There appears to be light at the end of the tunnel finally for undernourished, anemic young mothers and newborns in the harsh desert environs of rural Rajasthan with non-governmental organisations stepping in to help communities gear up to save pregnant women and babies. The issue has for long posed a challenge to the State Health Department with miscarriages and maternal and infant mortality still common.
The latest sample registration survey (SRS) indicates infant mortality rate (IMR) in rural Rajasthan to be as high as 72 per 1,000 live births. The State government intends to bring it down to 28 by 2015. While the maternal mortality rate (MMR) has dropped from 388 in 2004-2006 to 318 in 2007-2009, it is still a long way from the targeted 109 per 100,000 live births by 2015.
Educating young pregnant women and their families to identify danger signs that may indicate life-threatening complications for the mother and the baby, identifying a skilled provider and a birth location, saving money, and arranging for transportation are some of the critical aspects of the Birth Preparedness and Complication Readiness (BP/CR) campaign launched by White Ribbon Alliance for Safe Motherhood, India (WRAI).
Schemes like Janani Suraksha Yojana have been successful across the country and have resulted in a 12-fold increase in institutional deliveries since its launch in 2005.
But according to the Central Bureau of Health Intelligence, the figures in Rajasthan dropped from 32.2 per cent in 2007 and have remained stagnant at 29.6 per cent since 2008. Similar findings are echoed in an Operation Research implemented by ‘SUMA' Rajasthan White Ribbon Alliance for Safe Motherhood, in partnership with White Ribbon Alliance India, in 10 villages of Osian block of Jodhpur district. The research indicates that as many as 70 per cent deliveries are still conducted at home by relatives or midwives or private compounders. Barely 25 per cent expectant mothers registered their names in the first trimester of pregnancy or access ante-natal care or post-natal care. In case of complications, their access to care is impeded by delays — delays in deciding to seek care, delays in reaching care, and delays in receiving care.
The research further reveals that lack of value of women's lives coupled with a strong culture of silence, specially related to reproductive or sexual health due to social norms, makes it difficult to engage women and families in birth planning and emergency mitigation.
Despite these odds, 400 women who have been a part of the action research process. Ganga Devi from Khabada village had lost 3 babies earlier. This time she followed the BP/CR calendar that the family had filled up during a visit by the ASHA and the anganwadi worker. There was an emphasis on her dietary needs and regular ante-natal check up. She knew where she would be taken for delivery, who was needed to be contacted for transport and also who would be donating blood in case she needed it. Ganga also saved Rs. 2,000. Her reward is a five-month-old healthy baby.
65-year-old Chukki Devi from Beh Charana, who has helped deliver a child in almost every family in her village, today is an advocate of institutional deliveries. Unsure of the facilities and care they would receive “families still insist we accompany them to the hospital for the delivery,” says 50-year-old Imarti, Chukki Devi's assistant and a trained Dai .
When 25-year-old Pushpa from Beh Charana went into labour, she herself called up the 108 Ambulance service. Though her four-year-old daughter was delivered at home, she now proudly holds two-month-old Yuvraj who was born after a caesarian section at the District Hospital.
Husbands and mother-in-laws make the crucial decisions when it comes to maternal and newborn health issues in the family. Therefore their awareness of danger signs and participation in Birth Preparedness Plan is of critical importance. “We have worked very closely with the families, State Health Department as well as representatives of panchayats, self help groups and taxi service providers. The inputs have collectively improved timely use of skilled maternal and neonatal care, reducing maternal mortality and morbidity in the project area,” says Tej Karan Ratnoo, coordinator of Gramin Vikas Vigyan Samiti.
