Sahyadri Books Online Trivandrum.: 201. The Maternal Morbidity Situation In India. P S Remesh Chandran

Wednesday, May 6, 2020

201. The Maternal Morbidity Situation In India. P S Remesh Chandran

201

The Maternal Morbidity Situation In India

P. S. Remesh Chandran

Editor, Sahyadri Books & Bloom Books, Trivandrum

Image by Mojca JJ, Pixabay. Graphics: Adobe SP.

The rich in India survive pregnancy; others are usually deaths on arrival!

The main causes for the higher maternal mortality rates in Asia, especially in India, are lack of adequate pregnancy and delivery care, lack of trained and dedicated hospital staff, lack of clean and risk-reducing delivery homes for temporary stay near one’s home, higher costs of periodical checkups, lack of access to governmental blood transfusion networks and the greed for money, negligence and dereliction of doctors and attending staff. In every survey and study report published on women and mother mortality in India we will see all these causes listed except the last one. If all the listed causes are remedied but the greed, negligence and dereliction of doctors and attending staff continue, then what use is there of corrections? In 1985 the World Health Organization was convinced that around ninety percent of these women deaths in India in hospitals could have been avoided through proper handling. After the well known hike in corruption in India, especially in the health services, what could this rate be now?

One fifth of the world’s maternal deaths happen in India and around 94 percent of these women who die with or without babies belong to low-income families. The meaning is clear: had they had money they would have survived. On an all India basis the most women dying in association with pregnancy is in the state of Assam. In South India the most women dying is in the Karnataka State. The fewest maternal deaths are in the Southernmost and the highest literate state of Kerala- an environment created and nurtured through decades by the well-informed educated people of Kerala and the health professionals and hospital staff in the state, not by the illiterate or under-educated politicians of Kerala who cannot see beyond their noses.

Image by Juda M. Via Pixabay.

The United Nations evaluated that as a Millennium Goal Signatory Country in the General Assembly, India could not achieve the goals in bringing down maternal deaths. It was not because of the insufficiency of budgetary provisions but because of the horrible corruption and illegal eating into in the budgetary provisions. That was the picture in 2005- one fifth of the world’s maternal deaths happening then in India. With five years, according to the 2010 international estimates, this mortality rate improved- it became one quarter of the world’s maternal deaths happening in India instead of one-fifth! Where were the constitutional bodies including the state and the national human rights commissions and women’s commissions and the various parliamentary committees during this period? Why couldn’t these apex bodies prevent at least the increase in women deaths?

1,25,000 mothers or would-be mothers died each year in India. Still the statistics projected by the government’s health authorities internationally claimed that there was tremendous progress in curtailing mothers’ deaths in India. One was statistics, the other was reality, and the world could see through. In 2014 India’s maternal deaths reverted back to the one-fifth’s place in international estimates. Why? The international bodies, as fund givers, began to investigate and ask for details of actions taken including penal actions and compensations to victims given during the past years, following internet articles describing the atrocities against women going on in India in hospitals without anyone penalized and without anyone given compensations. There were frantic searches for old case records in hospitals before forwarding the required reports within the deadline. Every record and file ended where the incident was reported to higher authorities. Those were the last communications in those files and records. There ended action. When the reports were received and the truth of none penalized and none paid compensations for years found out, international agencies stopped funds to India health: in those countries it is a crime to finance human rights violations and corruption. Theirs is world people’s money anyway which cannot be released to unaccountable establishments. So government became unable to continue to bear the expenses of maternal deaths on behalf of doctors and the doctors began to be ordered to pay compensations to women victims from their own pockets. Incidentally the first order of the kind originated in Kerala in a case of leaving surgery scissors inside the abdominal cavity of a woman in the operation room of the Taluk Headquarters Hospital, Nedumangadu in the Trivandrum District. The order came from the Secretariate of the Government of Kerala. No wonder women deaths in India began to come down.

If government has surplus money from foreign funds in addition to the usual budgetary provisions it will happily pay compensations to victims on behalf of its doctors. If the foreign funds dry up and the government has only its own budgetary fund it will not have enough funds to pay compensations for women from what is left after the inevitable corruption by its departments and darling officers. So it will ask doctors to pay compensations from their own pockets. So, women deaths and atrocities against them in hospitals stop. Doctors and subordinate staff become more careful. So, that is how international funds to India health finances human rights violations and corruption. That is the logic behind the argument when international funds stop, atrocities against women will also stop in Indian hospitals.

Most of government’s convictions and beliefs on pregnant women are amateurish than mature. The fools in government- all males of course- predicted and government once believed and departments propagandized that once a pregnant woman in a household who did not go to a hospital and died in child birth at home, all other women in that household for generations to come would go to a hospital for giving birth to a child. The truth was, after learning about the death of a woman in a hospital in child delivery, not only the women in that particular household but all women in that whole village for generations to come would never dare go anywhere near a hospital, let alone for child birth. Government through its wise guys could not understand that women dying in hospitals during child birth would deter other women from going to hospitals for pregnancy care and delivery. The medical officers of the government also helped their employer in deterring women away by butchering those who came their way.

The government’s assurance in 2016 was that all pregnant women in India would get full ante-natal care including scans, tests, tetanus injections and iron folic acid tablets for 100 days. Only the rich and only the educated and only those who could travel got them and believed to have delivered healthy babies safely. Those in rural homes with no means of travel and money never got them. It was all like hotel brochures offering luxury services with their bug-infested beds, unhygienic cheap food and blood-pressure raising services. It was estimated that in most states, only about two to three percent of women who even got to those institutions got these services. The money allotted by government was there but no services, like a river running into parched dry desert sands and totally vanishing within minutes.

In a country where geography and ethnic composites are diverse, there will also be local factors affecting pregnancy adversely. There can be calcium-deficient areas and protein-poor areas depending on location. Inland villages can be iodine-short and sea shore villages iodine-rich. Highlands and lowlands will have different oxygen saturation and different rates of oxygen intake and breathing. All these may affect pregnancy and child delivery and contribute to the local community factors. Local health care personnel are expected to know about these local community factors and take them also into account while providing women pregnancy care. If they know about these depends on whether these staff are long-stationed there which is never possible with the frequency of transfers and postings in the health services. And these transfers and change of stations is too frequent in health services, precipitated at their whim and impulse or like or dislike of those subordinates in the field in remote stations by senseless bureaucrats sitting in city offices, to keep these local factors well known to and accountant for by the personnel who are sent there. Also know that the general norm in the Indian health services is none will be allowed to stay at a station for more than three years for fear of contracting the national diseases of corruption and graft!

Image by ID 4935210. Via Pixabay.

We can understand people dying for unknown diseases with no known cures. But that is not the case with child birth. Child delivery has been going on in the world since the first man and woman appeared out of nowhere. Every aspect of this process is well known to man. Whatever complications arise, they have also been predicted and regimens instructed in advance. Every kind of check lists is available with the health services, accessible to doctors, nurses, technicians and para medical staff to be followed in emergencies. The only complication and unknown factor is in keeping the woman healthy in her home before and after child birth, and providing the conveyance to pick up and deliver her to the nearest hospital the earliest. That was where India failed miserably. Studies conducted in various Indian states proved that most women deaths were for want of transportation to a hospital. Even if there was it was all over before the woman reached a hospital because the transportation was not quick. Most cases were deaths-on-arrival. And most cases were tea plantation workers in the remotest places also, with the unlikeliest of communications and the scantiest of transportation.

If you have money, if you have a mobile phone, you can call a taxi and pay the fare for going to a hospital when the delivery pains begin. Or you can only subject yourselves to whatever experienced local help is available in the village, which will usually be better than whatever is available in a hospital, i.e. with your kind of money. Often you survive with the local midwifery skill and deliver a baby and at times you give in, with or without delivering a baby. Village midwifery skills were available in plenty in villages and were more than enough to cater to the needs of the womenfolk in those villages. This pool of skill was supplemented by the Senior Midwives and the Auxiliary Nursing Midwives retired from government service. So this pool of expertise always remained there, the dying ones replaced by the retiring ones. Then the greedy medical field noted this after the overcrowding of gynecologists in the cities and no one getting anything to even break even after the cut-throat competition among doctors. Their trade organizations handsomely attired as the Indian Medical Association and the State Government Medical Officers’ Associations moved in for the kill and swayed government to harnessing the local skilled midwifery services in villages so that they could monopolize this child delivery care in villages too and a get a portion of the pie there too.

Remember that even in government hospitals, it is skilled midwifes who make most deliveries safe and possible and prevent botched deliveries from becoming blood baths, not doctors, because these midwifes are far more experienced that those green inept doctors. And when such botched deliveries end in maternal deaths in hospitals, these organizations again move government to declare official investigations into such incidents so that the fire of public fury could be doused and the involved attending staff could be finally absolved officially in the end. And these ‘investigating officers’ will of course never be ones who experienced at least once the pain of delivering a baby but all males who caused that pain. There are hundreds of such reports on the death of women and children in hospitals in India and any one can check who those ‘specialist members’ in those committees were- males or child-delivered females. And anyone can also check what those ‘specialist investigations’ outcomes were.

Enquiery committees on maternal morbidity constituted by culprits.

Every special committee report on women’s pregnancy deaths in hospitals in India says a few things which are standard as if no one knew about them! These ‘specialists’ reports’ till today never have specifically mentioned corruption and bribery rampant in hospitals as one of the main causes of women deaths in hospitals. These specialists, if and when they were in service, may have been the heaviest bribe-takers and the most corrupted in their services. Their reports abound in references such as ‘community-based clean and safe delivery huts must be provided to pregnant women (must be to die in isolation!), utmost care must be given to them during and after delivery (i.e. ask them to come to hospital with bribes everyday!), pregnancy care must be brought to villages (to monopolize and commercialize pregnancy care in villages too), a national blood transfusion network shall be established (this world space club member country doesn’t even have one still today!), and teach young girls health and sex (they have not yet heard of You Tube!), and every other thing that are pleasant and safe to say. But not a thing about the real threats to pregnant women in hospitals!

It is a pleasure for detached and unrealistic officers to recommend that women coming to hospitals shall be asked by monitoring officers if they were or were not given good treatment in hospitals. After going through horrible experiences from health care staff in hospitals which woman in an illiterate under-developed country will tell investigating officers that she was subjected to unbelievable bribery and ill treatment in hospital? The only way to ensure better treatment for women is to investigate every case of bribery and ill treatment in hospitals that are rumored among people and reported in press, and punish everyone involved severely and exemplarily. But who can do this in a country where even the directors of health services are imprisoned and lying in jails for large scale corruption and bribery?

There is also the ludicrous propagandization in these reports that maternal mortality is rather uncommon in India and therefore difficult to study. Maternal mortality is not uncommon in India, actually it is in plenty. But what is true is maternal mortality is difficult to study in India because the culprits in these cases and the ones who are duty-bound to hand over the records in these cases are one and the same. It is because even after the maternal deaths they are staying in position because they are not suspended and the records are not traced and confiscated and the investigation conducted in their absence. Since Independence, India waited sixty years to attempt an All India Study on Maternal Deaths which points to nothing but the culprits who are also the authorities making it difficult to getting available the medical records of the deceased women.

Image by Juda M. Via Pixabay.

Regarding India, the World Health Organization and the world’s professionals have a belief that if those women are educated and rich, they will get more maternal and child health care in India. It is wrong: such women are subjected to more bribery; that is why they get that service. It indeed has to be admitted that the WHO’s are the world’s best professionals, doing laudable selfless service in the farthest regions of the world, without caring to set up their own lucrative private practices in their own large metropolitan cities and towns. But the diplomatic relations and business relations of this organization’s biggest contributors with the country concerned count and what they actually want to say does not come into their reports. Not that they do not know the real conditions of governmental health care services in India.

Images Courtesy: Pixabay.
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FROM THE BOOK:

https://www.amazon.com/dp/B087D34RVM

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About the Author P. S. Remesh Chandran:

Author Profile Of P S Remesh Chandran By Sahyadri Archives.

Editor of Sahyadri Books & Bloom Books, Trivandrum. Author of several books in English and in Malayalam. And also author of Swan: The Intelligent Picture Book. Born and brought up in the beautiful village of Nanniyode in the Sahya Mountain Valley in Trivandrum, in Kerala. Father British Council trained English teacher and Mother University educated. Matriculation with distinction and Pre Degree Studies in Science with National Merit Scholarship. Discontinued Diploma studies in Electronics and entered politics. Unmarried and single.