In the heartland of India we see a tragic irony, where the most populous state in the country – Uttar Pradesh – sees as many deaths as it does births. These deaths are completely preventable and yet are still occurring in numbers that stand in stark contrast to those of other states and the national average. The number we here refer to is the Maternal Mortality Rate (MMR).
MMR is used world over as an indicator of the existence of basic maternal care and rights, the higher the number the greater the concern for maternal safety. UP, where the MMR stands at 258 (Census, 2011), warrants grave concern and in-depth analysis as to why the mothers in the state find themselves in such an insecure position. Motherhood in UP has come to be morbidly associated with the sorrow of death rather than the joy of birth.
The primary causes for maternal deaths in India and their nature showcase just how preventable these deaths are, whether it be haemorrhage, which is caused by widespread anaemia and malnutrition among pregnant women, or unsafe abortions. Economically downtrodden women without access to or knowledge of effective and safe contraceptives are forced by their husbands to abort their child in an unsafe environment, often leading to a painful death.
Social determinants such as marriage in an early age and early and repeated childbearing where 47 percent of girls marry before the age of 18 are also contributing factors.
Further, a patriarchal mindset and a strong son preference in urban areas, even among the rich, has led to illegally detecting the sex of the foetus, and in case of it being a girl, the child being aborted, often in unsafe conditions.
The patriarchal nature of Indian society leaves the fate of the mother’s life in the hands of an unquestioned husband, with the woman having to pay the price with her life. This is more prevalent in states like Uttar Pradesh.
Benefits of Govt Policies Aren’t Reaching Many Women
It should not be forgotten that the essence of Vedanta is in its values, and as per correct Vedantic knowledge, the Sanskrit words used by the husband for the wife were Pathni (the one who leads the husband through life), Dharmapathni (the one who guides the husband in dharma – righteousness and duty) and Sahadharmacharini (the one who moves with the husband on the path of dharma).
This is how ancient Vedic culture viewed the partnership of husband and wife. Hence, the foundations of a patriarchal India are broken by Vedic knowledge itself.
Today, initiatives such as the Janani Shishu Suraksha Karyakram (JSSK) and the Janani Suraksha Yojana (JSY) exist as policy attempts to ease the financial burden on poor women by providing free transport to medical institutions, free medical care and assistance and incentivising safer deliveries by providing a 48-hour stay at the state’s cost.
However, despite the existence of these initiatives, UP stands worse off with its Maternal Mortality Rate much higher than the national average.
This is because these initiatives are still not being able to deal with the problem that is embedded in the mindset of these societies. There is a societal belief that pregnancy is not a medical condition, therefore, pregnant women and their families do not seek medical care during that period.
If women are not brought to hospitals by their husbands and families and are forced to deliver without professional care and expertise, irrespective of the pain and complications, they cannot even access the existing policies.
Lack of Institutional Accessibility
Institutional deliveries account for only one-fourth of the deliveries in UP and Bihar. Thus many mothers bleed out without the assistance of any doctor or nurse and die during the delivery, simply because it’s not perceived as a big enough problem to go to the hospital for.
When patriarchal custom requires the husband and the mother-in-law to dictate the welfare of the mother-to-be, institutional access is almost always denied.
Any approach to maternal death prevention requires institutional accessibility and it is this prerequisite that initiatives such as the JSSK and the JSY attempt to make feasible. In states like Kerala where the MMR is comparable to those of developed countries, it is the easy access to medical institutions, their economic feasibility and medical expertise that has increased the maternal care and ambit of maternal rights.
However, in states like UP, the institutions are far from being accessible, feasible or functional. UP has 583 fewer community health centres than Indian public health standards require, less than a third of which have an obstetrician or gynaecologist and about 45 percent do not have funds to operate even the one ambulance they have.
The transport if provided at all, is so unhygienic and unsafe that infections picked up there cause complications at best and death at worst.
A gruesome story comes from Balampur, of 17-year-old Mehroonah, who was keen to deliver in the hospital. When she went into labour, she was bundled into an autorickshaw. “The baby’s head was coming out and she was born in the vehicle”, Mehroonah told Scroll, a year after her delivery.
Rural areas in Uttar Pradesh still see a heavy institutional discrimination of lower castes. Cases have often been reported where upper-caste nurses and doctors altogether refuse to interact with the lower-caste patients.
Lower-caste mothers even during the delicate time of the water-breaking are told to walk to the bathroom themselves or their families are told what to do, without any physical assistance.
Further, high illiteracy rates cause lack of knowledge of safe contraceptives and early marriages, which lead to teenage pregnancies with often horrific complications during birth.
This impacts urban women as much as it does those living in rural areas. Article 21 of the Indian Constitution guarantees the Right to Life, yet before the mothers in UP even come close to safeguarding this right, schemes such as the Pradhan Mantri Matritva Vandana Yojana limit their benefits just to the first birth and to Rs 5,000 from an erstwhile Rs 6,000.
With UP’s Total Fertility Rate standing at 3.1 for 2016, the fact that government schemes only take the first child into account puts poor women in the state at a great disadvantage. Further, assuming an improved infrastructure, the reduced monetary benefit is blind to the grief of UP where awareness of and access to medical assistance is a struggle to say the least.
According to verse 30.9 of Shantiparva, Mahabharata, Bhishma Pitamaha said: "The teacher who teaches true knowledge is more important than ten instructors. The father is more important than ten such teachers of true knowledge and the mother is more important than ten such fathers. There is no greater guru than mother," .
On the top of it, corruption is rampant with the aforementioned Rs 5,000 being cut down by half by middlemen, bureaucrats and service providers. Horror stories of mothers being made to wait for hours during contractions and only being given medical attention when paid for are not unheard of in states like UP and Jharkhand.
The government has been blind to the fact that in expecting bank accounts and a direct bank transfer to curb corruption it assumes that women have a control over their bank accounts, which in a rural and patriarchal UP is rarely true, even less so for pregnant women.
Dealing with maternal rights in UP would require addressing not only institutional capabilities and access but also the psyche of the patriarchal society as well as recognising the demerits of the existing system. As the MMR remains adamantly stuck in UP, a medical crisis looms over India’s most populous state with maternal mortality being the linchpin to gender ratio, infant mortality and other health indicators.
(With inputs from IndiaSpend, Scroll and Rewire.)
(The writer is a lawyer by profession, practicing in the Delhi High Court and is a founder partner in a law firm, V&K law. Views expressed in the article are that of the writer, The Quint neither endorses nor is responsible for the same.)
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