India, despite poor health care, sees drop in maternal mortality
Maternal mortality in India has fallen by 60 percent since 1980, despite widespread poverty and skeletal health care. The progress surprised some health-care workers.
New Delhi — It is rare good news for poor women in India. A new report has found a significant drop in the rate at which women across the world die as a result of childbirth – with one of the most dramatic falls in India.
Maternal deaths in India decreased from 677 per 100,000 live births in 1980 to 254 in 2008, according to a study published in the Lancet, a leading British medical journal, in April.
“The overall message, for the first time in a generation, is one of persistent and welcome progress,” wrote the Lancet’s editor, Richard Horton.
The reasons for the drop in India are broadly the same as those worldwide: improved prenatal care and the presence, during labor, of skilled medical professionals. Improved access to education – which makes women more likely to know how to care for themselves and their children – has also made a difference.
Surprised by progress
Many health-care workers in India are surprised that such an improvement occurred here. Despite a booming economy that has grown at a heady 9 percent in recent years, social inequalities are growing and a skeletal health-care system remains woefully inadequate for the needs of a billion-plus, still largely rural, population.
The study’s authors point out in the report that researching maternal mortality rates in India is complicated by the country’s numerous – sometimes conflicting – data sources. But they conclude that the most reliable sources did suggest “a substantial decrease in maternal mortality.”
Medical professionals cite as particularly beneficial a government scheme designed to supplement a network of doctors and medical centers that is patchy at best and in many areas nonexistent. The Janani Suraksha Yojana (JSY) encourages women to go into clinics and hospitals to give birth.
The central government says more than nine million women joined the JSY scheme in 2009, up from a little over 700,000 in 2006.
Still a high rate
Still, India has a long, long way to go.
Earlier this week, Save the Children, an NGO, published a new State of the World’s Mothers report, which showed that India ranked first among 12 countries that account for two-thirds of under-five and maternal deaths in the world.
It added that the JSY scheme had “not been able to make the desired impact especially in the States with high maternal and child mortality rates and has been bogged down in irregularities…”
Indeed, India’s long-term shortage of poor or nonexistent medical care has led to a mistrust of doctors and hospitals, even in its big cities.
Take Sunita, who, like most women in her remote village in Madhya Pradesh, central India, gave birth at home.
Each of her four children arrived so suddenly she had no time to call a midwife – a term in rural India that tends to describe a woman from a low caste, with no medical training, who uses centuries-old customs to help women in labor.
Even if a doctor or hospital midwife had been available, Sunita would have refused their care, she says. “I have never been to a hospital and I will never go to a hospital,” says mother, who today works as a road builder in the capital, New Delhi.
She adds that if she fell pregnant in Delhi she would give birth in her one-room tarpaulin shack beneath a busy highway ramp.