India is falling behind other countries in meeting international commitments to improve obstetric care because it does not adequately monitor deaths and injuries in the critical period following childbirth and fix gaps in its health system and programmes, says the Human Rights Watch.

Public health experts say the key to progress in maternal health is ensuring that women with pregnancy-related complications get appropriate care during childbirth. However, this is not happening in India, even though it has started health care programmes that guarantee free obstetric care to rural women, says the international non-governmental organisation.

“India should be a leader in protecting and monitoring women’s sexual and reproductive health,” said Aruna Kashyap, researcher for the Women’s Rights Division of the Human Rights Watch.

“Yet women continue to die of entirely preventable deaths, and health authorities do not track down the reasons or do what is needed to rectify the health system.”

“Under-resourced”

The government counts the number of births in health clinics and hospitals, but these are often woefully under-resourced and under-staffed. Many women die or suffer serious injury after giving birth under these circumstances.

The government does not monitor what happens to women after delivery, especially in the 24-72 critical hours after childbirth, when the chances of their death are the highest. Without this information, it cannot save women who go back home and die or develop long-lasting complications, the report points out.

“Change monitoring approach”

The government should change its approach to monitoring and examine whether women with pregnancy-related complications are in fact getting the treatment they need and whether they survive in the postpartum period.

The government’s new Health Management Information System includes some of this data for monitoring, but it remains to be seen whether this data will be consistently collected and utilised for maternal health care programming at the district and State levels.

In the “Call to Urgent Action for Maternal Health,” issued after the October 26 meeting in Addis Ababa, Ethiopia, where experts met to review maternal health care, members of parliaments and civil society representatives from across the world reaffirmed their commitment to the goals set out in the landmark 1994 International Conference on Population and Development.

Key goals include providing universal access to sexual and reproductive health care to all women, reducing preventable deaths from childbirth and unsafe abortions, monitoring implementation, and reporting on progress, both locally and globally. India reaffirmed its commitment to these goals at the meeting.

Little systemic information

The Indian government promotes institutional delivery, using cash incentives to poor women, with the goal of providing access to skilled care. But there is little systemic information on whether rural clinics and district hospitals are able to provide adequate and timely care to save women with pregnancy-related complications, says the report.

The government treats the huge increase in clinic-based deliveries as progress — 20 million women gave birth in health facilities across India between mid-2005 and March 2009. However, there is no reliable information on what percentage of these women actually survived after childbirth or suffered complications after being discharged.

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