#India – Maternal Health Whistle Blower Arrested #Vaw #Womenrights


madhuri1

Published: Thursday, May 30,2013, , http://www.ibtl.in/
ByDr. Rita Pal

Madhuri Ramakrishnasway, a maternal health activist was arrested on the 16th May 2013 outside the court in Barwani, Madhya Pradesh [MP], India. The police had received a complaint from those in charge of a hospital currently under scrutiny for the alleged mismanagement and neglect of maternal health. The background of this complaint is as follows:- On the night of 11th November 2008, a very poor tribal woman from the village of Sukhpuri came to the Menimata Public Health Centre [PHC] during labour. She was admitted by those in charge who allegedly left her unmonitored all night. The hospital then demanded Rs 100, an amount she could not afford. She was asked to leave and the staff refused to arrange transport. Finally, the patient delivered her baby on the street with the help of the local “Dai” (Traditional Birth Attendant), only covered by a cloth held by her father in law. Having witnessed the event, Madhuri took the patient to another hospital to receive treatment. A protest was launched against the unacceptable incident that appears to have been one of many. This case was also part of the writ petition filed in the High Court of MP, Indore Bench in which the substandard state of maternal health services was raised – e.g. the 26 maternal deaths recorded in Barwani District Hospital in 2010 over 8 months were mentioned. The compounder of the hospital was suspended after repeated demands for action but was soon reinstated. It is notable that no one was subsequently held accountable for the dozens of avoidable maternal deaths that have taken place in Barwani. The picture is similar across the rest of the state. The finer points of the case are discussed in more detailed by an excellent Indian blogger and can be read here . “An investigation of maternal deaths following public protests in a tribal district of Madhya Pradesh” [Reproductive Health Matters] states

“We found an absence of antenatal care despite high levels of anaemia, absence of skilled birth attendants, failure to carry out emergency obstetric care in obvious cases of need, and referrals that never resulted in treatment. We present two case histories as examples. We took our findings to district and state health officials and called for proven means of preventing maternal deaths to be implemented. We question the policy of giving cash to pregnant women to deliver in poor quality facilities without first ensuring quality of care and strengthening the facilities to cope with the increased patient loads. We documented lack of accountability, discrimination against and negligence of poor women, particularly tribal women, and a close link between poverty and maternal death”

This whistleblower’s concerns were not without merit. She was subsequently witch hunted as the hospital in question filed a complaint against her, the patient and the patient’s husband. They received a court notice to appear at Barwani Court regarding this case on the 16th May 2013. Apparently, the police filed a closure report but sadly the court remained unsatisfied with this and the report was refused. Madhuri was arrested from the court and imprisoned in Khargone Women’s Jail. The petition completed by her supporters states

“Although the police had filed a Closure Report, it was refused since “clear reasons for closure had not been stated” and Madhuri did not opt for bail since the charges were clearly false[i]; one Section 148 actually refers to “rioting armed with deadly weapons”! She was sent to judicial custody until May 30th 2013”

It goes onto say

“We find unacceptable that the government targets those who work to protect the rights of the poorest Dalits and Adivasis who are suffering due to poor quality of health services; and we demand accountability from the erring officials who are indirectly responsible for thousands of women dying due to preventable pregnancy related causes”

Madhuri Ramakrishnasway is popularly known amongst the tribals of Barwani as “ Madhuri Ben” .She is a leader of Jagrit Adivasi Dalit Sangathan (JADS), a tribal and Dalit Rights Collective. Various advocacy groups under them often hold peaceful protests with a view to raising awareness of the substandard healthcare during pregnancy and labour. She has been involved in developing a grassroots movement demanding good care for rural maternal and child health in some of the remotest parts of the district. In support of Madhuri Ben’s concerns, it is notable that last year :

“The study, conducted on 819 deaths of a total of 1,065 probably maternal deaths reported in Madhya Pradesh between April 2011 and January 2012, suggests 132 women died on their way home or to a health facility” [Source – The Hindu ].

While recent news reports ran headlines about the sudden miraculous “improvement” in mortality rate in the state [ Times of India ], these reports conflicts with a presentation in the previous year on maternal death reviews in MP. Apurva Chaturvedi, State Consultant, National Rural Health Mission, and Archana Mishra, Deputy Director (NRHM), explained that 32 per cent of the reviewed deaths had occurred in district hospitals, 25 per cent in maternity centres, 13 per cent in sub-centres and 6 per cent in private facilities.

“Only 17.7 per cent of the expected maternal deaths are being reported and analysed while the remaining go unreported. Worse, in 37 per cent of the cases the cause of maternal deaths is registered as ‘other’,” they said.

The questionable statistics and the reasons for this was argued well by Sachin Jain. The government’s position isn’t convincing given the reports on the ground. It is therefore time for a legitimate investigation into the serious risk posed to vulnerable mothers in this state. The first task for the government is to cease harassing its whistleblowers who point out their spectacular failings. Then they should apply their minds more constructively to improving healthcare for patients at risk of neglect and death. They may also wish to improve their ability to collect statistics to avoid being embarrassed further. Click here to Sign the Petition

Author : Dr Rita Pal, Follow her twitter.com/dr_rita39

 

Needless hysterectomies on poor women rampant across India: Study #Vaw #womenrights


Malathy Iyer, TNN Feb 10, 2013, 01.12AM IST
(Oxfam said that unnecessary…)

MUMBAI: Is India witnessing a spurt in unnecessary hysterectomies? Data released by international charity organization Oxfam on February 6 says as much. The agency said that unnecessary hysterectomies were being performed in Indian private hospitals to economically exploit poor women as well as government-run insurance schemes.

A right to information ( RTI) request filed by one of Oxfam’s local NGOs in the Dausa district of Rajasthan showed that 258 of 285 women—65%—investigated over six months had undergone hysterectomies. Many of these women were under 30, with the youngest being 18 years old.

An editorial in the British Medical Journal quoted Oxfam’s global spokesperson Araddhya Mehtta as saying that the “trend is seen all over India but is particularly disturbing in Rajasthan, Bihar and Chattisgarh where doctors simply abuse their power of being a doctor”. In 2010, the Andhra Pradesh government tweaked its state-sponsored insurance scheme to disallow hysterectomies in private hospitals after surveys revealed that uteruses of a number of beneficiaries were removed merely to claim higher insurance amounts (the state insurance scheme is only available for the economically poor sections).

Dr Duru Shah, former president of FOGSI (Federation of Obstetric and Gynaecological Societies of India), said that modern medicines could fix 95% of woman’s menstrual problems without the need for surgery.

However, experts fear the trend of unnecessary hysterectomies possibly exists in urban centres such as Mumbai as well.

Indeed, an audit performed by insurance companies in Chennai in 2009 had shown that more than 500 women in the 25-35 age group had undergone hysterectomies. A Central government study in the wake of the Andhra Pradesh scam had said that women under 45 rarely needed hysterectomy.

A 2011 research paper in medical journal Reproductive Health Matters, conducted by SEWA Health Cooperative doctors in Ahmedabad, showed that insured women—both in urban and rural areas—had higher rates of hysterectomy. “Among insured women, 9.8% of rural women and 5.3% of urban women had had a hysterectomy, compared to 7.2% and 4.0%, respectively, of uninsured women,” said the study.

The OXFAM report, in fact, says that India should end its public-private partnership programmes (that allow poor women with government insurance plan to undergo a hysterectomy in private hospitals) until better regulation is in place.

Oxfam official Mehtta has been quoted as saying, “When women came with abdomen pain, doctors prescribed hysterectomy to women from poor economic backgrounds, telling them that it might be a cancer or a hole or a stone in the uterus without doing any thorough necessary investigations.”
Dr Duru Shah said that unnecessary hysterectomies affected the concerned woman’s health. “A young woman who has undergone hysterectomy may suffer early menopause (stoppage of periods) and the accompanying health problems of increased risk of cardiac diseases and fractures due to brittle bones,” she said.

Dr Rekha Daver who heads the gynaecology of J J Hospital, Byculla, said, “Generally speaking, there may be a marginal increase over the years. But this may only be because women from rural areas who travel to referral centres in cities don’t want to prolong their suffering.” She said it wasn’t feasible for these women to return to cities a second time for any treatment that may be required.

Incidentally, Maharashtra doesn’t allow hysterectomies in private hospitals under the insurance scheme launched last year for the economically weaker sections, called the Rajiv GandhiJeevandayee Arogya Scheme. “We have learnt from the Andhra Pradesh experience,” said Dr K Venkatesam, CEO of the arogya scheme.

However, not all agree that hysterectomies are on the rise. Gynecologist Dr Rakesh Sinha from Mumbai said, “It would be wrong to say there is an epidemic of hysterectomies in Mumbai or India. What has changed over the past few years is that we have facilities such as USG to make early and accurate diagnosis. Moreover, there are procedures available that allow women to go home within a day or two.”

 

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