Society Rajasthan's
Lifelines to Motherhood
by Neeta Lal
Last year,
Kamla, 28, a poor farmer in Rajasthan's Dholpur district, was
flabbergasted to see her eight-month-old fetus pop out of her uterus as
she toiled in a field. Bleeding profusely, the hapless woman fainted on
the spot. Thankfully, Kamla's co-worker, Sunehri, kept her wits about
her and rushed to a phone booth to contact a local obstetric helpline.
Within minutes, a van taxied in to ferry Kamla to a local hospital where
she safely delivered a baby boy.
For scores of mothers-to-be like Kamla, the Janani Suraksha Obstetric
Helplines - set up across 28 districts in Rajasthan under the Central
government's Janani Suraksha Yojana (JSY) scheme launched in 2005 - are
proving to be a blessing. A pan-India, safe motherhood intervention
project under the National Rural Health Mission (NRHM), JSY aims to
whittle down maternal and neo-natal mortality by promoting institutional
delivery among poor women. Overall, the project hopes to ensure that the
Maternal Mortality Rate (MMR - number of deaths per 100,000 live births
in a year) declines from 400-plus to 100 and the Infant Mortality Rate
(the number of deaths per 1,000 live births) from 55 to 40.
Rajasthan's 28, 24-hour helplines, which were set up in 2006 are also
supported by UNICEF. Apart from assisting pregnant women with early
registration at a local health centre, the helpline workers also take
charge of antenatal and postnatal care and arrange for transport to the
health centre at the time of delivery. In case a woman reaches on her
own to the first referral unit, re- imbursement of transportation
expenditure is made under JSY. And if she is not registered under the
scheme as a beneficiary, payment is made for transport by the helpline
staff. UNICEF inputs under the scheme include technical support, funding
to train resource persons and grassroots functionaries, conducting
sensitization workshops to familiarize communities with the helpline
system (especially its emergency phone number), workshops with private
vehicle operators and the infrastructure cost.
The JSY helpline system works seamlessly. Once the emergency call is
received, the staff immediately contacts a registered taxi, which picks
up and ferries the pregnant woman to the nearest health centre. At the
centre, the helpline staff coordinates the patient's admission and
hospital stay.
The initiative works on a simple system of mobile connectivity.
Currently, 28 NGOs in Rajasthan have been tapped to operate in select
blocks in as many districts. About half-a-dozen field workers in every
block have been given a mobile phone each. The helpline numbers have
been provided by Bharat Sanchar Nigam Limited along with 178 mobile
handsets for workers under the project.
One of the most important positive outcomes of this programme has been
that all across Rajasthan - the first state in the country to boast of
such helplines - the well-being of the mother/newborn is increasingly
becoming a close-knit community affair. As the JSY helpline focuses on a
strong referral service for women with obstetric emergencies, all
vehicles (state or private?) in the covered villages/blocks are
identified and registered. In cases of emergencies - when pregnant women
need to be rushed to health centers - the referral service is made
available immediately. A strong network is also built among the vehicle
owners, people with access to telephones and cell phones. This ensures
that the doctors/medical staff is present at the local medical centre
when the pregnant woman arrives. Much emphasis is laid on the
involvement/support of the local people to make the project a success.
Says an NRHM official, "From being just a pregnant woman's
responsibility, childbirth has now assumed the importance of a community
exercise, where everybody pitches in to ensure the well-being of the
mother and the newborn. This is a very healthy sociological
development."
Indeed JSY's helpline hasn't come a day too soon considering India
accounts for a sizeable 20 per cent of the world's maternal mortality
cases, according to UNICEF. Worse, in Rajasthan, low literacy, poor
infrastructure and poverty ratchet up this ratio to an alarming 445 per
100,000 births - one of the highest in the world.
According to the UN, more women in India die during pregnancy and
childbirth than in any other country in the world. India's MMR is thus
disquieting with one pregnant woman dying every five minutes. According
Paul Hunt, a human rights expert with the UN, who was in India recently,
India's MMR is "shocking" for a middle-income country. Hunt stated that
the Indian MMR is six times that of China's, 14 times that of Chile's
and eight times worse than even Cuba's, a country, which has been
witnessing political upheaval for the past few years.
"Most of the maternal deaths in India are avoidable as they are caused
by poor nutrition, abysmal antenatal care, home births which trigger
delivery complications and poor access to health clinics," says a health
project officer for UNICEF in Rajasthan. Poverty, poor transport and
health infrastructure force over 70 per cent of the women in the state
to deliver at home which could result in maternal deaths due to
hemorrhage, eclampsia, infections, obstructed labor, abortion and
anemia. "Due to insufficient health information, the poor often think
that if a pregnant woman has pain or bleeding, it is part and parcel of
a normal delivery," says the health officer. "This misinformation often
reduces mothers-to-be to a 'maternal death' statistic."
The World Health Organization (WHO) defines "maternal death" as "death
of women while pregnant or within 42 days of termination of pregnancy
from any cause related to or aggravated by pregnancy or its management."
While there are various reasons for India's high MMR, including early
marriage and childbirth, lack of adequate health care facilities,
inadequate nutrition and absence of skilled personnel worsen the
situation. The level of maternal mortality is an indicator of the
socio-economic growth and the health conditions of a society.
Though official figures of the JSY's helpline scheme's efficacy are yet
to be tabulated, there's no denying that the intervention programme has
altered the community dynamics in Rajasthan by focusing more on the
health of pregnant women and newborn children. Consequently, it has also
improved pregnancy outcomes through institutionalized deliveries.
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