At 167 deaths for every one lakh live births, India’s maternal mortality rate is still much higher than the Sustainable Development Goals target of 70. How can government hospitals help change the figure?
Nearly 45,000 women die due to childbirth-related causes every year in India. It is not only the lack of infrastructure and facilities but disrespectful care which turns women away from seeking healthcare. Respectful care is important and government hospitals have even led by example in some cases. Our Community Correspondents visit the district hospitals of Sahibganj and Gumla in Jharkhand that tell starkly different stories.
When a pregnant woman went to the biggest hospital in Sahibganj, her face and breasts were pinched and mustard oil poured into her vagina. “They left the baby unattended and abused my daughter telling her that she should die,” the woman’s mother recalls the ordeal that seeking maternal healthcare at the Sahibganj District Hospital is.
Blood-stained clothes are carelessly thrown around in the wards, used medical equipment not cleared away either. The beds are in a shabby state and most toilets unusable. “This is not the experience of one woman alone, verbal and physical abuse is common in the hospital, as is the lack of hygiene,” says Shikha Pahadin, the Community Correspondent who documented the state of the hospital in 2017.
In another case, an Adivasi woman had a stillbirth because she was not given proper care. An ASHA worker (community health worker) alerted Shikha about the case, but when Shikha went to the hospital two days later, no mention of the case could be found in the hospital’s records.
Studies show that quality of care, including respectful care, affects women’s decision in accessing a particular healthcare institution. According to a 2015 report, the institutional delivery rate in rural Jharkhand was 30.6% compared to the national (rural) average of 68%. The Maternal Mortality Ratio (MMR) for Jharkhand, at 208 deaths per 100,000 live births, is also higher than the national average of 167.
Most women our correspondent spoke to were not even willing to tell their stories on camera out of fear that the (Sahibganj) hospital administration may act against them.
As per the World Health Organisation, quality of healthcare includes, but is not limited to, making healthcare people-centred. A far cry from this ideal, most women Shikha spoke to were not even willing to tell their stories on camera out of fear. They fear that if they raise their voices against the hospital administration or the doctors and nurses, they might be subjected to further abuse.
The hospital has only four regular doctors, two each for the out-patient (OPD) and emergency departments. However, most doctors on the rolls have private practices and come to the district hospital only when called for.
“The doctor on duty once went to another district and even took the hospital’s set of medical instruments with him. By the time he reached the Sahibganj hospital, the woman in labour had had a stillbirth,” says Shikha, recounting another horror story from the hospital. She adds that no action was taken against the doctor by the hospital or by the patient’s family because no one had the courage or the will to do so.
While Shikha’s video portrays a grim picture where the reproductive rights of many, many women are being violated, Community Correspondent Shanti Baraik found that the Gumla District Hospital had a different story to tell.
The Gumla District hospital is well equipped with physical infrastructure and round the clock physicians and specialists. It’s gynaecology and neonatology departments are particularly sought after by women in the district. The patients and the staff Shanti speaks to in the interview all tell her that the hospital provides all the benefits that government schemes entitle pregnant women and newborn children to.
It is the quality of care and the dedication of the staff that attracts patients, especially pregnant women, to the Gumla District Hospital.
In 2016, the hospital was awarded the Kayakalp award, instituted by the Union Health Ministry. Under the award, the hospital received a cash prize of INR 50 lakh, which it invested further in its infrastructure. But it is not only the infrastructure of the hospital that pulls patients to it, it is the quality of care and the dedication of the staff that attracts them.
“The nurses and doctors here are very nice, I like the way they talk to the patients,” says Vinita Devi from Patia village who came to the hospital for her first delivery.
The Sahibganj hospital has also received grants for expanding physical infrastructure. In April 2017, PM Modi visited the hospital and ‘dedicated’ a solar power facility there. But this did little to reduce the abuse and neglect that patients go through. Physical infrastructure is an important aspect of healthcare, but not enough when there is rampant abuse and neglect by caregivers. In areas where healthcare facilities are already few and far between, abuse can further discourage women from accessing whatever little is available to them.
In September 2016, reports of a woman being served food on the floor emerged from the Rajendra Institute of Medical Sciences in Ranchi, the state capital. The hospital staff claimed that the woman was not registered as a patient and drew flak for citing this as an explanation.
The Sahibganj District Hospital recently got its general wards moved to another building, making more room for the labour wards. But Shikha feels that it is of little consequence when the hospital is understaffed, unhygienic and full of stories of neglect. Physical access to healthcare is one roadblock to reproductive rights, the other roadblocks being informed access and quality of healthcare.
An Adivasi woman loses her child and the hospital has no records, another woman loses her life because there is no doctor and no instruments and yet another is physically abused. These are the stories of a broken health system in which poor, rural women have no space to assert their reproductive rights.
A story of neglect and apathy also surfaced in the Gumla District Hospital in August 2017 when a man who lost his son was forced to carry his body on his back because the hospital did not arrange for an ambulance. The incident shook the state and led Chief Minister Raghubar Das to intervene and get the hospital manager sacked.
At a time when major health policies like Modicare are being floated, does it take such a shameful incident for the state to ensure that its citizens are treated with basic human dignity?
Videos by Community Correspondents Shikha Pahadin and Shanti Baraik
Article by Alankrita Anand, a member of the VV editorial team
The videos have been co-published with Firstpost.