,” the law marks a momentous achievement to make available free contraceptives, sex education, and comprehensive obstetric services (doi:10.1136/bmj.e8535). The struggle is not over however. With a largely Catholic, conservative, and patriarchal hierarchy, the constitutionality of this law has been challenged in the Supreme Court.

In a review of abortion policies worldwide, Sophie Arie reports a threat that countries may be headed towards being more restrictive (doi:10.1136/bmj.e8161). Closer to home, India may laud itself for a progressive abortion law but it continues to have one of the highest rates of unsafe abortions. Suchitra Dalvie, coordinator of the Asia Safe Abortion Partnership, shares grim statistics whereby, “every year about 11 million abortions take place [about 700 000 are reported] and around 20 000 women die due to abortion related complications.” Clearly the law has not translated into enabling physical, social, or financial access to these essential reproductive health services (doi:10.1136/bmj.f3159). Contrary to what may be expected, states are further imposing severe curbs on medical abortion pills (doi:10.1136/bmj.f1957). In the latest BMJ poll we look forward to hearing what you think of this.

Signifying a commitment to make comprehensive family planning services a reality globally, the London Summit on Family Planning (FP 2020) laid the ground for collaboration among donors and governments (doi:10.1136/bmj.e4160). At Women Deliver, Kavita Ramdas from the Ford Foundation emphasised, however, that “access to contraceptives” needs to be the message, and not just family planning. The importance of this is immediately evident in a similar conflict between the state and religion in Muslim dominated Indonesia where unmarried women are denied reproductive health services including contraception. Shereen El Feki, author of Sex and the Citadel, shared voices of young unmarried men and women from the Arab region who are “sexually active, but not sexually informed” as “marriage remains the only the only socially accepted context for sex—state-registered, family-approved, religiously-sanctioned.” The needs of this large and growing community of single men and women often tend to be neglected in the discourse on family planning.

Nozer Sheriar, secretary general of the Federation of Obstetric and Gynaecological Societies of India (FOGSI), shared that, with an estimated 21.6 million women worldwide experiencing an unsafe abortion each year and with about 70 000 deaths, it is a silent tsunami knocking door to door. As symbolised by Salvadoran doctors who stood strongly behind Beatriz so she would not die giving birth, there is a role for healthcare providers to support women’s choice on this reproductive right that society is so reluctant to give.

Notes

Cite this as: BMJ 2013;346:f3715

Footnotes

  • Follow Anita Jain on Twitter @ajain247

#India – Why were 103 women sterilised and left to die in a family planning camp #Vaw


 

On February 5, 2013 a mega female Minilap Ligation operation camp was held at Manikchak Rural Hospital (RH) of district of Malda, in West Bengal. On this particular day 103 women were sterilised. It was reported in the local media that the women who were sterilised in this camp were kept on the open ground (hospital campus premises) in semi conscious state, and their relatives were asked to take them back home immediately after the operation. This was highlighted in the media (NDTV and other news channels) as gross human rights violation and later enquires were conducted by the state health department and the national human rights commission. The National Human Rights Commission (NHRC) has issued notices to West Bengal’s Principal Secretary Health West Bengal and the Malda district magistrate, taking cognizance of an NDTV report that showed how nearly a hundred women were dumped unconscious.

Civil Society Fact-Finding: There was strong opposition to this from civil society groups as it is felt that despite government guidelines on quality assurance and standard procedures to be followed in camp settings are not being followed and implemented properly. This is a summary of this fact-finding exercise.

On April 6, 2013, an independent fact finding was conducted by a team comprising of public health experts, health and women’s rights activists and members of networks including Heath Watch Forum, Bihar; Coalition Against Two-Child Norm and Coercive Population Policies and Human Rights Law Network (HRLN). National Alliance for Maternal Health and Human Rights (NAMHHR) supported the team by sharing the ethical guidelines and checklists for case documentation. The team members are working actively on issues related to reproductive health and rights and are engaged in post ICPD processes in India. Dr. Prabir Chatterjee, RCH Raiganj, West Bengal; Praveer Peterfrom HRLN, New Delhi; Kanti from Smokus local NGO Raiganj, Leena Uppal from Coalition Against Two-Child Norm and Coercive Population Policies, New Delhi; Devika Biswas from Health Watch Forum, Bihar (also filed the PIL in Supreme Court earlier in 2012 about 53 women who were sterilised in a government school in Araria district of Bihar) formed the team.

The main aim of the fact-finding was to systematically document whether the standards specified in different guidelines (a) ‘Quality Assurance Manual for Sterilisation Services, 2006’, (b) ‘Standard Operating Procedures for sterilisation services in camps, 2008′ (c) ‘Standards for Female and Male Sterilisation Services, 2008’ were adhered to during this camp and assess whether the providers are maintaining standards of care as specified in the service guidelines.

Villages Visited: The team visited six villages in Malda district from where women had come for the operation.  Villages included Niranjanpur, Nawada Maheshpur, Fakirtola, Gopaltola, Bagditola and Najiruddinpur. Women who had undergone operations on February 5, 2013 and their families were interviewed. Meetings and interviews with the Chief Medical Officer of Health (CMOH), Block Medical Officer of Health (BMOH) of Malda district, five ANMs and four ASHAs were also conducted.

Key Findings: The fact-finding report describes the concerns and challenges faced by the women and their relatives, who underwent operations in the camp. It also throws light on the lack of basic minimum standards adhered by officials in the camp.   

One of the key finding was the fact that the standard camp protocols of the GOI were not followed. Infection control practices were inadequate. Though the GOI guidelines emphasise maintenance of prevention of infection, however the health care providers are unable to monitor or maintain records of infection control mechanisms followed at such family planning camps, given the large number of operations that that they conduct in a single day.

A total of nine women were interviewed. All women interviewed reported that they were not provided options for informed choice at the camp. All the women and their families voiced an environment of utter confusion and chaos at the camp. Women reported pain and minor complications after the operations, lack of complete knowledge about the operation procedure, consent being only in terms of thumb impressions and out of pocket expenditures during and after the operations.

A quick analysis of number and sex of children of all the women interviewed clearly showed a high preference for male child. Most of these women reported that they have been waiting for at-least one son before they go in for permanent sterilisation.  

Discussion: Women, who have undergone inhuman treatment where their dignity and rights have been denied, must be provided some form of redressal. The Family Planning Insurance Scheme which includes provisions for compensation to women who face failures and complications (and death) should be expanded to include humiliation of this nature. The Department of Family Welfare must also audit and ensure strict compliance of the quality assurance mechanisms it has already issued. The state government urgently needs to put the grievance redressal system/complaint box in place and ensure that such negligence is not repeated and the underlying deficits are addressed effectively.

It is hoped that the analysis from fact-finding will be of use to the larger community concerned with the experiences of women who have used family planning services and who are going to use them in future. It is also hoped that these findings will be deemed as relevant by the district officials at Malda, West Bengal who have been a part of this fact-finding process. 

We request you to share this summary widely and to urge your governments to stand up for women’s rights including their right to control their own bodies, fertility and sexuality!

Download Fact Finding Report

 

PRESS RELEASE- Govt removes two child norm from maternal entitlements #Victory #Goodnews


The Coalition Against Two-child Norm and Coercive Population Policies, the National Alliance on Maternal Health and Human Rights (NAMHHR), the Right to Food Campaign (RTFC), and the Working Group for Children under six (WGCU6) with the support of  national networks and NGOs , have been advocating for the removal of these conditionalities with the Ministry of Health and Family Welfare for the last three months.

Our submissions, supported by members of the NRHM Mission Steering Group and the Department, have led to a revised GO on theremoval of conditions related to the two-child norm and age from maternity entitlements like JSY and NMBS by the MoHFWw.e.f. 8 May 2013 , check GO on removal of 2CN in JSY

Our next effort collectively should be directed towards the removal of these disqualifying conditions from the IGMSY (Pilot) scheme of the Ministry of Women and Child to ensure that the universal maternity entitlements promised in the NFSB, will be unconditional.

We also hope that this directive from the Ministry of Health and Family Welfare  can now be used in your own states, to advocate for removal of this norm from all other schemes. Please let us know if we can work together or help in this.

In solidarity,Jashodhara, Sejal and Abhijit

*This is despite the fact that the poorest women (including Dalits and Adivasis) who most need these schemes as social support, are usually the ones who have more than two children. These women also have high unmet need for contraception. These women are constrained by the fact that child survival is lowest among them (four times more babies die among the poorest families as compared to the richest) and they desperately need children since the state does not provide adequate social support in old age.

  •   Coalition Against Two-Child Norm and Coercive Population Policies
  • CommonHealth – Coalition for Maternal Neonatal Health and Safe Abortion
  •  Healthwatch Forum, Bihar
  • Healthwatch Forum, Uttar Pradesh
  • India Alliance for Child Rights (IACR)
  • Jan Swasthya Abhiyan (JSA)
  • National Alliance on Maternal Health and Human Rights
  • Right to Food Campaign
  • Working Group for Children Under 6 (Right to Food Campaign)
  • Download GO on removal of 2CN in JSY

 

Press Release- Is organising for proper health services for a poor a `criminal activity’ ? #Vaw #Stateoppression


Release Madhuri immediately

 

New Delhi, May 20th , New Delhi

National Alliance for Maternal Health and Human Rights (NAMHHR), a group of civil society organisations from across the country have come together as a broad alliance, that strongly condemn the use of court proceedings against maternal health activist, Ms Madhuri working in Jagrit Adivasi Dalit Sangathan(JADS1) who has been arrested on 16th of May 2013. She has been arrested for forcing a pregnant woman i.e. Baniya Bai who was in a critical condition and was in labour to deliver in full public view just outside the Menimata PHC. The case was filed against Madhuri, Baniya Bai’s Husband, Basant and others by the compounder and was registered as FIR No 93 of 2008. This case of Baniya Bai is also part of the writ petition filed in the High Court of MP, Indore Bench in which the status of maternal health services was raised in light of 29 maternal deaths recorded in a span of 9 months in Barwani DH.

Madhuri appeared in the court on 16th May at Shri D.P. Singh Sewach, JMFC and informed, that the police had filed a closure report (khatma) but had not stated clear reasons for the closure and therefore the report was refused. Madhuri was arrested from the court complex and has been remanded in JC till 30th May 2013 and will be placed in Khargone women’s Jail.

As social health activists, many of us are witness to the fact that the area has a history of organised action and peaceful protests for improvement of rural health services, specifically for maternal health services. The details of the case clearly show that Madhuri informed the police officials and helped the pregnant women and newborn to get emergency obstetric care after delivery. However, instead the administration who should have taken a stringent action against the hospital staff (the compounder and the nurse) who forced Baniya to leave the hospital and asked for informal fees from the family members have arrested Madhuri.

We, the civil society groups are extremely disturbed by it and need an answer from the administration as why helping and organising for proper health services for a poor vulnerable family can be construed as a `criminal activity’.

Details of the case are as follows:

A ST resident of of village Sukhpuri, Barwani. Baniya Bai was taken to the Menimata PHC for delivery by her father-in-law, Dalsingh, on the night of 11 November 2008.  They made the 15 km journey on a bullock cart because no other transport was available.  After admitting and taking a cursory look at her, the compounder, V.K. Chauhan, and nurse, Nirmala, left the PHC and went home.

The next morning, Baniya was forced by the compounder and the nurse to leave the hospital.  Her family was asked for Rs. 100, which they did not have and so Dalsing immediately went to get money from their village.  Despite attempts to re-admit Baniya Bai to the PHC, the compounder flatly refused saying that they could not manage the delivery so she would have to go to Barwani DH or Silawad Hospital.

Baniya’s relatives tried to get the Menimata hospital compounder, nurse and staff to call for the Janani Express, but were unsuccessful. The family was told to make its own arrangements to refer to a higher hospital.  When forced to leave the PHC Baniya Bai crawled out of the labour room, on to the road outside the PHC, where she lay down in severe pain.

Eventually, Baniya’s mother-in-law, Suvali Bai, went looking for a Dai in the marketplace and found Jambai Nana, who had come to market collect her wages. After hearing about Baniya Bai’s situation, Jambai agreed to assist her, and at around 12PM, conducted a normal delivery on the road outside the hospital. The father-in-law gave his dhoti (loin cloth) to provide cover for Baniya Bai during delivery. Following this incident, a crowd gathered outside the health centre.

Madhuri was passing by, inquired about what was happening. She then called up the Silawad CHC, the Silawad Police Station as well as health officials from Barwani. Upon being informed, senior officials from the health department ordered for a vehicle to be sent immediately to the Menimata PHC. After being denied emergency obstetric care and being forced to deliver in public view, Baniya Bai’s and her child were taken to the Silawad Hospital for admission. The compounder was suspended after repeated demands for action from JADS, but was soon reinstated.

1 JADS is a membership- based mass organisation of several thousand families, has been campaigning for over 14 years for the realisation of the constitutional and legal rights of adivasis in Barwani, Madhya Pradesh, one of the most backward districts of the country.

contact us —http://namhhr.blogspot.in/

SIGN PETITION FOR MADHURI HERE —http://petitions.halabol.com/2013/05/17/release-maternal-health-activist-madhuri-immediately

 

PRESS RELEASE-Why are civil society groups against the two-child norm? #Vaw #Womenrights


“Two-child norm is gender-insensitive, disempowering for marginalised women in society and poses a serious risk to their lives”.

Though India’s population growth rate is now the lowest it has been in the last fifty years, India’s population stabilization efforts continue to centre around family planning, with a focus on fertility reduction.

The rush to control population by cutting benefits to the women who have more than two children and penalising them is for many an unconstitutional approach of the government. Recently, Naveen Jindal recommended the parliamentary standing committee to consider limiting nutritional support to children under government schemes to only the first two children to “encourage stabilization of population”!

In a country where we continue to have large numbers of people — women, Dalits, adivasis, the poor, CSOs strongly recommend that maternity benefits and nutritional support schemes should be made unconditional. There should be no restrictions in access to these public support programmes with regard to age or parity. The government should ensure minimum support facilities at work (including crèches, wage compensation, nursing breaks and adequate maternity leave for exclusive breast feeding) for poor women in the country.

Mr. AR. Nanda, former Secretary, Family Welfare, and Registrar General, Government of India, chief architect of the National Population Policy 2000 and Chairperson of the National Coalition Against TCN and Coercive Population Policies, debunked the need for coercive measures to promote population stabilization. He argues that steps to link entitlements to population control or family size need to stop and emphasis should be laid on providing women with adequate nutritional supplements, extended to women who need it the most, i.e. women from socially and economically weaker backgrounds.

Ms. Jashodhara Dasgupta from National Alliance for Maternal Health and Human Rights (NAMHHR) stated that according to National Family Health Survey 3 (2005-6), nearly 60% of the most vulnerable women of the age group of 15-49 years have more than two children and will be qualified from maternity benefits; these include scheduled castes, scheduled tribes, poorest wealth quintile and women with no education. Data also shows that women from these vulnerable groups are highly likely to lose their children; the probability is one in fourteen children will die before their 5th birthday. As such, disqualifying vulnerable women from maternity benefits just because they give birth to more than two children is a cruel denial of their reproductive and economic rights. Maternity benefits and support are most essential for the well being of poor women and for the future generation of our country. There is an urgent need to delink the supplementary nutritional programmes and maternity entitlements from the two-child norm; else the “inclusive agenda” of the government will be defeated.

Dr. Abhijit Das (Convenor of the National Coalition Against Two-Child Norm and Coercive Population Policies, New Delhi) expressed serious concerns that such a disqualification is gender-insensitive, disempowering for marginalised women in society and poses a serious risk to their lives.

#India- Activists decry linking maternity benefits to population control #Vaw #Reproductiverigghts


New Delhi, Jan 26 — Civil society groups have expressed shock at a parliamentary panel’s recommendation to restrict the nutritional support under government schemes to only two children per family and to disqualify mothers of more children from maternity benefits.

 

Debunking the need for coercive measures to promote population stabilisation, A.R. Nanda, former secretary, department of family welfare, said that India’s population growth has already slowed down considerably and the figures from the 2011 Census show that the decadal growth at 17.64 percent is the lowest in the last 50 years.

 

Reviewing the National Food Security Bill, the parliamentary standing committee on food, consumer affairs and public distribution has recommended that maternity benefits under government schemes should be restricted to only the first two children. The steps to link entitlements to population control or family size need to stop and emphasis should be laid on providing women with adequate nutritional supplements which should be extended to women from socially and economically weaker backgrounds, Nanda said on the sidelines of a function here on girl child.

 

Jashodhara Dasgupta from National Alliance for Maternal Health and Human Rights (NAMHHR) said that according to National Family Health Survey III, nearly 60 per cent of the most vulnerable women of the age group of 15-49 years have more than two children. “They will be disqualified from maternity benefits; these include the Scheduled Castes, Scheduled Tribes, the poorest and those with no education,” Dasgupta was quoted as saying in a release. As such, disqualifying vulnerable women from maternity benefits just because they give birth to more than two children is a cruel denial of their reproductive and economic rights, she said. Maternity benefits and support are most essential for the well being of poor women and for the future generation of our country, she said. There is an urgent need to delink the supplementary nutritional programmes and maternity entitlements from the two-child norm, else the “inclusive agenda” of the government will be defeated, she added.

 

The activists strongly recommended that maternity benefits and nutritional support schemes should be made unconditional. There should be no restrictions in access to these public support programmes with regard to age or parity.

 

The government should ensure minimum support facilities at work, including creches, wage compensation, nursing breaks and adequate maternity leave for exclusive breast feeding, for poor women in the country, they said.

 

Abhijit Das, convenor of the National Coalition Against Two-Child Norm and Coercive Population Policies, New Delhi, expressed “serious concerns that such a disqualification would be gender-insensitive”.
The recommendations have also been objected to by the National Commission for Protection of Child Rights (NCPCR).

 

The parliamentary standing committee’s other recommendations, which include diluting the existing commitments of the government to provide nutritional security to children, have also drawn criticism from the civil society as well as the NCPCR.
IANS

 

 

#Fellowship- Maternal Health #India #mustshare


THE MATERNAL HEALTH YOUNG CHAMPIONS PROGRAM

 

 

 
Maternal mortality is a major threat to women’s lives in developing countries. While maternal health outcomes have improved in some countries over the past few decades, rates of maternal death remain alarmingly high. Every minute, a woman dies in pregnancy or childbirth and over 300 million women in poor countries suffer from maternal morbidity. In many very poor countries the majority of mothers do not receive even the most basic health care, and quality care during childbirth – when both the mother and child are most at risk – is often unavailable.
 
Program Overview
To reduce maternal mortality and morbidity over the long-term, emerging public health leaders need to be equipped with the skills, commitment, and vision to respond fully to multiple causes and consequences of this threat.
 
Maternal Health Young Champions are students or young graduates in public health or a related field who are committed to improving maternal mortality and morbidity through either research or innovative field work in their home country.
Maternal Health Young Champions Program, a partnership between the Institute of International Education and Harvard School of Public Health, offers a unique fellowship to 10 young people who are passionate about improving maternal health in their home country. The Young Champions who are selected will be matched with in-country mentors from selected organizations for a nine-month research or field project internship focusing on a particular area of maternal health. The fellowship includes leadership training and participation in the Global Maternal Health Conference 2013 in Arusha, Tanzania.
 
Eligibility Requirements Applications are currently being accepted from candidates from Ethiopia, India, Mexico, and Nigeria who meet the following minimum criteria:
  • Bachelor’s or equivalent degree
  • 20-35 years of age
  • Clearly articulated plans for continued technical experience, research, or study
  • Demonstrated career commitment to improvement of maternal health, especially in developing countries
  • Interest in academic research or technical service provision in the field (excluding policy advocacy)
  • Articulated work/study project goals
Please circulate this information widely within your institution or networks, particularly to candidates whom you think would be excellent applicants for this program.

For more information on the program or to apply, go to www.iie.org/mhyc or contact:

John Bodra
Program Officer India
Tel: +91-11-2651-6873                     Email: info@iieindia.org.in

APPLICATION DEADLINE-NOVEMBER 10, 2012

 

#India- #MaternalHealth Program blasted by #NAMHHR


Indian Maternal Health Program Blasted by Critics

By Swapna Majumdar

WeNews correspondent

Tuesday, October 23, 2012

A requirement that participants have no more than two living children excludes numerous women in high-fertility regions in India who could most benefit from the $80 outlay.

Women in India with more than two living children are denied program benefits.
Women in India with more than two living children are denied program benefits.

Credit: Swapna Majumdar

NEW DELHI (WOMENSENEWS): At 28, Leela Devi, who lives in a small village in the impoverished northern state of Uttar Pradesh, seems like an obvious candidate for a new government program to improve the health of pregnant and lactating women.

Devi is weak and finds herself constantly tired. She has given birth seven times. Two of her children died soon after birth. The struggle to feed her surviving children meant that Devi, a daily wage laborer, had to return to work before she had adequately recovered from childbirth and pregnancy.

National health surveys have shown that high levels of under-nutrition and anemia in adolescents and women are exacerbated by early marriage, early childbearing and inadequate spacing between births.

Data show that more than half of women in India (55 percent) are anemic, with 63 percent of lactating women and 59 percent of pregnant women suffering from the condition.

But Devi and a huge portion of other low-income women will not be eligible for a new government health program that provides cash assistance of $80 because they have had too many children.

The Indira Gandhi Maternity Support Scheme is only open to pregnant women who are over 18 years of age and don’t have more than two living children. One 2011 study, however, based on the latest national family health survey, indicated as many as 63 percent of poor women between ages 15 to 49 would be disqualified from the program because they had more than two children.

The benefit requires a pregnant woman to register her pregnancy at a health center, accept immunization of the mother and child and agree to exclusive breastfeeding and growth monitoring of children.

With the scheme being piloted in four states, Uttar Pradesh, West Bengal, Jharkhand and Odisha–all high fertility states–health activists contend the government is promoting a coercive two- child policy in the name of population stabilization by offering incentives for only those women who have two children.

Flawed Scheme

The National Alliance for Maternal Health and Human Rights, a group of 17 nongovernmental organizations working on gender and health, conducted a study of the maternal health program and found that designers of the program visualized the eligibility conditions as encouraging a “small family norm.”

The group, which monitored the maternity scheme from an equity and accountability perspective, found that this approach ignored how maternity was embedded within the vicious cycles of poverty, ill health and impoverishment for rural and marginalized women.

Health activists say that by imposing the exclusion criteria that denies this benefit to women with more than two children, the scheme fails to address the fact that women have no control over their bodies and have little or no access to contraception. The women excluded by the eligibility criterion most need the cash benefit because they have such limited access to health and family planning services and have little choice about bearing children and birth control.

The eligibility criterion, in short, defeated its stated purpose of improving pregnant women’s access to income, food and rest, said Kalyani Meena of Prerana Bharti, one of the alliance’s partner nongovernmental organizations that conducted the study in the state of Jharkhand.

All 57 women studied by the national alliance in the four states, during the period of December 2011 to March 2012, had gone through three to seven pregnancies. They all had a high rate of pregnancy failures due to malnutrition and poor availability of health care.

Given the lack of regulations and income insecurities in the informal sector, women in these regions are often forced to go back to work soon after childbirth and can neither practice exclusive breastfeeding nor provide sufficient care since they work under difficult conditions in places without child care services.

Family Size Barriers

In Uttar Pradesh, the most populous state in India with a population of over 200 million and where Devi lives, the average number of children born to a woman during her reproductive years is 3.6; it’s 3.9 for rural women.

Even if women wanted to limit their family size, the high cost of accessing health care stops many of them. The study found that almost all women who go to health care facilities suffer daily wage losses because of long waiting hours at the public hospital. Those losses are doubled if they are accompanied by their husbands.

Skipping work to rest during pregnancy and post-pregnancy means losing wages for two-to-18 months, which adds up to financial losses of between $16 and $220, according to the study.

Most of the women studied said they had taken loans to cover survival costs and then cut back on food or returned to work early to pay off the loans.

The government’s cash benefit of $80 would obviously be helpful to such women.

The report’s investigators conclude that if India’s high maternal mortality rate (212 deaths for 100,000 live births) is to be lowered, along with high rates of anemia and under-nutrition, then maternity benefits must be unconditional and food and health coverage universal. Hoping their findings would feed into the evaluation of the scheme, the report also recommends that women’s advocates be involved in monitoring and evaluating the program and in engaging community women in social audits to ensure gender concerns are addressed.

Swapna Majumdar is a journalist based in New Delhi and writes on gender, development and politics.

To know about NAMHHR more log on to http://namhhr.blogspot.ca/

 

Hygiene shocker! Now, cleaners assist in delivering babies at maternity homes #Indiashining


 

Pritha Chatterjee : New Delhi, Fri Aug 03 2012, 01:58 hrs
News

Usha Devi’s newborn came into the world a few hours after the Northern Grid collapsed for the first time early on Monday morning.

When Usha went into labour at the 14-bed municipality-run maternity home in Khichripur, East Delhi, late on Sunday night, a nurse who was assisted by a cleaning staff helped her deliver — in a room lit by candles.

The centre is one of the 30-odd maternity homes in the city, sponsored by the government as part of its Janani Suraksha Yojana programme to promote “institutional” deliveries. Most of these centres suffer from an appalling lack of facilities and staff.

“The labour room was dark and hot. I was in pain. I did not know that a nurse, not a doctor, was attending to me. She saved my life and my baby,” Usha said.

When the Northern Grid failed a second time on Tuesday, the healthcare centre was once again without power. Usha and her child lay in the ward, where another expecting mother, Aarti, was writhing in labour pain.

Though not qualified, a cleaning staff administered her a drip.

“We have learnt a few things because of the perennial staff shortage. We help the nurses,” she said.

The auxiliary nurse midwife agreed: “We have learned to work without doctors. The sweepers have become our assistants.”

SORRY STATE

Delhi Health Minister Dr A K Walia said: “Most of these centres are managed by the civic agencies. We have been telling them to arrange for basic facilities like ultrasound machines.”

These centres have been around for over a decade and were supposed to be open round-the-clock. But it has been alleged that doctors — some of who are posted under National Rural Health Mission — were seldom available at night.

“We have eight-hour shifts. If the doctor is on night duty, a nurse still has to manage the other shifts alone. Babies will not wait to be born at the hands of a doctor. There is acute shortage of doctors,” a doctor at the Tri Nagar maternity home in North Delhi said.

Sources said there’s no ambulance for emergencies, though the rules state that there should be one at each centre. And at Patparganj centre, which has an ambulance, the vehicle cannot be used as the driver has been on leave for a month.

There are instances, sources said, when nurses have to fetch water from outside for deliveries because of erratic supply and poor storage facilities. At Geeta Colony, Tri Nagar, Shakurpur Basti and Patparganj centres, there is no running water in the labour room.

Spokesperson for the city’s three municipalities, Yogendra Mann, said tender notices would be issued for generators and inverters at the these homes. “We discussed with the Delhi government ways to develop a system for making CATS ambulances available at these centres whenever necessary,” he said.

“We are getting doctors from NRHM and are in the process of recruiting more through UPSC,” he said.

SEPTIC CONDITIONS

Even without the basic facilities, these centres perform anywhere between 50 and 70 deliveries every month, government sources said.

Doctors said their hands were tied because of the lack of diagnostic equipment. Moreover, there is no operation theatre as, in accordance with the policy, they are supposed to perform only “routine deliveries”.

A doctor at the Patparganj home said: “At the slightest sign of complication, we are supposed to refer our patients to the nearest government hospital. I don’t know why we (doctors) are posted here when we don’t have any support system to help the patients.”

A gynaecologist of Hedgewar Hospital said: “We are already overburdened. Our gynaecology ward has a waiting list of three months for an ultrasound.”

That is not the only problem. A nurse posted at the Geeta Colony centre said: “Distance between (government) hospitals and our centre is a huge factor when the clock is ticking. There are instances of women delivering on the way to hospitals.”

Doctors at the Patparganj home said nurses conduct deliveries in “septic conditions” because no staff has been appointed to do the after-delivery cleaning.

“There is no water supply in the labour room. Shortage of sweepers means there is no one to do the cleaning,” a doctor said.

 

INDIA- Caste Disparities in Maternal Health #mustread


 

WRITTEN BY  AUGUST 3, 2012 , NIRMUKTA.COM 

In India, the Ministry of Health and Family Welfare (MOHFW) through its various programs and schemes such as the “Reproductive and Child Health” program pledges to provide essential and basic maternal healthcare services. This is largely due to the dismal status of health of women and children in our country. India’s neonatal, infant, under 5 [children], and maternal mortality rates are worst than what we see for South-East Asian countries around us. Maternal healthcare which is prescribed as essential includes: three antenatal care check-ups (ANC), two tetanus toxoid injections (TT), a hundred iron folic acids tablets (IFA), delivery with the assistance of a skilled birth attendant (SBA), and contraceptives for fertility control. The services are provided at various health centres in the community as well as door-to-door by healthcare professionals such as the Auxiliary Nurse Midwives (ANMs), Anganwadi Workers and Multipurpose Health Workers.

Mothers in Patna, Bihar gather outside a hospital gate awaiting compensation for women via the Janani Suraksha Yojna.

District Hospital,Patna, Bihar. Mothers gather to receive ~Rs. 500 through a new program ‘Janani Suraksha Yojna’ which compensates women for safe delivery (SBA). (Image by esaroha. License: Creative Commons BY-SA-3.0 http://creativecommons.org/licenses/by-sa/3.0/.)

Such programs have been around for more than half a century and their design and description makes us believe that they should be successful in at least ensuring the availability of these services if not checking the mortality rates. Unfortunately, this is not the case. Over the years, innumerable studies have shown that the services are under utilized (<30%) and women continue to underrate benefits of pregnancy care. Several reasons such as poverty, illiteracy, parity, religion, dysfunctional health system, etc., have been identified. At the same time, caste has been found by many researchers as another key determinant but surprisingly this factor is rarely examined in-depth. It is argued that caste and poverty are synonymous; implying that since most lower caste women are poor and poverty is a key determinant there is no need to brood over caste as a crucial and an independent determinant. The underlying premise vended here is that once everyone becomes rich, lower caste will also become rich and all problems will be resolved.

The above-stated utopian explanation is hard to accept and merits enquiry. In the late 1990s, a study in ~30 villages of Maitha block in Kanpur Dehat, Uttar Pradesh (UP) was conducted to see if maternal healthcare services utilization varied by caste in an extremely caste conscious society. Maitha block is a typical rural community in UP where poverty, ignorance, and a complicated caste hierarchy is the way of life. In most rural communities we see presence of various healthcare professionals; above-mentioned government healthcare providers, doctors, quacks, healers, Dai, etc. In Maitha also, all these healthcare providers are present but in terms of pregnancy care the complexity of providers is worth mentioning. It is interesting to note that other than the Dai who belongs to lower caste and assists with the delivery of the baby (massages the womb, holds the baby when the baby is coming out, bathes the baby after birth and gives the baby to the mother), there is also Dhankun who belongs to the lowest caste and her role is reserved for tasks considered to be dirtiest such as disposal of the placenta, cleaning of the vagina, cleaning of the blood soaked clothes and floor, and cutting of the umbilical cord. Access to this wide variety of providers depends on one’s caste and class status. Lowest caste women such as Dhankun cannot expect a Dai or upper caste nurse or doctor to come to her house and help her deliver the baby, dispose off the placenta, clean her and her baby, etc. Lower and lowest caste women settle for what is available at home or within their caste community, which is usually the unskilled providers. This study revealed that upper caste women were 5 times more likely to be attended by skilled/trained birth attendants (ANMs, doctors, and nurses) and Dai and Dhankuncompared to the lower caste women. The practice of untouchability and caste discrimination is starkly visible.

Other than the delivery care, this study also showed that ANC, TT, and contraceptives were also disproportionately utilized by upper caste women than the lower caste women. Interestingly, IFA were equally utilized by both upper and lower caste women. Again, it is inevitable to comment on the role of untouchability while examining these mixed findings. Sadly, the nature of service delivery explains the contrasting and complex mechanics. When a woman is provided ANC, TT, and contraceptives (copper-t, tubectomy/sterilization are the most preferred contraceptive choice in India whereas condoms, oral pills, etc., are used <5%) the provider [reluctantly] establishes physical contact, whereas, IFA tablets can be dispensed without any physical contact between two individuals.

These study findings are disheartening and disturbing. Here it is very pertinent to mention that the study took into consideration other socio-demographic (poverty, literacy, parity, etc.) factors in order to confirm that caste was indeed a significant independent determinant. It was found that other than caste only maternal literacy was another critical determinant but no matter which factors were added to the statistical model the caste factor continued to influence healthcare utilization in favour of the upper caste women.

Three women in rural India holding their babies(Image via Unicef)

It was difficult to come to terms with the stark reality of caste discrimination after 50+yrs of independence in our society through this study. Fellow researchers commented that this is not merely discrimination it is genocide. I disputed, I denied, I defended but lost the argument when it became evident to me how our society is discreetly executing mechanics to slowly but steadily efface certain people because they happen to belong to a caste group we despise but can not do without. The morbid health status will push them to mortal state… it’s just a matter of time. We all are party to this genocide some consciously and proactively other passively.

Health programs in our country do not address the issue of caste discrimination for the reasons best known to the MOHFW only, I presume. Healthcare providers are trained and educated in various streams like clinical skills, data management, counselling, etc., but no training or workshops are held to sensitize them towards eradication of caste discrimination or promotion of health equity. Such training requirements will not find a place in the annual health plans of the States unless researchers tirelessly demonstrate that caste discrimination persists and influence our health indicators. The study in Maitha revealed that 4 out of 5 critical healthcare services were disproportionally utilized across caste groups yet such evidence will be considered weak and rare. Like all other Ministries MOHFW is also crowded with upper caste bureaucrats who deny caste disparities and would be reluctant to allocate budgets for such sensitization programs. It is an uphill task indeed but unless policies are put in place not much can be achieved since lower caste women do not consider themselves worthy of maternal care, they do not demand healthcare from their family members let alone from the healthcare providers. In such a scenario it is imprudent to expect a wave of change to advance from a village(s) and emancipate all.

 

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