India: Giving Birth Threatens Life In Tribal Odisha

By Sarada Lahangir

20 December, 2012
Countercurrents.org

When Santosini Sisa, 40, a resident of Phulpadar village in Odisha's Koraput district, who was eight months pregnant, had to be transported to a health facility her husband had to tie her to a pole and carry her across a river. (Credit: Sarada Lahangir\WFS)

Koraput (Women’s Feature Service) - “It was only because of God’s mercy that my child and I are alive today. I really am a lucky woman,” says Santosini Sisa, 40, a resident of the largely tribal Phulpadar village. Anybody who saw the way she was transported to the government hospital couldn’t but agree with her. A resident of one of the most inaccessible villages in Koraput district in Odisha, she was into her eighth month of pregnancy when complications set in and she required immediate medical attention.

But that was easier said than done. The primary health centre (PHC) closest to Phulpadar is in Padua village, about 10 kilometres away. Traversing this distance may seem simple enough by city standards, but for Santosini it would be like an obstacle race. First she would need to cross the Patali river, which could be in spate after the rains. Then she would have to walk another three kilometres to reach Goluru village, from where she would have to wait a long time to catch one of the few private vehicles plying between Goluru and Padua, a distance of about four kilometres.

Sure enough, when Santosini needed to be taken to the PHC, her relatives found that the only boat that plied the river had broken down. Her husband, Hrushi Sisa, was at his wit’s end, “We lost hope of saving her. We brought her on a cycle till the river bank but then there was no boat. My wife was screaming with pain by this time. It was a do-or-die situation. So we decided to cross the river by tying her on to a bamboo pole. Six people held her from different sides and that’s how we crossed that river!”

Somehow the couple managed to reach the Padua PHC. Once there they found out that the sole doctor was on leave. The auxiliary nursing midwife suggested that Santosini be taken to the Community Health Centre (CHC) at Nandapur, another eight kilometres away. The only government bus that connected Padua to Nandapur had left by this time. Local villagers lent a helping hand and the critically ill woman was ferried to Nandapur on two cycles.

This, at least, should have meant the end of Santosini’s journey. But that was not to be. The Nandapur CHC had no trained gynaecologist to handle the case of the woman whose condition had by now turned unstable. So the doctor referred her to the public hospital at Koraput, the district headquarters, about 40 kilometres away. As the doctor at Nandapur put it, “We had no gynaecologist to perform a surgical procedure so we had to send her to Koraput – her pulse rate had begun to go down.”

Ultimately, at Koraput an emergency caesarian was performed on Santosini and both mother and child were saved. Unfortunately, innumerable other women in the tribal districts of Odisha are not so fortunate. Despite the state having made some progress over the last three years, Odisha currently has a Maternal Mortality Ratio (MMR) of 258.

Why is Santoshini’s story important for India? Because it provides a clue as to why India’s MMR remains, despite a great deal of effort and policies like the Janani Suraksha Yojana, unconscionably high. According to Census 2011, India’s MMR stood at 212 and it is projected to reach 139 by 2015, thirty points short of its Millennium Development Goal of 109 per 100,000 live births. Odisha is one of the six states with the highest levels of maternal deaths – the others being Assam, Bihar, Uttar Pradesh, Jharkhand and Rajasthan.

As Santosini’s story proves, health care and transportation support for pregnant women in rural areas is almost non-existent, local PHCs are poorly equipped, the referral chain is weak, and health providers are missing. Add to this the high anaemia levels and poor nutrition of the average Indian woman, and the reason why India and Nigeria together account for a third of maternal deaths globally is not hard to understand.

Every year around nine lakh deliveries take place in Odisha’s 48,000 villages, of which around 1,35,000 deliveries require specialised interventions and emergency obstetric care. These cases could include incidents of sepsis, complications from unsafe abortions, prolonged or obstructed labour, and disorders caused by hypertension.

Emergencies that require prompt access to quality care and lifesaving drugs can arise without warning at any point during pregnancy and childbirth, but institutional deliveries in Odisha stand at a poor 47 per cent, with the situation in the tribal Kalahandi-Bolangir-Koraput (KBK) region much worse. According to the National Family Health Survey (NFHS-III), a conflict-hit district like Malkangiri has only 7.1 per cent institutional deliveries, while Raygada and Gajapati are only marginally better at 11.9 per cent and 13.0 per cent, respectively. A report of the National Rural Health Mission (NRHM) Odisha provides further clarity: Only 39 PHCs are operational as 24-hour facilities, against a target of 1,282. In 2010-11, the state had only 38 first referral units against a target of 254.

Two other factors are making the situation worse. One is the lack of trained medical personnel. In 2010-11, 50 per cent of the posts for doctors were lying vacant in Malkangiri, Nawrnagpur, Koraput and Rayagada districts. This means that every other PHC could be without a doctor. The second factor is poor connectivity – as is evident in Santoshini’s case. Only 40 per cent of villages have all-weather roads.

Health service is one of the basic needs of the people, especially the poor. The state government in 2005 had assured that it would work towards bringing health services to every door by 2012. That, of course, has not happened, with tragic consequences. It is well known that ill health is the most significant factor for rural debt in India. In tribal Odisha, families living below the poverty line end up spending anything between Rs 1,000 and Rs 1,500 (US$1=Rs 55) to buy a pouch of blood. They also pay doctors for caesarean sections which, according to government regulations, are to be provided free.

Biswajit Padhi, a Nuapada-based activist, working on issues of maternal health, reveals the true state of affairs, “The government assures us that cashless delivery, nutritional supplements and free transportation will be given to all pregnant and lactating mother under schemes like the Janani Suraksha Yojna and the Janani Shishu Suraksha Karyakram that was introduced in November 2011. The reality is nothing but a mockery of these promises.”

According to Dr Purna Mohapatra, Professor of Gynaecology, SCB Medical College, Cuttack, the most common complication in childbirth here is post-partum haemorrhage, a condition that causes the highest number of fatalities. Yet, as Sudhansu Mohan Das, the state coordinator for the White Ribbon Alliance, points out, these women are unlikely to get timely blood transfusions. “In spite of many women dying from postpartum haemorrhage, no significant steps have been taken to set up blood storage units in the 24-hour PHCs,” he says.

The state government, on its part, claims that it is working hard to improve health services. Explains Damodar Rout, Minister Health and Family Welfare, Government of Odisha, “We are appointing AYUSH doctors in the region to meet emergency needs. We have increased our mobile health units from 90 to 210 over the last two years and are filling up vacancies for health personnel. We are also holding health camps in inaccessible pockets with the help of the district administration.”

Odisha has been able to bring down its MMR from 303 in 2004-2006 to 258 in 2010-11. But clearly it needs to do much more if India is to shed its reputation of being the country with the largest number of maternal deaths in the world.

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