It has been a little over three weeks since 24-year-old Sophia gave birth to her fourth daughter in a government run community health centre (CHC) in Sitapur district. When Sophia went into labour, her husband Shabbu borrowed Rs. 300 from the neighbours before he rushed to the hospital. “I had Rs. 700 and I assumed together, this would be enough. We were expecting to receive Rs. 1400 from the hospital and everything was free anyway,” he said. The family was not prepared for the persistent haggling over baksheesh that began almost as soon as the ambulance arrived to pick Sophia up.

In rural U.P., negotiations for baksheesh range from casual demands for chaff-pani to dramatic threats of injuring the bleeding mother or the newborn. Sometimes, in the labour room, cash is flung back on the OT floor when found to be insufficient. In Shabbu’s case, the ambulance drivers, hospital cleaners, and nurses were, respectively, tipped Rs. 100, Rs. 250 and Rs. 700 after the baby arrived.

“The nurses threatened us that they will hurt my wife. One of them said we will spend more money running to Lucknow, if she started bleeding suddenly. I paid what they asked,” he said. When asked about the labour room deals, Dr. Amit Singh the Medical Officer in-charge said, “We are aware but labour room deals cannot be monitored by us.” By any assessment, the deals are so entrenched in the system that it is not considered a bribe anymore — it is now an entitlement, which the bribe taker sees as a right and the giver agrees.

Catching up with MDGs

Going beyond the tipping problem it was noteworthy that Sophia’s delivery was ‘institutional’ i.e. her child was delivered in a hospital, by a skilled nurse, instead of the village’s midwife. That is a cause for celebration in Uttar Pradesh because, the past decade, the government has been haemorrhaging money in the State without being able to make a noteworthy dent in the deaths of new born babies and new mothers.

Well into the post Millennium Development Goals (MDG) era, Uttar Pradesh’s Maternal Mortality Rate (MMR) stands at 392 maternal deaths per 1,00,000 live births. India’s national average is 178, which by itself is far from the MDG target of 109. Similarly for infants, 50 babies die per 1000 live births before they complete the first year. The national figure is 40, once again missing the MDG target of 29.

U.P. is one of the worst States for women — they are least likely to be educated, most likely to die during pregnancy, most likely to bear sickly new-borns, and these new-borns are most likely to be under-nourished at the age of five years, if they reach that age at all. In the CHC where Sophia delivered the baby two numbers on a yellow chart depict the situation: MMR: 330. IMR: 82.

To mitigate these, the government introduced the Janani Suraksha Yojana (JSY), a conditional cash transfer scheme (under the National Rural Health Mission) to benefit expecting mothers such as Sophia. Under the scheme pregnant women are entitled to free medicines, hospitalisation, and free food during hospital stay, free transport (after the delivery) and a incentive of Rs. 1400 for choosing to deliver the baby at a government or private hospital.

(A notice board about the Janani Suraksha Yojana at the Khariabad community health centre in U.P.’s Sitapur. Photo: Rajeev Bhatt)

However Sophia’s family spent Rs. 1050 for the delivery but the remittance of Rs. 1400, promised under JSY, has not come in yet because the family does not have a bank account.