The World Health Organization (WHO) estimates that of 536,000 maternal deaths occurring across the globe each year, 136,000 (20%) occur in India. Estimates from the global burden of disease for 1990 also show that India contributed 25% to disability-adjusted life-years lost due to maternal conditions alone. The nation of India has a population of over a billion and had an estimated maternal mortality rate (MMR) of 301 maternal deaths per 100,000 live births in 2003. The MMRs vary across the states of India, with the poorer North Indian states contributing a disproportionately-large proportion of maternal deaths. The geographical vastness and sociocultural diversity across India contribute to this variation. As the status of women is generally considered low in India, female literacy is only 54%, and women lack the empowerment from their male counterparts to make decisions, including the decision to use reproductive health services.
Unfortunately, there is little evidence that maternity has become significantly safer in India over the last 20 years despite the safe motherhood policies and initiatives at the national level, such as the government of India’s Ministry of Health and Family Welfare’s (MOHFW) National Rural Health Mission (NRHM). The geographical vastness and sociocultural diversity of the nation means that maternal mortality varies across the states, and uniform implementation of health-sector reforms to achieve India's goal to lower maternal mortality to less than 100 per 100,000 live births, is still very far away.
In a study performed by the National Family Health Survey (NFHS), they found that the educational and economic status of women influences the use of maternal care. Illiterate mothers and mothers from low economic status used basic maternal healthcare much less than their literate or wealthier counterparts and were far less likely to see a doctor. Only 18% of 39,677 illiterate mothers had institutional deliveries compared to 86% of 39,677 mothers with 12 or more years of education; Similar differences were found in the use of skilled care at delivery and use of postnatal care; only 19% of mothers of the lowest socioeconomic status received postnatal care compared to 79% of mothers of the highest socioeconomic status.
A possible cost-effective strategy to overcome these maternal health concerns could be through the form of financial incentives. In a report done by BMC Public Health in 2015, financial incentives were stated as one of the most effective forms of intervention to improve the state of maternal and reproductive health services. One of the most effective possibilities is a method known as conditional cash transfers, or a financial incentive program that provides monetary support to impoverished women (and their families) who agree to certain requirements such as attending perinatal or postnatal health monitoring, family planning, or nutrition programs. With a small payment from the local government or donor funding, women would not only gain earnings to help support their families but they would improve their overall health and support the local economy. Similar conditional finance programs have successfully been implemented in Mexico, Nicaragua, and Columbia.
Great information on maternal health. The disparity in childbirth around the world is devastating, especially when access is the primary barrier (and access conflates with cost, too).
ReplyDeleteAnother issue in maternal health globally is VVF (Vesicovaginal fistulas), although this gets much less attention. VVF is often caused by obstructed or prolonged labor, resulting in near-constant leakage from an abnormal opening between the vagina and urethra. Significantly exacerbated by malnourishment and early childbearing, VVF remains common in subsaharan Africa and areas of Asia, affecting roughly 2 million women worldwide, with 50-100k new cases a year.
The incredibly frustrating part of the disparity surrounding VVF -- the history. From 1845-1849, Dr. J. Marion Sims held and experimented on up to twelve enslaved women on his personal property in Alabama before discovering a cure. Only three of his victims are known by name, recorded only in his (pompous) journals -- Anarcha, Betsey, and Lucy (though, his assistant noted the names of the other women, though the accuracy is debated). Anarcha was operated on 30 times during the four year period. Upon discovering a cure, Sims left his plantation and traveled to Europe to teach other doctors and cure aristocratic (wealthy, white) women.
The racial disparities in healthcare, especially maternal health care, represent some of the gravest human rights violations.
https://www.who.int/news-room/facts-in-pictures/detail/10-facts-on-obstetric-fistula
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ReplyDeleteThis issue is very real in India Sarah, thank you for bringing this out. It reminded me of my visit to Rupaidiha this summer, a small village between the India and Nepal border. During my stay at the school campus, I came across two women, who gave birth in the washrooms of the school, by themselves, without informing anyone. To me, this sounded unimaginable. When asked why did they choose to do this, they mentioned that the border closes post 10, and when labour started, they knew they would not make to hospital in time. While they carried beautiful babies in their arms, my mind wandered to the repercussion of such steps, if things would have gone wrong.
ReplyDeleteIndia has a lot of challenges when it comes to implementing maternal benefit plan. In 2018, Jean Drez, one of the most renowned development economist in India, criticized the current financial incentive policies for being attached to biometric identification and limited to only one child per women. Most women in India, coming from rural backgrounds do not have identity cards, and biometrics already done, as due to the high population these aspects are not fully monitored. For such women, (which is maximum of them) these polices are not feasible.
Though India has shown reforms in it's current conditional cash transfer programs, these reforms have not been mindful of the basic needs of women. It has also not taken into account the intersectional issues that women face due to malnourishment and underlying ailments. The program is not inclusive of these issues, and therefore separate policies must be made to take into account the various underlying issues for maternal health in India. One of the top priorities in this would be the improvement of the public health care system. While public healthcare is provided at subsidized rates, it does not take into account the basic practical needs of the women. The basic practical need of a woman includes safe child birth, room availability and food. Many of the public healthcare facilities are unable to cater to all these needs, leading to miscarriages and death of the child due to infections.
The biggest criticism of the current maternal benefit policy is that it is available only to women who are 19 years of age or above. This leaves out the young adults and teenagers who might have unwanted pregnancies.
Klonner, Stefan.(2021) “Evaluating India’s maternal cash transfer programmes” https://www.ideasforindia.in/topics/human-development/evaluating-india-s-maternal-cash-transfer-programmes.html
Sarah,
ReplyDeleteGreat post! I am shocked. I did not realize India was struggling so badly with maternal issues. It was also interesting to see that the numbers haven't changed much in the previous years. I wonder what can be done so India reaches their goal. Is it up to world leaders to step in and help to try and lower the death statistics? What can be done to make sure India reaches it's goal of 100 out of 100,000? Very interesting to think about!
Wauren