WUNRN
INDIA - MATERNITY CARE
IMPROVES THROUGH WOMEN'S ADVOCACY
December 27, 2010
In one of the worst areas of maternal care in the world, a health advocacy
is teaching Indian women the three big factors in maternal deaths and how to
assert political and community pressure to avoid them.
RAJASTHAN, India (WOMENSENEWS)-- Payments demanded by doctors for conducting
deliveries of babies after 11 at night at a district public health center in
Udaipur, a city in the western Indian state of Rajasthan, came down
dramatically around August 2009.
That was
after 21 women elected by community members to the local self-government--or
panchayat--co-signed a letter to the doctor in charge of the government primary
health center. In it they complained about the financial exploitation, scarce
staff, absence of facilities and incomplete prenatal care.
Soon
after, they met with public health officials who promised to address their
complaints, which included demands for more funding.
The
women didn't stop there. They began visiting the health center every month to
monitor absenteeism among health workers and to ensure that clinicians' demands
for special payments be stopped.
In the
neighboring state of
One investigation found that women in one village did not receive care because a female health worker objected to walking across a muddy area to reach them. The activists then provided a medial official with a list of the women who did not receive any services during their pregnancy or childbirth. After that the government opened a satellite center to serve the previously neglected women.
Big Change
That kind
of advocacy and intervention represents a big change in the 219 villages in
nine rural and tribal blocks of
It's a
change that began when the Center for Health Education, Training and
Nutritional Awareness, a Gujarat based nongovernmental organization that has
been advocating for women and children in
To help
women of little or no literacy in these areas better understand their legal and
practical rights to maternal care the organization produced and distributed a
picture book on maternal health entitlements for use in village-level meetings,
which were held during their three-year project.
Meetings
were also held for community members and service providers to discuss what
constituted good maternal healthcare. These meetings also provided a forum for
discussing monitoring efforts on the denial of health services and other
deficiencies. Panchayat leaders used these information to initiate specific
advocacy measures to strengthen health services and enhance accountability.
Before
beginning its intervention, CHETNA partnered with six local NGOs that worked in
these districts to survey 200 village women. They asked questions about what
they knew about the clinical basics of maternal health and their legal rights
and entitlements to it.
After
these village meetings, the same women were surveyed again. The second round of
surveys found huge gains.
They
showed that the number of women who knew about the three big delays behind
maternal mortality -- delay in identifying complications and taking action,
delay in reaching the appropriate facility and delay in treatment at the health
facility leading to maternal mortality--increased to 108 from 38.
The number
of women who knew about the facilities where they could find maternal health
services increased to 152 from 52.
The number of women who knew about the village calendar for providing health services rose to 137 from 47.
Awareness Doubles
By the
second survey, twice as many women--110 instead of 50--knew what they were
entitled to under the government's national maternity program, which includes
cash incentives for institutional deliveries.
Half of
all maternal deaths in South Asia occur in five Indian states--Rajasthan,
Madhya Pradesh, Uttar Pradesh,
In
Rajasthan the maternal mortality rate of 388 for every 100,000 live births, far
exceeds the national average of 254.
This
information was shared recently at a meeting organized by the NGO as part of
its dissemination efforts to provide inputs to the national Planning Commission
as the government prepares a strategic budgeting plan for the next five years.
It was
pointed out that an assessment of almost 130 PHCs indicated that pregnant women
were not receiving continuous care from early pregnancy through delivery and
after.
It also
testified to poor facilities, equipment and supplies and said many remote
villages remained under-served despite the plethora of government schemes to
address these problems.