Dying to give birth, quite literally

In this age of cynicism, what figures of deaths - caused by nature, accidents, war and ourselves - would prove enough to jolt us out of our boredom? Fifty thousand? Hundred thousand?

Five hundred thousand, that is, half a million? And what about the figures of those maimed or injured for life? Would a figure of thirty times half a million wake you up? And if I were to say that about 80 to 85% of these needn't have happened, would that sadden you? Would it make you despair?

The truth is, these figures are real, not hypothetical and refer to women who either lose their lives or are maimed by what should have been the most natural thing in the world - childbirth.
India has 20% of the world's maternal deaths. And about 32% of the world's infant deaths. That is one of the reasons that the advanced world's health officials are currently looking at us with interest, hope and alarm.

The Millennium Development Goals (MDG) set and agreed upon by most countries have undertaken to bring down these figures by 75%, by 2015.

While most countries have made progress over the last ten years, and many billions of dollars of new money has been pledged to achieving this, the difference in progress among countries, and among various regions within those countries, remains enormous.

While in the most developed countries, there is one death per 30,000 women giving birth, in countries like Malawi, the ratio is one death for every six women! (In India, the rate is about 46 based on an all-India average, though Gujarat has a figure of between 54 and 55, and Kerala much lower).

The two main issues that lead to high rates of maternal mortality are poverty and gender biases. Recently, in a year-long survey and project carried out on the subject by Darpana for Development in the Chhota Udaipur tribal belt, we were repeatedly confronted with both men and older women telling us "If this one dies, we will get another". Women are still dispensable baby machines.

In most villages we found that instead of pregnant women eating green leafy vegetables and drinking milk, they were kept on a diet of oil and rice for the last couple of months of pregnancy, and the first few post pregnancy months, in the mistaken belief that other foods caused indigestion. Even worse were the childbirth practices in the villages of neighbouring Jhabua.

As a woman's labour pains began, all other women were herded out of the cottages and big, burly men entered. They tied the woman down and one man, the 'expert', stood over her head and kicked at her belly to push the baby out. That any women survived this was a miracle.

In many parts of the world, India included, poverty and lack of roads to a health care facility, or the lack of a nearby health care facility, leads to women giving birth at home, sometimes with and sometimes without midwives.

Birthing superstitions take over, many of which lead to septicemia or women bleeding to death. Even successful government schemes like our Janani Suraksha Yojana, which has brought more women to hospitals for giving birth by offering monetary inducements, can be subverted by
corrupt or lazy doctors.

Why is this of sudden and particular relevance? If India does not start doing better, there is no way that the MDG of a 75% reduction can be reached. Besides us, the 20-odd countries which have, in fact, reached a momentum that can help achieve the goal, also need to keep this up.

Not an easy task. But we need to think beyond the numbers - of each family made woman-less, of each child rendered mother-less by these unnecessary deaths. Perhaps then we shall be spurred into care.