NEW DELHI — Tens of thousands of Indian women die needlessly every year
during pregnancy or because of childbirth-related problems, a human rights group
said Wednesday, blaming a medical system hobbled by poor planning, caste
discrimination, a lack of accountability and limited access to emergency care.
India has a maternal mortality rate 16 times higher than Russia, and 10 times
higher than China, Human Rights Watch said in a report. That means one out of
every 70 Indian women who reach reproductive age will die because of pregnancy,
childbirth or during unsafe abortions.
“For an emerging global economic power famous for its medical prowess, India
continues to have unacceptably high maternal mortality levels,” the report said.
Aruna Kashyap, a lead researcher on the report, summed it up simply:
“Seventy-five percent of maternal deaths (in India) are preventable.”
While India has had an overall decline in maternal mortality in the past few
years, the rights group says those figures mask continuing — and sometimes
worsening — problems in parts of the country.
Some states, including the heavily populated north Indian states of Haryana and
Punjab, “actually showed an increase in maternal mortality. And significant
disparities based on income, caste, place of residence and other arbitrary
factors persist even within every state, including those that appear to be
improving access to care for pregnant women and mothers.”
The results have led to staggering numbers. In 2005, the last year for which
overall figures were available, about 117,000 women died due to maternal-related
reasons, Kashyap said.
A big part of the problem, the report found, was a lack of accountability over
maternal mortality, with government officials, hospitals and health workers
dodging responsibility for the problems that lead to such high death rates.
Those problems range from ill-trained obstetric staff to charging crippling fees
to poor villagers — $10 for a delivery in some clinics, plus $1 to cut the
umbilical cord and $1 for the delivery room cleaner. Those numbers may not look
high, but many Indian villagers support their families on less than $2 a day,
and are seldom able to save at all.
Plus, deliveries, and pre- and postnatal care are supposed to be free.
“These guarantees exist on paper, but when it comes to translating paper
guarantees into practice there’s a big gap,” Kashyap said in an interview.
The report said that in Uttar Pradesh, the country’s most populous state, only
about one in 100 community health centers, the government-run clinics where many
women deliver, have storage facilities for blood. In many smaller hospitals,
even minor complications often require transporting mothers more than 60 miles
(100 kilometers) over bad roads to larger hospitals.
In addition, caste discrimination continues to plague Indian mothers. One 2007
study in six north Indian states found that 61 percent of maternal deaths were
among Dalits — as “untouchables” are now called — and the indigenous people
known here as tribals, Human Rights Watch said. Those two communities are at the
very bottom of India’s complex social ladder, and are far more likely to live
without equal access to jobs, education or health care.
In Uttar Pradesh, caste discrimination is an ingrained part of the medical
system, doctors and activists say.
“Upper-caste health workers refuse to visit Dalit communities,” said Lenin
Raghuvanshi, a rights activist. Because of that “pregnant Dalit women do not get
(nutritional) supplements and the majority of them are anemic.”
Human Rights Watch made a series of recommendations to improve maternal medical
care, including requiring that all pregnancy-related deaths be formally reported
to authorities, institutionalizing a system of investigating those deaths and
establishing an early response system, including a telephone hot line, for
obstetric emergencies.
