Inadequate monitoring of maternal deaths following child birth is coming in the way of India meeting international standards in obstetric care, an international human rights body has said.

According to Human Rights Watch, 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. "The Indian government does not monitor what happens to women after childbirth, especially in the first 24 to 72 critical hours, when the chances of dying are the highest,"

the report by the rights body said. Without this information, it cannot save women who go

back home and die or develop long-lasting complications, it added.

"The Indian government should change its approach to monitoring and examine whether women with pregnancy-related complications are in fact getting the kind of treatment they need and whether they are surviving childbirth in the postpartum period," it said.

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 district and state levels.

Citing the example of Uttar Pradesh, the HRW says that though the state has the second highest maternal mortality rate in the country, government health records in some districts showed "zero" deaths.

The Human Rights Watch documented cases in which women died after childbirth even though they gave birth in health facilities. The Indian government promotes giving birth in public health facilities, using cash incentives for 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.

The government treats the huge increase of clinic-based deliveries as progress. Twenty 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 20 million women actually survived after childbirth or suffered complications after being discharged.

"Skilled birth attendance and quality of care are two sides of the same coin," Aruna Kashyap, researcher for the Women's Rights Division of Human Rights Watch, said. "Unless India can draw up a time-bound plan of action for independent certification and monitoring of public and private health facilities as 'quality care providers', there is no guarantee that women giving birth in health facilities are receiving the skilled birth attendance needed to save them," he added

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