A sociologists detailed questioning of those near and dear to 27 women who died from childbirth in Jhagadia of Bharuch district suggests that attempts to check maternal mortality need to look beyond medical facilities and obstetrics to include the economic, social and familial conditions of women.
The study has caught the attention of state Health Minister Jaynarayan Vyas,who said he has obtained 50 extra copies and distributed them to officials in his department.
The study by Leela Visaria,honorary professor at the Gujarat Institute of Development Research (GIDR),shows that more than half the women who died were in rocky marriages and were sometimes physically assaulted even during pregnancy. One was sexually abused because she was mentally challenged; another was abused by an alcoholic father-in-law.
The husbands of some had extra-marital affairs,and the women coped badly,sometimes intentionally hurting themselves and neglecting their health. In many cases,they were largely left to fend for themselves while pregnant or their families responded late. One husband stayed away during the entire treatment,while one family told the researcher that even if she (the deceased woman) dies,it is ok with them.
Those who bore children out of wedlock were particularly worse off. A 19-year-old illiterate woman who bore a married mans child,for example, attempted an abortion twice,which worked the second time,but she died of severe infections from this. It was her first pregnancy.
A 35-year-old woman,who had been deserted,had an unattended delivery after a failed abortion late in her pregnancy. She dumped the baby in a garbage dump,which health workers retrieved. She refused to breast-feed it,however,and the child died after seven days. She too died after 25 days. It was her fourth pregnancy,and all four babies died in the neo-natal stage.
The mentally challenged woman who was sexually abused died from severe bleeding during childbirth. She had been taken for sterilisation after her first pregnancy (she was with child thrice),but she ran away and remained without family support till the end.
Of all 27 deceased,three-fifths were illiterate and belonged to families living in one-room thatched huts. Their husbands educational backgrounds were also not much different,resulting in poor employment opportunities.
Perhaps partly because of their social and economic conditions and partly because of real and perceived problems with hospitals and formal health institutions,many feared approaching these and instead relied on bhuva-bhagat or informal providers.
Visarias study very rightly concluded that maternal mortality is a complex issue and a single discipline can never fully grasp all its dimensions, Vyas told The Indian Express.
There are some constraints with the study,like the sample size being just 27. Nonetheless,this is a very good pointer and someone should extend and expand this. It clearly lays down the path of future research, he said,adding he and the officials in his department would try to digest it and see how it can be taken forward.