NEW DELHI: Less than 10 per cent of childbirths are institutional deliveries in the tribal districts of West Singhbhum (Jharkhand), the Dangs (Gujarat) and Koraput (Orissa), while it is 84 per cent is Tiruvallur (Tamil Nadu).

These striking disparities have come up in a recently released baseline survey on the ``Well-being of Children and Women'' conducted by the National Sample Survey Organisation and the United Nations Children's Fund (UNICEF).

Survey in 43 districts

The survey, conducted in 43 districts between March and May 2005, stresses the need for focussing on maternal health in the country, where nearly 1,30,000 women die annually from pregnancy and childbirth-related complications. Almost all these deaths are preventable.

Despite high budgets in the Reproductive Child Health programme-II of the Union Health and Family Welfare Ministry, the maternal mortality rate (MMR) continues to be unacceptably high and has shown no sign of reduction in the past one decade.

Every five minutes a woman dies of pregnancy-related causes. It is estimated that for each woman who dies, 30 others develop chronic, debilitating conditions that seriously affect the quality of life. For every 1,00,000 live births in India, 407 mothers die — a number four times higher than the National Population Policy (NPP) 2010 goal of restricting the incidence to 100.

While there are a number of reasons for the high MMR including early marriage and childbirth, lack of adequate health care facilities, inadequate nutrition and absence of skilled personnel, the problem is also caused by posts of doctor and trained health worker remaining vacant at the village and block levels. According to the 11th Plan approach paper, across States six to 30 per cent of the posts of doctor remain vacant and random checks show that from 29 to 67 per cent doctors are absent.

The lack of emergency referral transport is a major impediment to reduction of maternal mortality. A majority of women have very poor access to appropriate emergency obstetrics care, what with the distance of health facilities with trained medical personnel.

Under the National Rural Health Mission, ASHAs (accredited social health activists) are being seen as a vital link to government programmes on reducing maternal mortality. They will address the health needs of rural population particularly among the vulnerable sections and guide women to access the facilities for ante-natal care, institutional delivery, post-natal care and counselling on nutrition and family planning services, point out Health and Family Welfare Ministry officials.

However, lack of empowerment of women, gender inequalities and discrimination limit their choices and contribute directly to their ill health and death. Even the best infrastructure and facilities will be of no use unless women are aware of and have access to them.

More than good quality health services, what are required are empowerment of women and a guarantee of their human rights, right to life, liberty and security to have access to appropriate health care, and the right to survive childbirth, according to the UNICEF.

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