Women, interrupted

This high number of dying mothers is confirmed, incidentally, by a recentreport of the United Nations Population Fund UNFPA, which states that fourmothers die for every 1,000 live births in India, or one woman dies due topregnancy and childbirth every five minutes in this country. Orissa stillrecords the highest number of such deaths 739 and Kerala, the lowest87.

There are, of course, good reasons for these deaths, and they have beenextensively documented over the years. The Voluntary Health Association ofIndia VHAI in its last report underlined two of them: lack of generalhealth care, and the absence of a rational management of high risk mothersand those needing emergency obstetric care. For every woman who surviveschildbirth, VHAI points out, 18 to 20 are left with serious complicationslike cervical lacerations, pelvic inflammatory diseases, uterine or bladderprolapse. UNFPA figures indicate that 12 per cent of such deaths can beattributed to abortion-related complications; 20 per cent to anaemia; 13 percent each to toxemia and sepsis and 23 per cent to excessive bleeding.

All these figures add up to a bleak narrative of national priorities andpersonal compulsions; of social norms and individual choices and of age-oldgender discrimination. The media made a great deal of one particularstatistic that emerged from the NFHS-2 3 out of 5 women believe thatwife-beating is justified. But why should that surprise anyone in asituation in which at least 30 per cent of women aged 15-19 are married,many of them much before the legally minimum age of 18? When at 1 in 5 haveexperienced domestic violence? When 68 per cent of woman have to ask forpermission to go to the market and 76 per cent, to visit a friend orrelative? Not entirely surprisingly, low powers of decision-making was mostmanifest in Bihar, UP, Rajasthan and MP.

The persistence of early marriage was one of the disturbing trends and,interestingly, very little seems to have changed on this issue from the daysof the first NFHS survey conducted in 8217;92-8217;93. The median age of the firstchildbirth for women aged 20-49 was unchanged at 19.6. Even when change hadoccurred, as in the declines witnessed in child mortality rates, things werestill dire.

There is evidence of 1 in 15 children dying within the first year of life,with infant mortality levels being 56 per cent higher in rural areas andwith the risk of dying for girls, aged between 1 and 5, 47 per cent higherthan for their male counterparts.

Health and education then continue to be priority areas for possibleintervention. The NFHS-2 findings clearly indicate that educating girlsremains the best health investment the state can make. Whether it is inpostponing the age of marriage; bringing down infant mortality rateschildren born to illiterate mothers are more than twice as likely to beunderweight or stunted as children born to mothers who have completed atleast high school; providing better nutrition within the family; or inpegging down fertility rates the TFR, or total fertility rate, for womenwho have completed at least high school is 2 children, compared to the TFRof 3.5 for illiterate women, female education changed the pictureradically.

At a time when the state is increasingly withdrawing from the social welfaresector, recent data highlights the crucial role that public healthcareinstitutions continue to play in people8217;s lives. While 70-80 per cent ofhealthcare in India is handled by the private sector, the State remains theprimary source of preventive services, such as immunisation, maternalhealthcare and family planning services. With cutbacks in funding to publichospitals even supplies of iron and folic acid tables, so important inantenatal care, tend to be erratic, even unavailable.

What comes through is the neglect of health in the everyday life of Indians.Only 50 per cent of women participated in decisions concerning their ownhealth, according to the NFHS-2. The UNFPA Report highlights that health,especially women8217;s health, is just not a priority area for most families. In25 per cent of cases involving maternal death, family members were not evenaware of the seriousness of the woman8217;s condition. Combine this with theexisting levels of disease and malnutrition said to be the highest in theworld for women and children and you have all the elements of a tragedy.

In the NFHS-2 survey, about 1 in 10 women never consume milk or curd and 1in 3 have never eaten chicken, meat or fish. In some states, like Orissa,the problem is even more marked, with 50 per cent undernourishment amongwomen reported. At a national level, 52 per cent of women suffer fromanaemia. It is no surprise that children are also affected 74 per centIndian children are anaemic.

It8217;s time to stop considering a nation8217;s health just in terms of GDP. We8217;refacing nothing short of an emergency, no less significant for the silencethat enshrouds it. Of course, there are the occasional spots of brightnessin this picture. Today, one-third of deliveries take place in healthfacilities, the NFHS-2 tells us up from one-quarter last time. We need toreplicate these success stories in regions where death sits like a familymember at the dinner table.