Maternal Health Rights Campaign
Jagrutha Mahila Sanghatane (JMS) continued its focus on mobilizing Dalit women around basic entitlements while deepening its focus on violence against women, maternal and neonatal health during 2014-15.
As part of Karnataka Janaarogya Chaluvali (KJC), JMS has been actively leading documentation and actions in Manvi taluk to draw attention of the district and taluk administration to problems in the public health system specifically those affecting maternal and neonatal health. Using formats developed by KJC, JMS tracked documented and analyzed 7 neonatal deaths,three maternal deaths, several instances of complications during delivery and post-partum period in three panchayat areas of Manvi taluk.
Of the 5 women who lost their newborn infants, four were first time mothers, ll belonged to SC/ ST communities and all had hb <10gm%
Two first time mothers were carrying carrying triplets and twins respectively:
- Both were seeking antenatal care in private hospital.
- The woman with triplets lost all three in a private hospital in her 7th month of pregnancy. She had visited the Tornanadinni PHC only once.
- The woman carrying twins died in a private hospital during delivery along with one newborn. She had been asked to seek antenatal and delivery care in a private nursing by the pediatrician in Manvi taluk hospital.
- The fifth newborn died because the nurses in sejjelagudda PHC did not refer the woman to the taluk hospital even though she had lost water and had started bleeding because they wanted to extract Rs.1000 from the family, a routine charge for all cases.
- The sixth because the 108 ambulance driver wanted to earn his commission from the private hospital and therefore he did not take the newborn infant to the Sindhanur taluk hospital
- The seventh newborn died because the local PHC had not picked up the risk factors of the woman who had syffered two abortions earlier and was HIV positive. She had not been informed of her EDD and had not been told that she should deliver in taluk hospital.
Of the three maternal deaths:
- All three belong to the SC/ ST community
- All were first time mothers and the women were aged less than 25 years of age.
- One died in her last stage of pregnancy while the other two died immediately after delivery.
- One died at home, one in a private hospital and the other in VIMS, Bellary.
- All three deaths were related to their Hb status:
- One woman died of convulsions in her eighth month of pregnancy and her Hb status was reported to be 7 gm%.
- The second woman died of post partum hemorrhage following a C-section and a hysterectomy. She received blood transfusion but did not survive.
- The third woman had been complaining of breathlessness, weakness and exhaustion towards the end of her pregnancy. She was shifted to the ICU in OPEC superspecialty hospital after a normal delivery. But OPEC said they can’t treat her and she was moved to a private nursing home where she died four days later.
- Two of them had sought antenatal care in private nursing homes:
- Both of them had been referred to private by government staff:
- In one instance it was the local ANM who had referred her to a private nursing home in Manvi for a commission.
- In the other case it was the pediatrician in Manvi taluk hospital who suggested that the woman go to the private hospital in Raichur on the pretext that there is no care in government hospitals for pregnant women with high risk factors.
- Both of them had been referred to private by government staff:
JMS made an independent representation signed by 80 women from the community to the Deputy Commissioner (DC) and Chief Executive Officer (CEO) about shortage of IFA tablets and demanding immediate restoration of their supply. JMS being part of Arogya Raksha Samiti (ARS) of Potnal Primary Health Centre (PHC) also sent a letter signed by the ARS members to the DC and CEO of ZP about restoring IFA tablets in the district.
Maternal Health Advocacy & Follow-up in Raichur district – JMS (2015)
JMS’ documentation and action on maternal and neonatal deaths raised an alert among sanghtans in other taluks who also documented similar cases in their areas. A district level analysis of maternal and neonatal health issues was put together by Karnataka Janaarogya Chaluvali (KJC):
- Poor identification of risk factors such as BP, anemia, history of pregnancy loss and so on
- Columns related to risk factors in Taayi cards are all blank
- ANMs and ASHA workers rarely conduct home visits to provide support for nutrition, care during pregnancy, treatment for risk factors
- No delivery planning is done with the women and her family. Example: women were not aware of the EDD
- Growing anemia is a serious threat to the lives of women and children particularly from marginalized communities. However this has NOT been addressed by the district administration. Even though IFA tablets have been in short supply for more than six months, the district administration did not make any provision for its procurement. It was left to each PHC to buy locally. Even after KJC brought it to the notice of the district administration the DHO was yet to submit a proposal for its procurement to ZP. It is the poor women and their newborn infants from marginalized communities who have paid with their lives for such a gross violation by the district health authorities. Two women needed blood transfusion at the time of delivery and one of them died. This is a silent emergency.
- Pregnant women are being sent to private nursing homes by the government staff themselves who get cuts and commissions. The DLHS survey 2010 reported that 46% of the women are delivering in private. This proportion may have increased over the years as there is active referral by the government staff ranging from doctors, specialists to ANMs and ambulance drivers. Such unethical practices have led to the death of mothers and newborns. Instead of acting on such complaints the district administration is turning a blind eye and allowing such unethical practices to flourish.
- It is unacceptable that women are pushed to seek poor quality antenatal and delivery care in the private sector, when they are supposed to receive it free of cost in the government facilities. This has led to maternal complications, deaths and increased out of pocket expenses. The district administration is guilty of inflicting such violence on women from marginalized and poor communities by not strengthening the public health system:
- 70% of the specialists’ positions are vacant in the district. There are no fulltime permanent gynecologists and obstetricians in the taluk hospitals because of which they have become dysfunctional and cannot provide first level emergency obstetric care.
- Even though there are only 8 vacant positions of medical officers in the district, most do not stay in the headquarter village and are not available round the clock in the 24X7 PHCs in the district (examples: Hirekotnekal and Sejjalgudda).
- 62% of the supervisory cadre is vacant.
- 57% of the Jr. Health Assistant (male) positions are vacant
- 40% of the Jr. Health Assistant (female) positions are vacant
- 44% of drivers positions are vacant
- 36% of group D workers positions are vacant
- 32% of pharmacist positions are vacant
- 20% of staff nurse positions are vacant
- There are only 2 out of required 7 senior pharmacists in the district
- 18% of lab technicians positions are vacant
Even though Raichur enjoys special status under Article 371J of the Constitution, the district has been discriminated against when it comes to filling up staff vacancies in the public health system. Non-availability of staff is the single most reason for increasing maternal and neonatal complications and deaths in the district.
All maternal, neonatal and infant deaths have to be audited by a committee constituted by the DC. The team should include members of women’s sanghatans and representatives of the community. However there is no transparency about the audit process in Raichur district. Typically it is the Medical Officer of the concerned PHC along with the THO who conducts the audit, which defeats its very purpose. These audit reports have not been made public and there is no information about what were the gaps identified in the system and what corrective measures were taken.
Demanding health care facilities…
JMS also participated actively in several protests and meetings by KJC’s raichur district forum:
- Protest on Independence Day, 15th August 2014, demanding restoring supply of IFA tablets: Following submission of memorandum to the District in charge Minister, the latter directed the Zilla Panchayat CEO to locally purchase IFA tablets from ZP funds and supply it to all government facilities. In about two months’ times, supply of IFA tablets was restored.
- Overnight protest against one maternal death and three neonatal deaths all on the same day in one CHC in Mudgal, Lingsgur taluk: KJC Raichur district committee staged a massive overnight protest against maternal and neonatal deaths, large-scale corruption and illegal private practice by the medical officer of the CHC, following which one staff was dismissed, one staff nurse was suspended and the medical officer’s illegal private clinic was closed.
- Meeting with the Chairperson of the Women’s Commission: JMS along with several other sanghatans participated in a district level review meeting organized by the Women’s Commission on 30th January 2015. JMS presented the various challenges women faced while accessing support in times of crisis and the gaps in the functioning of the various departments. The Chairperson of the Women’s Commission while issuing directives to the respective departments also thanked JMS and other sanghatans for bringing these issues to her notice and urged them to keep in touch.
These protests were widely reported by the state level and local media. Subsequently the state department of health and family welfare conducted a kind of death audit through video conference where family members presented their testimonies.