In the last 24 months alone, 62 women have died from pregnancy and childbirth-related complications in Nadurbar, Maharashtra’s most backward district.
While the average mortality rate in Maharashtra has now dropped to 68 per 1,00,000 women, it is still around 100 per 1,00,000 in Nandurbar.
Campaigners and activists put this down to early marriages and a very high fertility rate. Local doctors say that even today a tribal woman in this famished belt gives birth to an average of nearly four to five children. “With every pregnancy and birth, a woman’s risk of dying increases,” said Dr Revati Joshi, medical officer, public health centre (Bhilgaon) in Akrani’s taluka; a region seen as the most sensitive in this regard.
In the nearby Shahada taluka, Tarvi Vasave (65), has birthed 17 children — the oldest one being 50 years old, and the youngest 15. “There were almost no health facilities at that time. Many kids would die really young. People gave birth to more children to make sure some of them survived,” said Vasave.
While Vasave gave birth to 12 boys and five girls, she said that five of them — four boys and a girl — died.
Just as Nandurbar Zilla Parishad’s district health officer Nitin Bodke claimed the fertility rate had dropped over the years, Mangesh Brahmne, local coordinator for the UNICEF in Nandurbar, said that even among young women, he has come across several cases where a woman has delivered seven or more children. Click here for more election news
Vasave herself says that her daughter, Girna (25), has delivered four babies already. Girna’s husband, Kundan (27), says he does not mind performing vasectomy, but since all his four children are daughters, he still wants to “try for a boy.”
Dr Suchitra Pandit, president, Indian Society of Perinatology and Reproductive Biology, said, “There is a clear connection between high fertility rates and child-birth related complications.”
Official statistics tell the sorry tale. In 2018-19, 3,062 pregnant women out of 28,068 — roughly 13 per cent — were found to be suffering from severe anaemia, in which their haemoglobin (Hb) count was below seven at the time of childbirth. Further, given the fact that only 20 per cent of deliveries in the backward region are institutional in nature, this figure might well be understated.
Joshi admitted that severe anaemia cases were rampant, especially in the Akrani taluka. Heena Gavit, sitting BJP MP, echoed her viewpoint. “I was shocked to come across one such case where a woman’s Hb count had dropped to just two at childbirth,” she said. While Gavit said that she has been pushing an adolescent girl health care programme, local activists say “a lot more needs to be done in this regard.”
Ironically, the maternal death issue doesn’t figure much in the election narrative, where Gavit, herself a doctor, is facing a challenge from Congress’s sitting MLA, KC Padvi. Padvi, when contacted, said, “Things have improved. But I agree more needs to be done. It needs a social change.”
“That is the saddest thing. It isn’t on the priority list of tribal families,” said Brahmne. Nandurbar has the lowest human development index in the state, and is counted among the most backward districts in India. Several tribal hamlets in the region are yet to be electrified, and lack the most basic of facilities, which adversely impacts the nutritional health of pregnant women.
Joshi further said while the normal weight gain in a pregnant mother is expected to be around 9-11 kilogram, the average weight gain in these belts in a poor 5-7 kg.
“The level of haemoglobin reserves should be good for a woman about to bear a child. But when 14-15 year olds become pregnant, this can be low. This can lead to several complications,” said Pandit.
“Each repetitive pregnancy magnifies the health risks, especially when she doesn’t have access to health care. Back-to-back pregnancies can deplete essential nutrients, making mothers at higher risk for anaemia, septic shock, and post-partum haemorrhage, and also putting their babies at risk of low birth weight and pre-term birth and malnourishment,” Pandit added.
Bodke contended that the local health administration had made several interventions, and that the “things were improving.” Sources, however, said that “existing government infrastructure in the vulnerable pockets was inadequate to take special care of someone who has had a significant number of children as mandated.”