Why Aren’t Biharis Making Dismal Maternal Healthcare a Poll Issue?

That Bihar votes are based on caste is one of the factors, says political strategist Amitabh Tiwari.

4 min read
Hindi Female

The World Health Organization has set a parameter of one doctor for every 1,000 people. However, in Bihar, there is just one allopathic doctor to serve every 43,788 people, according to the National Health Profile 2019, by the Indian Council of Medical Research.

Bihar has 2,792 allopathic doctors in government hospitals.

This huge disparity sums up the healthcare infrastructure in the state that is soon to go to polls.

Maternal and child mortality rates in Bihar are higher than the national average – equating to approximately two mothers out of 1,000 dying at childbirth, and four child deaths out of every 100 children born, according to CARE India.

Another report by the Journal of Clinical and Diagnostic Research states that Bihar is among the states in India with the lowest health profiles. The accessibility of health facility is very poor, and due to dire poverty, several people are malnourished.

The report reveals that “nutritional condition of Bihar is poor” due to which “half of the women in pregnancy and reproductive span period are anaemic” with the percentage of women below normal BMI as the second highest in India.

In NITI Aayog’s 2019 report, Healthy States, Progressive India, Bihar ranked 20th out of 21 large states ranked in the health index on the overall performance.

Despite the dismal reality of healthcare in Bihar, the issue eludes the poll planks for the upcoming Assembly elections. While it has not been a talking point in political rallies, it is almost absent from the public discourse as well.

So, why isn’t healthcare an election issue?

With a Focus on Basic Survival, People Vote on Basis of Caste Alone

“Bihar votes are based on caste – even if the voters are not happy with a certain political party’s work in the health sector, they will vote for that party based on caste,” political strategist Amitabh Tiwari told The Quint.

“It’s about bread and butter – it’s about caste vote – people know healthcare will not change, poor people prefer going to moneylenders than asking leaders for better health infrastructure,” he added. “Voters prefer basic amenities like roti, kapda, makaan over education and health.”

Just a year before, in 2019, in one of the worst outbreaks of acute encephalitis in the state, over 150 children had died.

Although MoS for Health and Family Welfare, Ashwini Choubey, had declared the cause of the outbreak to be litchis, some studies said it was due to the consumption of litchis by undernourished children.


According to the research conducted by Frontline magazine, the children who were impacted by the outbreak were malnourished, belonged to economically poor backgrounds, and were majorly from the scheduled castes, and backward and extremely backward castes. It added that the affected children had fever and other symptoms in the morning, and most of them had gone to bed empty stomach the previous night.

In 2019, The Quint reached Bihar’s second-biggest hospital, Darbhanga Medical College and Hospital (DMCH), where dilapidated buildings, filth, lack of doctors, nurses and health equipment exposed the horrific picture of Bihar’s healthcare system. Despite being the second biggest hospital in Bihar, DMCH was seen to be criminally understaffed.

The Nitish Kumar-led National Democratic Alliance (NDA) government in 2019, in its reply to the Supreme Court, said that the state healthcare had a shortage of 57 percent of doctors, whereas the percentage of shortage of nurses and lab technicians stood even higher – approximately at 71 percent and 72 percent, respectively.

A study conducted by Oxfam India last year, just ahead of the 2019 Lok Sabha polls, also found that the Janata Dal (United)-led government had failed to provide quality healthcare to women – including safe motherhood and improvement of maternal and child nutritional status, among others.

Citing the National Family Health Survey report, Oxfam said children born to mothers under the age of 20 are more likely to die during infancy than those born to mothers aged between 20 and 29 years.

Every year, thousands of women in the state die of pregnancy-related disorders, such as obstructed labour, internal haemorrhage, hypertensive disorder, infection, and anaemia, the Oxfam India report said.


‘Rural Healthcare Ignored By the Govt and Media Alike’

According to a Reserve Bank of India report, Bihar spends 4.1 percent on medical and public health and family welfare. In comparison, Kerala allocated an average of 5.6 percent of the budget in the health and family welfare sector as against the average state spending of 5.3 percent.

According to the NITI Aayog 2019 report, Kerala topped the rankings in the national health index.

According to data from PRS Legislative Research, the budget allocated by the Kerala government in the health and family welfare sector over the last five years was higher than the average budget allocation of other states.

Sankalp Shriwastav, a former political consultant with I-PAC, said that Bihar’s rural areas lack primary healthcare centres because “the government does not think it’s necessary to invest in health and family welfare.”

“Bihar is not interested in investing in healthcare. They focus on caste; till they start investing in healthcare and people start questioning the political parties about healthcare, things won’t change,” said Shriwastav.


And poor investment in healthcare is the reason for the public health sector in the state to be crumbling, Dr Shridhar Kadam, Additional Professor at Indian Institute of Public Health (PHFI), told The Quint.

“Healthcare is never a priority, not just in Bihar but across the country – investment in public health sectors is very poor,” Dr Kadam added.

Only two states – Karnataka and Punjab – spend lower than Bihar on medical and public health and family welfare as a ratio to aggregate expenditure.

“ASHA workers in Bihar have been protesting against the system, that these workers are not paid on time... ASHA workers are the primary caretakers of the children in rural areas, even their needs are not met by the government,” Shriwastav told The Quint.

Shriwastav and Dr Kadam added that the media, too, has failed to focus on rural healthcare, lending to healthcare not being a poll issue at all.

(At The Quint, we are answerable only to our audience. Play an active role in shaping our journalism by becoming a member. Because the truth is worth it.)

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