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Society
Maternal
Mortality
Civil Societies Call for Action
by Anil Gulati
Munna was nine months
pregnant. She did experience pains few days back, when her husband and
mother-in-law rushed her to the nearest primary health centre in Kushwai
of the District Shahdol in the State of Madhya Pradesh in India. They
had to make her travel by bus from their village, and then in pain Munna
had to walk, which she could barely to reach the health centre.
But unfortunately the Kushwai health centre, where they had come with
lot of hopes, did not had a medical doctor for last one and half years.
One male health worker mans the centre. Though, he puts in his best but
that may not be enough for women like Munna and others who need medical
support.
Inspite of reaching the primary health centre, she did not get any help.
She has to travel another eight kilometers to Burhar, the place where
there is a community health centre. The centre is fortunately newly
built and has facilities for delivery. Munna did develop some
complications during the delivery but fortunately survived to see her
new born.
She was lucky but thousands of women which die in the state are not. App
10,000 women die every year in Madhya Pradesh during pregnancy or within
42 days after pregnancy. Majority of these could be prevented. Medically
these deaths may be due to hemorrhage, infection, eclampsia or unsafe
abortion or any of three delays. But fact is there exists a yawning gap
in our health system which stands in between life and death of women in
the state. This gap has linkage to availability and access to health
services, infrastructure, awareness among communities of not only the
services but even recognizing danger signs, issue of how where they can
access the services etc. Studies also tells us that for every maternal
death in India, 20 more women suffer from the impaired health.
But if the situation at ground is like this, and has been there. What is
the state’s response to an issue like this? Does it impact the political
leaders, their discourse? Does issue of women dying in the state is
debated in discussions where funds are allocated or decisions are made?
Does state’s machinery care for it? Does civil society raise its
concern?
The year 2004
To answer some of these questions a dip stick assessment was done in
year 2004 at various levels within civil society, debates in the state
assembly, media analysis. Outcomes were revealing. First of all the
issue concerned only few in health department. There were only handful
of civil society partners, and their major role was to support service
delivery system. As such there was no push or urgency to bring change.
Interestingly, the issue had never being debated on the floor of the
state assembly, a place where elected representatives ‘of the people,
for the people and by the people’ decide. It did not impact them, many
of them were not even aware of the fact that state has this high number
of maternal deaths? An issue like this was never raised by the political
leaders in the debates which happen there – an issue of total neglect at
the highest political body. Media covered ‘event news’ around the safe
motherhood day, probably they never got the right information too.
Present
That was a starting point, but nevertheless situation has changed today.
Today state recognizes it as a major issue when it comes to women and
children. State calls for an action. It is on high priority list of the
political head of the state, state party is being questioned on the
number of deaths, gaps on the infrastructure and many related points.
Today more than 150 civil society organizations are raising concern on
the issue and demanding urgency and urgency of action in the state.
How it happened and what does it impact and what strengths does it
generate? Movements don't just happen; the energy that underlies them
must be marshaled, channeled, and focused. The principal means by which
this is achieved in our society, and within our political tradition, is
through advocacy networks and coalitions.
Networks like Madhya Pradesh Voluntary Health Association, Madhya
Pradesh Jan Adhikar Manch and Collective for advocacy, resource and
training, Madhya Pradesh Samaj Sewa Sanstha, Mahila Chetna Manch, and
many others have not only contributed to help bring the issue at an
individual level but as a part of informal collation added to that force
which helped bringing the agenda on political normative framework. Some
of the strengths which this informal network helped bring were the
numbers of civil society partners raising concern on the issue spread
across different regions of the state. From a handful few now it is more
than 150 civil society partners in the state working in all divisions to
bring the issue to forefront. The turn around is also in their way of
working from being a service delivery partners or a social mobilization
partners in supportive and submissive role in a new avatar of advocacy
partner. In this new role civil society speaks on the issue of right to
health, its violation, demands state’s accountability to provide for
safe motherhood. In this new business influencing people who make
decisions which impact human lives is the key.
The primary target of the civil society was to bring the issues which
impact lives of women at the villages, blocks and districts to the
agenda of the people who make or influence decisions, i.e. state
assembly debates, political leaders, members of legislative assembly,
ministers, media, rights commission etc. They had been to some part
successful. Expression of this concern was undertaken by directly
meeting and sensitizing political leaders. The evidences highlighting
gap were shared with political leaders, urging them to rise above
politics and give a strong call for action. These non governmental
organizations wrote memorandums, shared information and collected
evidences for the same purpose. Media engagement also supported by
providing an enabling environment for change. Strong evidences i.e. case
of maternal deaths which can be presented, health system gaps were
highlighted which added pressure on the state and the leaders to react.
Resultant of this solid gains achieved. Today questions on maternal
mortality are being raised in the state assembly, the highest policy
making body of the state. It is not just few many voices are being
publicly heard on the issue. There is a increased concern within media.
From nowhere it came to a point where state publicly acknowledge the
problem, and its commitment to act. Many new polices and schemes have
been announced and that too in the rapid succession. This amount of
concern and even expressed publicly by leaders had never been seen
earlier in the state on the issue of maternal mortality. But that is not
enough today empowered civil society and media is always looking with
eagle’s eye on the new measures of the state and vocally points out the
gaps This is a positive sign, where people are voicing their opinion.
But it is not easy as said. Political leaders have started picking up
real cases of deaths, gaps in infrastructure in the state, violation of
rights, gaps in policies and seeking answers to what is being done by
the state to response to the situation.
Advocacy experts tell us that ‘people centered advocacy’ is the best,
i.e. position when people who suffer can speak for themselves. A step
has been taken in the same direction by the engaged networks. Madhya
Pradesh Jan Adhikar Manch in their work with communities helped to bring
the issue to debate in various gram sabhas which were held by panchayats
in Gwalior – Chambal division. Similarly women who had participated in
various women conventions hosted by Madhya Pradesh Samaj Sewa Sanstha
came forward and wrote about the problems women face in rural areas when
it comes to issue of safe motherhood and why do women die in their
villages while giving birth. As per sources of Madhya Pradesh Samaj Sewa
Sanstha more than 200 women have written to the Chief Minister. On a
simple fifty paise post card, they wrote by themselves and it was send
to the Chief Minister. It looks simple but powerful, if it gets to his
eyes. Recently a large number of women from villages across Madhya
Pradesh have joined a signature (or thumb-impression) campaign to press
for their right to health and to call upon the Government to ensure that
the dream of safe motherhood becomes a reality. As a part of a special
drive to raise concern on this crucial issue, more than 20,000 women
from different villages of the State are now in the process of signing
(or placing their thumb impression) on a various banners demanding the
right to health and calling upon the State to ensure that the dream of
safe motherhood becomes a reality. Madhya Pradesh Voluntary Health
Association, Madhya Pradesh Samaj Sewa Sanstha are the civil society
partners who are collecting these signatures/thumb impressions of women.
They say that they do so after they are adequately sensitizing them on
the issue of maternal mortality. Then if they feel that some concrete
action is needed to improve the situation, they come and sign. Plan is
to present the banners with their signatures to policy makers.
One might say that this is good effort, which indeed it is to bring the
agenda of maternal mortality on to the political and action framework
but it is still a long way to go. This is true. But if one looks back
one and half years where there was hardly any concern, hardly anyone
called for action, except few that too ‘within the box’. The focus was
limited. From nowhere it has come somewhere, which is an important
achievement by any means. Need of the day is to provide possible answers
to the state, which is willing to listen. Answers which can help deliver
results, within the context of the field realties and socio – cultural
aspects – a new call to many !
December 24 2006
Top |
Society
The Week of December 24, 2006
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2006 : The Year of Indian Diaspora by Aroonim
Bhuyan
Bloody 2006: No End to Violence in 2007 by
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A Bold Judiciary Augurs Well for the Nation by
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A Samuel Pepys of Emergency India by V.
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Which God's Own Country by J. Ajithkumar
Communist Turnaround : From 'Land to Tiller' to
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Communalism or Affirmative Action by Ram
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Counting on People by Swapna Majumdar
A Tribute to a Poet by V. Sundaram
Urban Floods: Bane for
the People by VK Joshi
Tackling the
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In Quest of Space Colonization by Subra
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Psoriasis by Dr. Savitha Suri
Toxic Blood by Yasmin Rimi
Investing in Indian Real Estate: Is Your Checklist
Complete? by Sandeep Donald Shah
Why is Literature Indispensable for Human Life?
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Three Cheers for Thuggee Raj! by V. Sundram
Recognition for NARI's Work - A Report
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A Lonely Christmas in Jerusalem Shoshana
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Exposing the Hidden Half by Devindra Kohli
Porn & Mainstream Media Boundaries have become
Blurred by Elsa sherin Mathews
Mothers' Help: Home Surveillance Systems by
Gagandeep Kaur
Kerala's Feisty Fisherwomen by Nilanjana Biswas
Maternal Mortality: Civil Societies Call for Action
by Anil Gulati
The Olympics in London by Rajesh Talwar
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