Even as the recent neonatal deaths caused outrage over the state of the public health delivery system, the central issue of women’s reproductive rights have been consigned to the margins.
While neonatal mortality is a reality to be reckoned with, an analysis of the figures for recent years shows a sense of alarmism is not yet warranted.
The neonatal mortality in Dharmapuri district between 2006 and 2010 was 3,353, with an annual average of 671 and a monthly average of 56, according to the government data. However, the number of deaths have fallen since 2011. There were 1,834 neonatal deaths, with an annual average of 512 and a monthly average of 42 in the past three-and-a-half years, showing how neonatal intensive care units have helped to bring down the hospital neonatal mortality.
The neonatal mortality rate of a hospital is not an indicator of its performance but that of the region it caters for, says a health official. Hence, to link the figures to those of a district headquarters hospital is a “spurious correlation,” he reasons.
Logically, the figures should also be seen as an indicator of the status of the women of the region. It is here that other correlates such as low sex ratio, child marriages, multiple pregnancies and lack of reproductive rights have come under the spotlight after the latest neonatal deaths, say women health experts and women rights activists.
The fall in Dharmapuri district’s sex ratio in the past three years is a case in point. In 2011, the sex ratio at birth was 927, but it fell to 861 in 2012 and 873 in 2013. A society that has no place for female foetuses is also the one that holds its woman at the lowest rung, the activists point out.
Women’s reproductive rights have remained peripheral in the grassroots public health framework. Interventions have failed to take men on board. “The man who wants the male heir is also the one who refuses contraception and forces his wife into multiple pregnancies,” they contend. The onus of reproductive/sterilisation awareness is thus targeted at women.
“Nineteen years may be an age for marriage, but is that an age for motherhood,” asks an anganwadi coordinator. But to speak of that is a taboo in her village setting. The lone village health nurse of a primary health sub-centre is responsible for health care delivery to a population of 5,000-7,000. For her, it is impossible to engage with a man on sterilisation or his wife’s reproductive health, the coordinator points out.
Patriarchal biasA study of some young mothers who lost their newborns recently shows “an innate desire for a son.” It may be possible that the malnourished woman, bearing her third or fourth child desiring a son, was also a woman who did not exercise that choice of ‘female infanticide,’ a hushed reality here, as the child sex ratio figures reveal.
“It is time public health interventions went past the welfare discourse and pitched a tone of emancipation that foregrounds women as agents and not as subjects,” the women activists say.
