On 29 March, Amar Ujala had reported that a 30-year-old woman died after giving birth in a village called Amjad in Okhalkanda block of Nainital, Uttarakhand. This situation is far from been summed up in a single line.
The report went on to say that since the lady’s village lacked any medical facility, she had to be rushed to the nearest Primary Health Clinic (PHC) in Okhalkanda. However, due to signal problem, the ambulance could not be contacted and after a time gap she had to be taken in a personal vehicle. She gave birth midway and died shortly after.
Isn’t it shameful for any civilised society that a pregnant woman died so horribly because a call could not be connected? There is no coincidence that she belonged to to a ‘disadvantaged’ group of society – she was a woman, a Dalit living below poverty line and a resident of a backward rural area. She was the mother of four children, her relatives told me.
Again the situation is still not simple enough or isolated to be summed up in a few lines. The local papers are replete with news of women and/or neonates dying during and shortly after childbirth due to lack of timely medical assistance in Uttarakhand.
According to the NITI Aayog's 2018 health index, Uttarakhand has registered a negative growth in health indicators for 2015-16. The figures are disturbing.
The neonatal mortality has increased from 26 to 28 (per 1000 births) and under 5 mortality increased from 36 to 38 (per 1000 births). Leaving no scope for cheer are the fields that registered a decrease – sex ratio from 871 to 844 (per 1000 males) and institutionalised deliveries from 64.3 percent to 62.6 percent.
Since hospitals are the only health resource infrastructure available in India, the deliveries not happening at the hospitals come in the category of unsafe birth practices. Simply put, around 40 percent of the babies born in Uttarakhand begin life in unsafe surroundings. Ironically, with no hospitals in the vicinity and poor transportation, delivering a baby at home becomes the safest option.
Pushpa Devi, pregnant and mother of a 14-month-old girl from village Risyara in Someshwar, Almora recalls,
“My husband insisted on an institutional delivery. I reached Someshwar PHC at 2 am after I experienced labour pain. The doctor came after 1 hour and was very rude to us since we are poor. The hospital said that they could not perform the C-section there and referred me to Almora. Upon reaching Almora, they again referred me to Haldwani, where my daughter was born normally. The next day when my mother-in-law came the first thing she said was, ‘All this trouble for a girl.’ Now she insists my second delivery should be at home itself.”
According to Sneha* (name changed) whose is amongst a few well-to-do families in a remote village in Nainital,
“Obviously there are problems in rural areas. I had to go for ultrasounds to Haldwani and had to depend upon the ASHA’s and ANM’s for checkups. There are very few doctors in PHC. Many times, there are no lady doctors. The poor people especially Dalits don’t go for any checkups or ultrasounds. Deliveries take place at home. They come to the hospitals only in emergency situations.”
The Problem in Uttarakhand
According to WHO and other research, most of the maternal and neonate deaths in low resource settings are preventable. For this, all the three stages of childbirth – antenatal, natal and postnatal need attention. Apart from these, family planning, maternal health prior to pregnancy, and safe and affordable abortion options are all inevitable for a healthy mother and baby.
Is our medical infrastructure capable of handling all these things, especially for marginalised women? Why is this critical aspect of women security and safety absent from all political discourses including from the agenda of women rights activists?
Uttarakhand has unique geographical, topographical and socio-economic challenges that make availability of medical facilities problematic. However, after 20 years of attaining statehood, the hill villages are at an even more deplorable state than before. Apart from the natural disasters and terrain hampering medical care, there is now a fast emerging problem of out-migration. Around 1,000 villages have already been declared ghost villages. Therefore, those that are left behind are destitute, mainly schedule castes.
They lack the bargaining power for facilities and the inaccessibility of the area reduces the interest of skilled people, including doctors (statistics also point towards glaring vacancies), to come and work.
It is notable that Ayushman Bharat has already been introduced in the state, but since it is a scheme targeted for secondary and tertiary health care, it leaves out primary health care.
So what is the solution? Currently, our healthcare is based on National Health Mission, applied nationwide, but perhaps we need to evolve specific measures to suit spatial differences. Maybe our ANM's or Auxiliary Nurse Midwives have to be more in number and better equipped in the villages. Facility of airlifting critical patients should also be debated. The viability of PHC’s of the type of Delhi’s Mohalla Clinics should be studied. Numerous health booths with first aid care, video-conferencing with specialised doctors and satellite phones could be set up with minimally trained handlers. Most importantly, we need to be aware of our rights as a voter and know what we can demand of our representatives and governments.
Election-time should be utilised to create awareness among the common people regarding their rights to lead them towards participatory governance.
The Amar Ujala report ended with the talk of compensation for the victim's family. While it is a laudable, we must consider intervention at the right levels to better the condition of mothers and women.
(The author is a freelance writer from Nainital. All 'My Report' branded stories are submitted by citizen journalists to The Quint. Though The Quint inquires into the claims/allegations from all parties before publishing, the report and the views expressed above are the citizen journalist's own. The Quint neither endorses, nor is responsible for the same.)