Women in rural India continue to die because of indifference and neglect by healthcare authorities...

This is a public health warning. Do not express concern for the state of healthcare in this country. Do not express anger that women die because they are either denied care or help is delayed when they have complicated pregnancies. Do not demand that healthcare is an entitlement that the poor have a right to demand and that the government must deliver.

Chances are if you are too vocal about an issue like this, and if you happen to be working in an adivasis-dominated district anywhere in India, the district administration will hint that you have Maoist tendencies. And that alone is enough to land you in jail and even, as in the case of Dr. Binayak Sen who has spent a lifetime working as a doctor for the poorest, get you a life sentence for sedition under an antiquated law.

This is no exaggeration. On December 28, 2010, more than 500 adivasis demonstrated peacefully in front of the district hospital in Barwani, Madhya Pradesh. They were not demanding wages or forest rights. They were protesting the death of a 22-year-old pregnant adivasi woman, Vypari Bai, caused by callousness and negligence of the medical authorities.

Vypari Bai's story is not unusual. It is enacted hundreds of times in the poorer parts of this country. On November 27, Vypari Bai, who was eight months pregnant, developed high blood pressure and eclampsia, a life-threatening condition of pregnancy. She needed urgent medical help. From her village of Ban, her relatives carried her in a cloth sling for 10 km to the nearest Primary Health Centre at Bokarta. There she was told that the place was not equipped to deal with her condition. So she was sent to the Community Health Centre at Pati by ambulance. There again there was no help and the family was told to take her to the district hospital in Barwani.

Made to run around

The story did not end there. In Barwani, at the time of admission her blood pressure was high. The normal procedure in such situations is to try and normalise the blood pressure and induce labour. Although she was given some medication for the BP, nothing was done to induce labour. Instead, her relatives were asked to take her to a private hospital for an ultrasound in an auto rickshaw even though the facility existed in the hospital. The ultrasound confirmed that the foetus was still alive.

Yet, despite her relatives pleading for help, no doctor was ready to attend to Vypari Bai. Instead, they were advised to take her to Indore, 150 km away. For refusing to do so, they were asked to sign a statement that they took full responsibility for the consequences. By this stage, it would have required a miracle for this young woman to survive. She did not. On November 29, in the early hours of the morning, she died.

Her death has enraged the adivasis in Barwani district who have seen too much of this kind of callous neglect. A survey of maternal deaths in the district hospital from April to November 2010 revealed that there were 25 maternal deaths during this period, nine just in November.

A year earlier, in 2008, in a similar incident, a pregnant woman was turned away from the Primary Health Centre in Menimata in Barwani district when she had already begun labour because she would not pay. She was entitled to free treatment. As a result, she delivered her child literally on the road, outside the hospital. Those who expressed their disgust at this were charged by the district administration under various sections of the Indian Penal Code.

On December 28, the district administration once again slapped charges against some of those who demonstrated peacefully in front of the hospital and arrested Bachhiya Bhai on charges framed against him in 2008. He was finally released on bail after eight days. But the charges against him, under Section 146 IPC (unlawful assembly, rioting, armed with deadly weapon which when used is likely to cause death) and Section 186 IPC (obstructing public servant from discharge of public function) remain. Over 200 of those who participated in the December 28 demonstration have also been charged.

We know about Barwani because there is a group there, the Jagrit Adivasi Dalit Sangathan that is organising and working in the area. But there must be hundreds of similar stories from around the country.

The response of the district administration is shocking enough. What is worse is that this is happening five years after the National Rural Health Mission (NRHM) was launched to check precisely these kinds of incidents, where poor women are made to go from pillar to post for help when they develop complications during pregnancy. Institutional deliveries were seen as a way to bring down the unacceptably high maternal mortality rate. Yet, according to the National Family Health Survey – 3, only 13 per cent of births to the poorest women and 18 per cent of births to women with no education or who belong to the scheduled tribes are delivered in institutions. So no one will argue that increasing access to medical help when women need it most is an urgent need.

Only on paper

This need was supposed to have been addressed by the NRHM. Its guidelines state that every Community Health Centre — that comes between the Primary Health Centre and the District Hospital — is supposed to provide “24-hour delivery services including normal and assisted deliveries” and “Essential and Emergency Obstetric Care including surgical interventions like Caesarean Sections and other medical interventions”. Furthermore, specific districts have been selected in every state where the district hospital is designated as a Comprehensive Emergency Obstetric and Neonatal Care Centre (CEMONC). The Barwani district hospital is designated as such. Yet, despite a staff that includes four gynaecologists and two anaesthetists, no one was available to help Vypari Bai.

The real story of India's progress lies in the detail of how programmes like NRHM are implemented, or not implemented. It is a story that is not told often enough to make us angry. Occasionally, we pay attention to the needs of our children. But women like Vypari Bai, who die because no one cares, remain invisible, the ghosts of another India.

Email the writer: sharma.kalpana@yahoo.com