It
was scorching hot as we parked the car outside this small village in the Indian
province of Uttar Pradesh, something we'd done a dozen times in the past few
days. As we walked through the village entrance, I hoped that, this time, we'd
find a professional health care worker here.
More women in India die from pregnancy than anywhere in the world, in part because of its large population. Uttar Pradesh, India's most populous state, has the country's most dismal figures related to maternal mortality, or death from childbirth.
The Indian government recognizes the problem and spends millions trying to eradicate it. But women continue to die here in record numbers.
I was investigating why. I had sat with families, listening to husbands who lost wives and parents who lost daughters.
But I hadn't yet heard these stories from health care professionals. Most health workers were difficult to locate, either in the field vaccinating children against polio and filarial, or visiting patients. Those I found working in clinics were so busy treating people that I couldn't in good faith interrupt.
I was getting anxious. Interviewing medical professionals was the key - their information could help explain the gap between funding and care. I began chasing them from village to village, hoping someone would take a break.
We walked through the village to the home of a local matriarch, and she promised to introduce me to the town's ASHA, a health care worker appointed by the village head. I waited in the matriarch's courtyard, listening to children playing nearby, hoping the ASHA would come.
According to the World Health Organization, India's maternal mortality ratios are 16 times that of Russia, 10 times as high as China's, and 4 times as high as Brazil's. To combat the problem, India's government created the National Rural Health Mission, with the goal of giving poor women and children access to health care.
Addressing maternal mortality specifically, it offered 1400 rupees (US$28) to each rural woman who gave birth in a clinic instead of at home. The financial incentive worked, and more women than ever were giving birth in clinics. But women kept dying.
I had waited in the courtyard for 40 minutes when the ASHA finally arrived. Her name is Trishna, and she wore her off-white sari draped around her head. At first, she was hesitant to open up. She shared the information in her notebook, where she recorded the area's pregnancies. Eventually, she also told me her concerns. I would later learn that some of her problems were shared by many Indian health care workers - the power struggles between nurses, the workers who charged impoverished people for services that were supposed to be free. She spoke of nurses taking bribes in exchange for treatment.
We talked for two hours.
I soon met with other health workers, and the picture of maternal mortality in Uttar Pradesh became clearer. The rural clinics, although a positive innovation, were overcrowded, in part due to the success of the US$28 incentive to give birth there. Sometimes, two pregnant women shared a bed, or women would sit on the floor.
Some rural clinics frequently went without electricity. In case of emergency, clinics generally had no means to transport women to hospitals, and blood transfusions couldn't be given on site. Rarely were any of the health workers trained in obstetrics and gynecology.
I spoke with a health care worker who had helped birth two generations of babies in her village. She had no scale to weigh patients, nothing to measure blood pressure. She rode to distant villages on the back of her husband's motorcycle and used her own money to hire a village boy as her driver.
I learned that official figures on death due to pregnancy couldn't be trusted. Most women who gave birth in clinics were sent home within a few hours or the next day, with no follow-up care. Some of the women died days later. I met village health care workers who had never learned that when a woman dies within a week of giving birth, it's still considered maternal mortality.
It became clear that, while the Indian government had the best intentions in establishing clinics and guidelines for maternal health, its efforts fell short of the mark. Yes, the program succeeded in having more women give birth in clinics, but the hoped-for impact - lives saved - wasn't there.
Money wasn't the only the problem. Millions of dollars in government funds for health care in Uttar Pradesh go unspent each year, according to one study by the Indian Planning Commission.
The real issue is accountability.
Rural villagers need someone to complain to if they feel they've been mistreated at a rural clinic, or if their family members die as a result of childbirth. Their complaints need to be investigated, and those responsible need to be held accountable.
Also, every death from pregnancy should be accurately recorded.
In March, India's parliament reconvenes. I have been meeting with members and educating them on these issues, in the hope that they will educate their peers and help address maternal mortality in their constituencies.
Backed by the right policies, both Sri Lanka and Malaysia have managed to halve their maternal mortality numbers in five or six years. By putting in place the right measures, India may be able to do the same.