In Santhali villages in Godda, along Jharkhand’s border with Bihar, many slanting stone megaliths that mark the community graves are those of young women who died in childbirth in recent years. Tribal families in the hamlets scattered in Sundarpahari and Poreyhat – many of whom speak only Santahli - recount desperate struggles for medical help when young women in their families in advanced stages of pregnancy experienced complications.

At Paharpur village in Sundarpahari, Gopin Soren spoke haltingly as rain fell over the hut where his 19-year old daughter Sadbeeti, pregnant for the first time, died last year. “On Thursday we went to my son in law’s home in Borhwa, everything was fine. The next morning my wife and I got a message that my daughter had fainted. We reached and called a local medical practitioner. He tried to give her a saline drip but he just could not find her vein,” he recounted. At 5 pm he, Sadbeeti’s husband, and two relatives carried Sadbeeti six km on a cot to Paharpur.

Back in their village Gopin asked the village sahiya (health worker) Phool Marandi for help to reach the health sub-center at Sundarpahari 20 km away. The sahiya called the call-center to request a Mamta Vahan – a free of cost ambulance service for rural women through privately-owned vehicles started in Jharkhand in 2011. By now Sadbeeti was having convulsions, a condition called eclampsia. “I decided to call the vehicle owner Pintu directly. I called him thrice between 7 and 9 pm. He said he is out right now. I understood that he does not want to come. The villagers had attacked a person caught stealing the electricity transformer in the village a day earlier. Maybe he feared that there will be more violence,” she said. At 2 am, Sadbeeti died eight months and two weeks pregnant.

Twenty km away in Ghanghrabandh village in Poreyhat, Denmey Murmu described she had watched her only daughter Talabiti Marandi, 22, die after giving birth. “Eight hours after she gave birth she started clenching her fists and she said she had a burning sensation. Sarojini the sahiya refused to call a vehicle so we hired a private vehicle for Rs 1,300 after mortgaging my jewellery for Rs 2,000,” she said. On January 19, Talabiti Marandi a graduate from Mahila College, Godda died on her way to Godda government hospital.

Most Santhali and Pahariya families here survive on a diet of rice and potatoes. Pregnant women are meant to get Iron and Folic Acid (IFA) supplements tablets - each costs 20 paise - after their second trimester but Jharkhand government stopped distributing these for two years after the central government discontinued providing the tablets between 2010-12.

“Many women have severe iron deficiencies and are at high risk because after the delivery their blood does not clot, the uterus does not contract and the woman may die of post-partum bleeding. Government has schemes to provide four ante-natal check-ups so complications can be prevented. For instance, eclampsia is common among women in later stages of pregnancy and manifests as high blood pressure. If doctors detect this early, they can put the woman on hypertension medicine till the foetus is removed through a caesarean section,” said Lindsay Barnes of Jan Chetna Manch who has worked among rural women in Bokaro villages since 1993.

Godda hospital that caters to the district’s population of 13 lakh has 40 beds and two ambulances. It started providing facilities for a caesarean section only last year. It was supposed to get a blood bank in 2000 but the space marked for this is being used as National Polio Surveillance Project office and doctors’ restrooms. In case of complications, patients are referred to the government medical college in Bhagalpur in Bihar, 70 km away. Godda should have a Mamta Vahan in each of its 201 panchayats but only 111 vehicles have been hired right now as officials say they could not find vehicle owners in all panchayats.

“Since this year we have tried to increase institutional deliveries. I have received no written complaints about Mamta Vahan or any of our hospital staff,” said Godda civil surgeon Dr PK Ram.

Earlier, a government enquiry was done in 2011 after 25-year old Mary Hasda in Tetaria village had reported that staff at the district hospital left a cloth inside her birth canal after she delivered a stillborn baby. She had reported that the hospital staff asked for Rs 500 bribe after she gave birth to the stillborn baby.

“The enquiry team interrogated the family – which spoke only Santhali - as if they had done a crime. In April, another five member team came on a one day-visit after a PIL by All India Progressive Women’s Association but they did not meet all the families or hold any officer accountable,” said Soumik Banerjee, a researcher who documented 23 maternal deaths of women 18-23 years of age in the two blocks between April 2011 and March 2012 – an average of nearly two deaths a month. Nine families had reported spending Rs 4917 on an average on transport, bribes, and on buying medicines.

Jharkhand has a maternal mortality ratio (MMR) of 278 deaths per 100,000 live births, much worse than the national average of 217. Godda along with Palamu have a MMR of 318.

“Only 46 percent of all deliveries occur at sub-centers in villages and that puts women at risk,” said Director National Rural Health Mission in Ranchi Dr Praveen Chandra. NRHM has a budget of Rs 716 crore this year. “We need to have 7,044 health sub centres but have only 3,958 and of these, only 940 are ‘Level 1’ i.e. more than three deliveries occur there every month. We have the funds but lack infrastructure, ambulances, and staff,” he said.