ahmedabad: nearly 1.2 lakh pregnant women die in india each year, especially in rural areas. gujarat's component: 4,000. india, in fact, is responsible for over 20 per cent of all maternal deaths in the world. this may shock a layman, but not a health professional. the numbers have not declined in the last decade despite plethora of health policies. and, india continues to grapple with this menace with obsolete methods, like developing a network of public health centres (phcs). a study by iim-a associate professor dileep mavlankar states that phcs simply don't have the capacity to handle emergencies that pregnant women may face. in his paper, policy barriers preventing access to obstetric care in rural india, he has said instead of basic health services, such women need emergency obstetric care. even countries in africa and latin america have realised this and have changed their health policies accordingly. "unfortunately, this knowledge has not been communicated in india to policy-makers and programme implementers," mavalankar says. "the recent population policy and draft health policy of the centre do not fully recognise the importance of emergency obstetric care in reducing maternal mortality." he points to three basic flaws in the health policy: allowing only qualified obstetricians, to perform caesarean operations or any abdominal surgery, allowing only anaesthetists to administer anaesthesia and creating utopian guidelines to license blood banks. "basic doctors (mbbs) are not allowed caesareans even during an emergency," he says. "countries in africa and latin america allow this after some training. having an obstetrician at every phc is impossible when you consider that 70 per cent of our population lives in 5.5 lakh villages." not surprisingly, in many districts there are only two obstetricians for a population of two million. the same applies to anaesthetists with one to six anaesthetists in each district on an average. gynaecologist rajan joshi believes you don't always need a caesarean during an emergency. "normal methods can suffice," he says. "but mbbs doctors first need to be trained. i feel uncertain about basic doctors conducting caesareans." he, however, feels more doctors would be ready to spend time at a phc if better facilities and pay are offered. "i remember animals crawling in the phc when i was training in the 1980s. many countries have made it mandatory for doctors to go to rural centres but no one minds it as they are paid heavily and helped in settling in the rural setting." though rules for blood banks have improved after the aids scare, they have brought many unnecessary norms as well. for instance, it is mandatory for a bank to have at least eight rooms and three air-conditioners, a norm that would make blood banks unviable in rural areas where barely a couple of bottles are sold daily. founder member of prathma blood bank jagdish buch could not agree more. "doctors in rural areas often operate on women with less than five grams of haemoglobin," he says. "anything below eight grams would be unthinkable in urban centres, but these doctors have no choice." buch adds they have both the infrastructure and stock to open satellite centres in rural areas, but for the restrictive norms. in fact, they had one such centre at rajasthan hospital which was shut down by the food and drugs authority. "now, those patients depend on who can run faster, either them or us." mavalankar, who has been working in the public health sector for many years as part of iim's public systems group, says many factors are responsible for such policies. for starters, doctors associations have a strong urban bias and want to protect their private sector earnings. besides policy-makers are ministers who lack technical qualifications and heath secretaries are career bureaucrats. "also, there has been too much focus on birth control and polio vaccination programmes neglecting everything else. emergency obstetric care have been one of the casualties".