WUNRN
Women's Feature Service
India - New Delhi
India: Birth of the Republic, Births in the Republic
By Pamela Philipose
New Delhi (Women's Feature Service) - "We never had anything like the
Republic we are going to have now..." - That was Dr Rajendra Prasad, as he
put the motion for the adoption of India's new Constitution to vote in the
Constituent Assembly two months before India became a republic in November
1949.
Imagine for a minute that shambolic entity called the Republic of India at that
moment, with its 361 million people and innumerable needs, demands and
expectations. Not all of these people received the Republic's attention. As
fresh evidence emerges of India's unconscionably high rates of maternal
mortality (MMR) and infant mortality (IMR) - UNICEF's 'State of the World's
Children 2009' has just put India's MMR at 450 per 100,000 live births and its
IMR at 57 per 1,000 live births - it points to the lack of support accorded to
the nation's young mothers.
Who were these women anyway? According to Census data, women numbered around
175 million in 1951. They had a life expectancy below the national average of
40 years. By age 16, they were more likely than not to have been married, and
they would have given birth, on an average, to six children in the course of
their lifetimes. The poet A.K. Ramanujam may well have been describing one of
them when he once wrote, "I see my mother run back/from the rain to the
crying cradles..."
It is not as if the leaders and planners of the Republic did not have the right
perspectives or the necessary empathy. As early as 1946, the Health Survey and
Development Committee of the Government of India had noted that morbidity in
Indian women was the result of malnutrition, frequent pregnancies and anaemia. In
1955, Prime Minister Jawaharlal Nehru, in his foreword to 'Social Welfare in
India - The Planning Commission', observed: "...Welfare must be the common
property of everyone in India and not the monopoly of the privileged groups as
it is today. If I may be allowed to lay greater stress on some, they would be
the welfare of children, the status of women and the welfare of the tribal and
hilly people in our country." The Planning Commission's 'Plans and
Prospects for Social Welfare in India, 1951-1961' laid down in the narrative
for the First Five Year Plan that "Women are considered to be handicapped
by social customs and social values and therefore social welfare services have
specially endeavoured to rehabilitate them."
With such telling observations and with such excellent intentions, why did the
country lose the plot on maternal mortality? How did things go so wrong that,
today, India does worse than the much-poorer Bangladesh in terms of its
under-five mortality rate? That one in 71 of India's women die of maternity
related factors, compared to China's one in 1,300?
The feisty, clear-sighted women, who wrote the Report of the Status of Women
Committee in 1974, had sounded the alarm bells loud enough. They had warned of
the consequences of the steadily declining share of investment in the social
services and the easy assumption that all welfare programmes will benefit women
indirectly, if not directly. The Committee had pointed to the inadequate number
of maternity beds which, in 1968, constituted less than 17 per cent of total
hospital facilities and to the fact that only about nine per cent of births in
rural areas were attended by trained personnel. It had expressed concern that
the numbers of auxiliary nurse midwives were clearly inadequate and that the
masses of Indian women were consigned to the status of "expendable
assets". The Committee had also tracked the health budget and flagged the
fact that by the Third Five Year Plan (1961-1966), India was allocating more to
Family Planning (Rs 269.70 crore) than to health programmes (Rs 226 crore). It
observed: "From the Third Plan ... restraint of population growth received
a much greater emphasis and priority, with time-bound targets for reducing the
birth rate and heavy investment in the administrative network to mount the
programmes on the lines of a military operation... Some state governments even
adopted measures to deny maternity benefits to women government servants after
the third child. We feel strong about this measure, for the denial of maternity
benefits to a working woman is likely to affect both the health of the mother
as well as that of the child." This, incidentally, was stated years before
the political backlash to forced sterilisations during the emergency manifested
itself.
While the Fifth Plan tried to correct this trend somewhat, health continued to
figure low in national priorities, with expenditure on public health declining
from 1.3 per cent of the GDP in 1990 to 0.9 per cent in 1999. There is, then, a
history to the stark figures that stare out of UNICEF's 'State of the World's
Children 2009 Report', a history of callous administration and deliberate
neglect. The UNICEF report underlines that "Growing inequities, combined
with shortages in the provision of primary health care and the rising cost of
care are complicating the country's efforts to meet the health-related
Millennium Development Goals."
The high maternal mortality levels in India are the direct consequence of four
factors. One, the lack of agency of the expectant mother - National Family
Health Survey-3 (NFHS-3) estimates that 45 per cent of Indian women are married
before they reach the age of 18 and that 37 per cent of married women face
domestic violence. Two, the poor general health of the mothers: here again the
NFHS-3 reveals that 56.2 per cent of "ever-married women aged 15-49"
were anaemic. Three, serious infrastructural lacunae, ranging from poor quality
village roads to badly equipped primary health centres and district hospitals.
Four, direct causes such as haemorrhage, sepsis, eclampsia, obstructed labour
and complications of abortion, which may or may not be linked with the other
three factors.
Maternal health is the fountainhead of social well-being including, most
crucially, infant health. The National Rural Health Mission (NRHM) has the
potential to be a catalyst for such well-being, with its strategy to train at
the household level Accredited Social Health Activists (ASHAs), expand the
agency of Panchayati Raj institutions in health delivery, and strengthen the
existing three-tiered system - of sub-centres to cover 3,000-5,000 people;
primary health centres to cater to 20,000 to 30,000 people, and community
health centres, with at least 30 beds, covering a population of 80,000 to
1,20,000.
The point is that you don't need high technology to bring down maternal
mortality rates. Dr Abhay and Dr Rani Bhang's interventions in Gadchiroli,
Maharashtra - providing home-based health care delivered through trained female
community health workers - brought down the neonatal mortality rate in the
region by 70 per cent.
What the Republic needs to do today is to make up for lost time and keep both
Mother India and the Other India at the centre of its health delivery.
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