Research Area : Women's health
Globally, every year over 500,000 women die of pregnancy related causes and 99 percent of these occur in developing countries. The Millennium Development Goals (MDG) of the United Nations has set the target of achieving 200 maternal deaths per lakh of live births by 2007 and 109 per lakh of live births by 2015. India as a whole and most states within it lag behind this target considerably. India has a fragmented and myopic approach to addressing maternal health, which is a part of the problem. Through this project, CEHAT has been attempting to highlight the gaps in maternal health related policies and programs in India and make a case for a broader, more comprehensive and rights-based approach to addressing the issue of maternal health.
In the past year, a national level review on policies related to maternal health was carried out, which threw light on the many lacunae both at policy and implementation levels. The review found that India’s policies focus very narrowly on reducing maternal mortality, while overlooking the broader framework of sexual and reproductive rights. As a result, several important issues affecting the health of women are not even addressed. Abortion as a right finds no place in policy and efforts of the government to improve maternal health do not take into consideration ensuring right to abortion services. Prevention of unwanted pregnancies is an integral part of sexual and reproductive rights, but our programs continue to push female sterilization as the only method of contraception, without providing women with other options. Similarly, domestic violence which is known to have an impact on women’s control over their fertility, as well as pre and post partum health of mothers is not even addressed as an issue of concern. Policy and programs continue to focus their attention solely on ensuring institutional deliveries, but issues such as violence faced by women during childbirth at the hands of health professionals remains unacknowledged. Post-natal care, the review finds, is extremely poor, and not much effort is being made to improve it. Awareness and access to safe and legal abortion services too is poor. These are serious blind spots at the policy level. In terms of provision of services, the review found an overwhelming presence of the private sector in this regard. Public-Private Partnerships to encourage institutional deliveries have been implemented without any sort of regulation of the private partners. This has implications for quality of services as well as equity in access. Even apart from the PPPS, the overwhelming majority of services such as ANC are accessed from the private sector where its presence is great. In terms of access to services too, the review found stark inequalities based on class, caste, religion, urban/rural location in access to services.
While the national level policy review has pointed out significant gaps, what is evidence is that several policies and programs related to maternal health are implemented at the state level. In the coming year, we aim to look at the specific intervention states and districts with the objective of identifying these policies, gaps therein and their implementation on the ground. The two states that have been selected for the forthcoming year are Bihar and Odisha. Specific state policies and programs related to maternal health will be identified and analysed. PIPs of the selected intervention districts will be analysed with a focus on identifying gaps specifically related to referral services, emergency obstetric care, availability of medicines etc. Data from interventions being conducted by partners in the respective states will also be looked at. Policy papers and policy briefs for the two states will be prepared which would be useful for state level advocacy.
In addition to this, based on the data collected as part of the GPAF project, a national level policy paper will be prepared. A consultation bringing together a national advisory group on maternal health will be organized at the end of the year. It will consist of government representatives, domain experts as well as partners of the GPAF project.
Team: Sana Contractor, Padma Deosthali, Sumeet Pokharnikar, Dhruv Kulshreshta, Tejal Barai Jaitley, Oommen Kurian
Supported by: Oxfam India