Don’t let young mothers die

On July 7, 2011, the Registrar-General of India (who is also the Census Commissioner) – and which office, for some unfathomable reason, best known perhaps to some babu in the GOI, remains located in the Ministry of Home Affairs, instead of the Ministry of Family Welfare – released the figures for MMR, IMR and TFR for the country.  It made the front page of The Hindu and The Assam Tribune, pg 8 of the Indian Express, pg 13 of the Hindustan Times (two paras) and did not figure in the Late City edition of the newspaper that tom-toms its No 1 status, not just in India, but “in the world”, The Times of India.

The infant mortality rate (IMR) – the number of infant deaths per 1,000 live births – has registered a 3 point decline at 50 from 53 in 2008, thought every 6th death in the country pertains to an infant. Sadly enough, the mortality rate of girls is higher than boys indicating a “worrisome trend” for the government.
But this is crucial data that tells us the real story of “shining” India and of “developing” Assam.  Let’s unravel the gobbledy-gook of these capital letters:  MMR is Maternal Mortality Rate (i.e. the ratio of women who, on an average, aged 15-49 years die due to maternal causes while pregnant or giving birth, in proportion to 100,000 live births). IMR is Infant Mortality Rate (i.e. the number of infants who die on an average in proportion to population) and TFR is Total Fertility Rate (i.e. the number of children that a woman is expected to bear during child-bearing years).

The main goals before government health campaigners in Assam were set a few years ago: these were reduction of MMR from the current 480 (RGI, 2004- 06) / 333 (CES-RRC, NE) to less than 200 by the year 2011-12, IMR from 64 (SRS 2009) / 46 (CES-RRC, NE) to 40 by the year 2011-12, reduction of Total Fertility Rate from the current 2.7 (SRS) to 2.4 by the year 2011-12.

For Assam, the news from the Register-General is a mixed bag.  If we put a positive spin, let’s just take one statistic: MMR has dropped from 480 to 390.  This is an amazing 90-point drop, higher than any other state in the country, and a staggering achievement. But we are still at the bottom of the heap – despite the superb performance by the National Rural Health Mission in the state and across India, Assam’s 390 MMMR is 82 points higher than the next worst performing states: Bihar, Uttar Pradesh and Madhya Pradesh.
So there is a vast amount of work still to be done.  I speak from the field and experience, having initiated with my team at the Centre for North East Studies and Policy Research the innovative idea of Boat Clinics, which works specifically in these three areas in 13 districts of Assam.  It is a huge task and our partnership with MRHM is crucial to reach the vulnerable areas of the sapori and char population across the Brahmaputra Valley.

Let’s take a look at what was proposed for India and where it stands. The Centre proposed an all-India MMR reduction by 200-300 by 1990 and suggested that it go below 200 by the year 2000 in a Health Policy Statement of 1983. In the National Health Policy of 2002, the National Socio-Demographic Goals were reduction of MMR to below 100 per 100,000 live births by 2010. This would translate into a drop in the MMR to 2 per 1000 live births by 2007 and 1 per 1000 live births by 2012.

This is part of the Millennium Development Goals set by former UN Secretary general Kofi Annan, and which were aimed at improving the condition of women worldwide, but especially in poorer and less developed economies. Those goals are aimed at health, education and other indices of vulnerability and are set for 2015. India’s MDG MMR rate for 2015 was 109.
What are the facts?

• Every 5 minutes, one woman somewhere in India dies from complications of childbirth
• 15 per cent of all pregnant women in India develop life- threatening complications
• 65 per cent deliveries occur at home
• 60 per cent of all maternal deaths occur after delivery but
• only 1 in 6 women receives postnatal care
• Over 2.5 crore live births take place in the country; over 30 lakh mothers face life-threatening complications and nearly a lakh among them die
• MMR overall has come down to 212 (2007-09) from 254 in 2004-06
• And, what’s more the average lifetime risk of a woman in a states like Assam (more than Uttar Pradesh) of dying from complications related to pregnancy or childbirth is more than 200 times greater than for a woman living in an industrialized country.

Thus, the statistics actually show that it is more disastrous or dangerous to be pregnant or about to give birth in Assam than any other part of the country because the rick of dying from a motherhood-related issue is highest here. So, Assam, which prides itself on the dignity, honour and place that women have in society actually allows tens of thousands of its women to die in the process of giving life.  How is that acceptable?  The Assam Tribune at least gave front-page treatment to the Registrar-General’s report (although it was limited to a few paras) but few papers, either in Assamese or any other language, have bothered to go into detail of this disaster that has overwhelmed our society even as we speak so glibly of development, growth, Look East Policy, panchayati systems, transparency, governance, an end to insurgency and conflict, peace processes and packages, underground, overground, middle ground, chintanayaks/ buddhijeevis  (intellectuals),  advisory committees, analysts,  media pundits and noisy television anchors etc.

All these are important – but they become virtually meaningless because we are allowing such a gross violation of human rights every day: our young mothers to die, without providing enough access to health services. An entire generation and generations after that are condemned to die because we are just not bothered.

Is this enough to shake up our media, our chintanayaks, buddhijeevis and media? I don’t know. Can those who raise the gun and now swear by peace pledge to make this a priority?  I wonder.

That is why and while we must acknowledge that excellent work is being done in several sectors across Assam and the North-east, we still have many miles to go before we can even begin to say that we have turned the tide and many more miles before we can say we are winning the real battles – of health, of education, of communication.

Which states are doing well? One could be glib and say that the rest of India is forging ahead. It isn’t: actually, it is the Southern States, which have sped ahead in the race to meet basic human development goals. Kerala’s MMR is 81 against the national average of 212 (and the MDG score of 109); its IMR is 12 against 28 and TFR is 1.7 (as set by the UN).

So the lesson here is simple: focus on health and education and the rest will follow – including security, growth, development and peace. If we forget the basics, we’re doomed to repeat the failures of the past.
By Sanjoy Hazarika
By the Brahmaputra