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Weight gain during pregnancy in rural India 7 kg as against 13-18 kg norm: Survey

By Our Representative
About half of rural women in India eat less than usual during pregnancy, leading to very small weight gain, on an average just about seven kg in the six states surveyed, compared with a norm of 13-18 kg for women with low body mass index (BMI). The worst is Uttar Pradesh, where the weight gain was found to be just four kg, says the Jaccha-Baccha (Mother-Child) Survey 2019, released in Delhi on Monday.
Conducted in June 2019 in six states, Chhattisgarh, Himachal Pradesh, Jharkhand, Madhya Pradesh, Odisha and Uttar Pradesh, in 10 to 12 randomly-selected anganwadis spread over two blocks in one district in each state, in all 342 pregnant and 364 nursing women (those who delivered a baby during the six months preceding the survey) the report finds that women are “shockingly vulnerable”.
Thus, while 26% women were unable to read or write, their average age at marriage was 19 years, just about 61% households had a toilet, 49% were found to be eating less during pregnancy, 22% women would eat were eating nutritious food every day during pregnancy, 30% women felt they did not get enough rest during pregnancy, 34% women said they faced problems during pregnancy due to lack of money, and 30% households borrowed or sold assets to meet delivery expenses.
Coordinated by well-known development economists Jean Drèze, Reetika Khera and Anmol Somanchi, the survey report said, “Little attention was paid to the special needs of pregnancy – good food, extra rest and health care.” Worse, it added, “Often, family members or even women themselves had little awareness of these special needs.”
“For instance”, the report said, “48% of pregnant women and 39% of nursing women in UP had no idea whether or not they had gained weight during pregnancy. Similarly, there was little awareness of the need for extra rest during and after pregnancy.”
The report stated, “The main reason for not eating more is that many pregnant women feel unwell or lose appetite. The proportion of nursing women who reported eating nutritious food (e.g. eggs, fish, milk) ‘regularly’ during pregnancy was less than half in the sample as a whole, and just 12% in UP.” The result was, “Some women were so light to start with that they weighed less than 40 kg at the end of their pregnancy”.
Calling rest an “unmet need of pregnant women”, the report said, “Almost all the respondents had done household work regularly during their last pregnancy. A significant minority (21%) of nursing women said that no-one (not even a grown-up child) was available to help them with household work during pregnancy. Almost two thirds (63%) said that they had been working right until the day of delivery.”
It continued, “Due to lack of food and rest, most of the respondents had felt tired or exhausted during pregnancy. As many as 49% reported at least one symptom of weakness, such as swelling of feet (41%), impairment of daylight vision (17%) or convulsions (9%).”
Pointing out that “pregnant and nursing women are acutely deprived of quality health care”, the report said, “Many of them receive some basic services (e.g. tetanus injections and iron tablets) at the local anganwadi or health centre, but they get very little beyond the basics. Small ailments easily become a major burden, in terms of pain or expenses or both.” As a result, “at the time of delivery, women are often sent to private hospitals.”
Asserting that “institutional deliveries are supposed to be available free of cost to all women in public health centres”, the report regretted, “In practice, we found that nursing women had spent close to Rs 6,500, on average, on their last delivery. This amounts to more than a month’s wages for a casual labourer, in the survey areas.”
Pointing out that under the National Food Security Act 2013 (NFSA), all pregnant women are entitled to maternity benefits of Rs 6,000, unless they already receive benefits as formal-sector employees, something that the Government of India “ignored this for more than three years, before launching the Pradhan Mantri Matru Vandana Yojana (PMMVY) in 2017”, the report said, “In flagrant violation of the Act, PMMVY restricts benefits to one child per woman – the first living child.”
Institutional deliveries are supposed to be available free of cost. In practice, women spent close to Rs 6,500,  more than a month’s wage of a casual labourer
Additionally, the report said, “Benefits have been arbitrarily reduced from Rs 6,000 to Rs 5,000 per child. Even these meagre benefits are elusive. Among nursing women eligible for PMMVY, only 39% had received the first instalment. The government’s own data show that PMMVY covers less than one fourth of all births as things stand.”
Even to receive this benefit, which is given in three installments, the report complains, the applicants must fill up a long, cumbersome form ahead of each instalment, it said. Worse, “They also have to produce their ‘mother-child protection card, Aadhaar card, husband’s Aadhaar card, and bank passbook, aside from linking their bank account with Aadhaar.”

“Further, they depend on the goodwill of the Anganwadi worker and CDPO to ensure that the application is filed on-line. This entire process is challenging, especially for women with little education”, the report said, adding, “On-line applications are often rejected, delayed, or returned with error messages for a series of reasons that are familiar from studies of Aadhaar-enabled payments of welfare benefits in other contexts (e.g. pensions and NREGA).”
Quoting anganwadi workers (AWWs), who take care of application formalities on behalf of the women, the report said, “One third of AWWs reported general Aadhaar-related issues, and 15% reported bank-related issues.” Young women in their sasural, either carrying a baby or nursing an infant, who are in need of rest, “they are constrained to spend time and money on fixing errors that have crept in for no fault of their own – with no guarantee that the issues will be resolved.”
The report said, “Some women had to pay anything between Rs 50-200 to enrol for Aadhaar. When Sushman Devi (from Sonebhadhra, UP) was trying to make corrections in her Aadhaar records, local officials kept delaying the matter. Ultimately she had to borrow money to go to the Block headquarters to get the corrections made. She borrowed Rs 2,000 from her sister to get corrections made to her and her husband’s Aadhaar card.”
PMMVY benefits (except in Odisha) require identification documents of the husband, the report noted, adding, “There were cases where women had not been able to apply, or the application had been delayed, because of failure to produce the husband’s Aadhaar card. Some husbands did not have Aadhaar cards, some women were living with men to whom they were not married, or were single mothers.”
Further: “There were several cases where applications had been delayed or stalled because Aadhaar cards with the father’s name or address were not accepted.” Thus, “Pooja is from Uttar Pradesh and married to someone in Surguja, but she had no way of providing a proof of address for her new address. The Aadhaar enrolment centre advised her to get a certificate from the sarpanch. It was rejected.”
Revealing that “demographic data glitches (e.g. typos in Aadhaar number, misspelling of names, wrong date of birth on Aadhaar, mismatch between Aadhaar card and other records, etc.)” also lead to the PMMVY application getting rejected or delayed”, the report cited several instances in this report.
Thus, “In Odisha, Rani Gope had to get multiple corrections made to her date of birth; Hulari Munda has three IDs each of which shows a different date of birth. Marcilin Munda’s Aadhaar card overstates her age by 10 years (1980 instead of 1990).” All these errors “crept in for no fault of the women who were applying for PMMVY, but they are paying the price for it.”

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