New United Nations global maternal mortality estimates contradict the Indian government's claim that it is “on track” to meeting U.N. goals for reducing maternal mortality, according to Human Rights Watch.
“The Indian government should stop playing number games with women's lives,” said Aruna Kashyap, Asia women's rights researcher at Human Rights Watch, in a press statement. “The Indian government is dangerously misleading the public, and itself, about the nature of progress on maternal health.”
An assessment by the World Health Organisation and other U.N. agencies found that even though India is “making progress” in declining maternal mortality, it is not “on track” to meeting its goal under the U.N. Millennium Development Goals. The 2008 figures, the latest global estimates, were released in advance of the U.N. Summit on Millennium Development Goals on September 20, 2010, at the U.N.
A large figure
The U.N. agencies also found that maternal deaths in India, along with countries like Afghanistan, Bangladesh, the Democratic Republic of Congo, Ethiopia, Indonesia, Kenya, Nigeria, Pakistan, Sudan, and Tanzania together accounted for 65 per cent of all global maternal deaths in 2008.
In May, the Indian government contested the report of the U.N. special rapporteur on health, and disputed his contention that India would fail to meet its U.N. goal for reducing maternal mortality. “Going by the rate of decline in the past and comprehensive efforts being made across the country, it appears that India is on the right track with regard to MDG-5,” the government said at that time.
The Indian government continues to focus on the number of women who give birth in a health facility, known as ‘institutional deliveries,' as a measure of progress on maternal health. But this approach gives an erroneous picture about progress on maternal health, Human Rights Watch said. The Indian government stated that maternal health in the country had considerably improved because 10 million women had given birth in health facilities in 2009 and into 2010. Under its flagship National Rural Health Mission and Janani Suraksha Yojana (JSY), or safe motherhood scheme, the Indian government uses cash incentives to encourage women to give birth in health facilities. The government does not, however, measure the number of women who survive the delivery and the post delivery period, a much more accurate measure of success.
For many women, the tragedy of maternal mortality and morbidity continues. Repeated health system failures – poor transport, referral mechanisms, emergency obstetric care, and continued care in the post-partum period – hamper delivery of care to pregnant women, Human Rights Watch said. The death of a woman in the streets of New Delhi in July is a case in point, the statement pointed out. News reports said that she had given birth unattended on the pavement, lay there with no assistance for four days in dirty rain water, and then died.
In a report in October 2009, Human Rights Watch detailed why using the number of institutional deliveries as a measure of progress on maternal health is misleading. Many women told Human Rights Watch that health workers were asking them to say they delivered in a health facility to receive the cash incentive, promising to split the money. In reality, the women had delivered at home. Due to poor access to emergency transport, many women died on their way to a health facility. This is not reflected in the figures, and little has been done to improve emergency transportation.
Lack of facilities
Most hospitals that Human Rights Watch visited were able to conduct only normal deliveries. Even health facilities-designated comprehensive emergency obstetric care centres did not have emergency obstetric facilities.
Women were routinely referred from one hospital to another, until they reached a far-flung medical college hospital for care, assuming they were able to reach such a hospital in time. Further, many poor women had to spend considerable amounts of money to reach a health facility and secure care.