Women have been let down by the public health system

India, which accounts for the largest number of maternal deaths in the world, is unlikely to achieve the fifth Millennium Development Goal of reducing maternal mortality to 109 per 1,00,000 live births by 2015.

Though India has been reporting a steady decline in the maternal mortality rate (MMR), the latest figure of 178 per 1,00,000 live births in 2010-12 is an indication that the United Nations’ goal will be missed, say two reports — “Dead women talking: a civil society report on maternal deaths in India” drafted by CommonHealth and Jan Swasthya Abhiyan and “India infrastructure report — the road to universal health coverage,” released by the Infrastructure Development Finance Company here this past week.

Preventable deaths

In their report, CommonHealth and Jan Swasthya Abhiyan, a coalition for maternal-neonatal health and safe abortion, have cited gaps in the implementation of interventions by the government through the National Rural Health Mission. Their report says a significant percentage of women who died were from socially and economically disadvantaged sections.

The public health system, it says, failed women belonging to the Scheduled Castes, Scheduled Tribes, minority religious groups, those living in geographically remote areas and migrants because of the way services such as antenatal and post-partum care are structured and delivered at present.

Noting that almost all of these deaths were preventable, the report pins the blame on the health system for failure to provide maternal health care, even emergency care.

“The report shows that in spite of several programmes, there is a great gap in accountability and governance and most of the programmes have been implemented poorly on the ground. And it is the most disadvantaged women who have been let down by the public health system,” Subha Sri of CommonHealth said.

She said India currently lags behind countries like Nepal and Bangladesh in curbing these preventable deaths. “There have been health system failures at all levels, and the public health system has to be strengthened and monitoring mechanisms put in place. Our report found that the private sector too has been exploitative and of poor quality,” Dr. Sri says.

The report attributes the high death rates to various reasons, including unavailable, delayed, inappropriate emergency obstetric care, gaps in antenatal and post-partum care, delay in emergency transport, lack of abortion services and prevalence of anaemia.

The India Infrastructure Report cites low government expenditure on health sector as a reason for failure in meeting the goals. It says a large part of the population has little or no access to quality and affordable healthcare.