Despite the government’s promises, lack of infrastructure and problems of access endanger maternal health across rural India. Communities are stepping in and holding the system accountable.
Lali Roy Baraik is a young mother of two. In 2008, when she was pregnant for the first time, she did not visit a hospital. “I delivered at home. I was not prepared; it happened suddenly. There was no one else at home, not even my husband. I tried going out and asking for help. By the time the ambulance came, I had already given birth so I didn’t go to the hospital,” she recounts.
Baraik is not an exception but the norm. In her area in the Shikharpur tea estate in West Bengal’s Jalpaiguri district, the frontline health workers and anganwadi workers undertook a research which revealed that most women were giving birth at home despite adequate health facilities available in their vicinity.
In 2005, the government launched one of its flagship maternal health schemes, the Janani Suraksha Yojana (JSY)– a conditional cash transfer scheme that aimed to reduce maternal mortality by incentivising institutional deliveries. The largest conditional cash transfer scheme in the world, JSY aims to reduce out of pocket expenditure for deliveries. Despite its promises of free ambulances, free stay at hospitals and free medication in addition to cash incentives, many women continue to remain out of its ambit.
The reasons are twofold. There are problems with delivering the services, especially with poor infrastructure, shortage of staff and corruption. But there’s more to the story. Research among women in Shikharpur in Jalpaiguri revealed that women were not aware of any of the facilities available to them and were also impeded and intimidated by the language barrier with service providers.
But people across rural India are coming together as communities to solve both problems of access and information as well as redressing infrastructural and service delivery shortages that impact maternal health.
In Shikharpur, the frontline health workers were activated by the Child in Need Institute (CINI), a non-governmental organisation. In turn, the ASHA workers went into their communities disseminating knowledge about maternal health and the rights of women to access healthcare.
Kamla Lohar, an ASHA worker in the area, says, “they were not aware of their rights and entitlements. We informed them about the government facilities– that they get medicines for free, that they don’t have to pay for transport. Previously, they had no information about these things. We also accompany them to the hospitals and the right health facilities.”
Baraik also delivered her second child at the local hospital. In 2016, out of the 67 pregnant women in the village, only three delivered at home, and in 2017, there have been no home deliveries.
At the other end of the country, Rajasthan is one of the states with high maternal mortality rates. The National Family Health Survey data from 2015-16 reveals that only 65% rural women delivered at a public health facility in the state.
One of the reasons is that, like in the Bhoola village of Sirohi district, there are simply no facilities equipped to deal with deliveries. The village only had a sub-health centre with no delivery room. Kanhailal Agrawal, the village council head of Bhoola, says “Women were forced to travel up to 35 kilometres to the nearest facility. Government ambulances are useless, most of the time the phone is engaged or they arrive after an hour. So, we had to hire private vehicles for transportation. Patients living in the interior areas, about five kilometres away from the main road, had to be carried on homemade stretchers to the road.”
But Kanhailal was not one to sit and watch as his community members risked death due to unavailability of basic infrastructure. He joined hands with a local social worker, Sohan, to find a solution.
Rajasthan has a unique healthcare institution in the form of the Rajasthan Medicare Relief Societies (RMRS). Modelled after the Rogi Kalyan Samiti of Madhya Pradesh, RMRS was started in 1995 in the bigger public hospitals. By 2005, they were present in all health facilities including the Primary Health Centres. This independent body ensures the smooth functioning and service provision at all public healthcare facilities in the state.
But in Bhoola, there was no active RMRS. As a first step, Sohan ensured the reactivation of this important institution. It was not easy. Kanhailal joined the RMRS and they kept petitioning the government to start a Primary Health Centre, even with the threat of a hunger strike. As a result of their tireless activism, Bhoola is on its way to get its own Primary Health Centre where the residents can get proper treatment and women no longer have to travel far for delivery. Bhoola is the perfect example of how change is possible when the community is mobilised into action.
70 kilometres from Udaipur, in Jambuda village, the same problem plagues the residents: no delivery room in the Sub Health Centre. This forced pregnant women to travel over 50 kilometres to access proper healthcare facilities.
Kanta Devi, a resident of the village recounts how 20 years ago, a pregnant woman lost her life because of the lack of facilities. “She had gone to fetch water when she went into labour. By the time the midwife attended to her, she was already in a critical state and lost her life.” Women from the village came together and wrote a petition that was first given to the local village council (gram sabha) and then forwarded to the Block Development Officer (BDO). The construction of a labour room was sanctioned and an amount 2 lakh rupees raised. More importantly, there have been structural changes in the way women’s health is perceived in the community today. Divya Bhagora, the female village head, says “Earlier women did not participate the village council meetings, nor was women’s health considered an important topic of discussion at these meetings. Since I became the village head, I started asking the women to join in and today, they participate regularly.” Thanks to the initiative of changemakers like Divya, things are slowly but surely changing for women across rural India.
While on paper, schemes like the JSY sound perfect, the daily reality of pregnant women proves how government promises fall short in their implementation. Today, communities and the women themselves are realising their potential in effecting change and holding the government accountable. Communities have not only emerged as effective monitoring institutions for government schemes but their collective action is forcing the government to enact the schemes on ground and provide better services.
These stories of hope from Rajasthan and West Bengal show the way forward: bettering maternal health is not a matter of faceless statistics and numbers. It lies in the stories of real women who now feel confident about accessing healthcare and know their rights.
Videos from Rajasthan by Community Correspondent Shambhulal Khatik
Video from West Bengal by Community Correspondent Susanti Indwar
Article by Madhura Chakraborty, a member of the VV editorial team
These videos have been co-published with Firstpost.