Saturday, April 11, 2015

Gujarat NGO workshop doubts govt claims on reduced maternal mortality rate

By Our Representative
A recent workshop held under the aegis of the Jan Swasthya Abhiyan, Gujarat, at Vadodadra has doubted the Gujarat government’s loud claim that the state has registered 23.75 per cent decline in maternal mortality rate (MMR) between 2004-06 and 2010-12, from 160 per 100,000 to 122 per 100,000.
Quoting a study conducted jointly by local NGOs working on maternal health (Sewa Rural, Chetna, Sahaj and Anandi), the workshop was told that “out of 46 maternal deaths that were documented and analysed (from 15 blocks of 11 districts), an alarming 28 deaths occurred during the post natal period.”
The study said, an analysis of the 28 post-natal deaths suggests that eight deaths “occurred within 24 hours, three within a week of the delivery and the rest (17) between eight to 42 days of delivery.” It added, “Out of the 46 maternal deaths, the highest number of deaths (26.08%) were directly attributed to haemorrhage during antepartum, intrapartum and postpartum period.”
Even if one relies on official figures, the workshop was told, the state has far to go to achieve the millennium development goals (MDGs) of the United Nations – MMR of 109 per 100,000 by 2015. Only three states of India have so far achieved MDG — Kerala with an MMR of 66, Tamil Nadu with an MMR of 90, and Maharashtra with an MMR of 87.
Participated by representatives from 20 civil society organizations, experts and government officials, the workshop was offered specific instances of how maternal health remains a neglected area in Gujarat. Names were changed in order to hide the identity.
The first instance was of Jyoti from Anand district, who was pregnant for the second time and was severely anaemic. She was given iron supplements by a rural health Asha worker. But she would not consume them. In her ninth month, she was admitted in a government hospital as she was suffering from cold, cough and very low haemoglobin. She was given four bottles of blood in two days and discharged.
A few days later, Jyoti complained of labour pain. Due to lack of blood facility in the government hospital, she was admitted in a private hospital, where she delivered a baby boy. However, she was severely anaemic, and the family could not pay for the blood. Her family requested for discharge from the hospital the next day. Four days later, the woman complained of breathing problems and died.
Another instance was of Gangaben from Dahod district. She went to a private practitioner during her ninth month of pregnancy with breathlessness and giddiness. She was given medicines and not treated for any other complications. When she approached a private doctor a few days later, she was diagnosed to have an intrauterine foetal death and was referred to the Civil Hospital.
Since there was no doctor, her family took her to two different private hospitals before she was admitted in one, where she delivered a stillborn baby, was discharged and sent home. No health worker visited her to check on her. She developed bleeding on the fifth day and died while being carried in an ambulance.
Third was the case of Urmila, a tribal migrant from Panchmahals district. She was pregnant with her fourth baby and suffering from breathlessness during the ninth month and visited a primary health centre (PHC), from where she was referred to the taluka hospital, and further to the district hospital. The doctor there recommended her to a private hospital where he would be unavailable at night.
However, Urmila’s family returned home since it could not afford expenses in the private hospital. After a few days, when the family managed to arrange for some money, they visited a private hospital in another town, from where she was referred to a medical college. The doctor in the medical college there referred her to a private hospital. Tired, the family decided to go back home. Urmila died the same night.
The workshop was told that while the Gujarat government claims emergency services at doorsteps in every nook and corner of the state, these instances show that “this is a far cry.” It wondered, “How and when will the health department ensure the availability of blood at short notice without making it a patient’s responsibility?”
Participants complained of a severe lack of “any form of post-natal care after childbirth”. There was, in fact, only “some notional effort” to provide ante-natal care, while post-partum care seemed completely absent almost everywhere.
The workshop heard views on healthcare system in Gujarat by senior economist Prof Indira Hirway, budget analyst Mahendra Jethmalani, and activists Renu Khanna (Sahaj), Neeta Hardikar(Anandi) and Jagdish Patel (People’s Training Research Centre). Dr Diviesh Patel from the state health and family welfare department was also present.

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