As told by Human Rights Watch researcher Aruna Kashyap.
On the Ground in India
It was scorching hot as we parked the car outside this small village in the Indian province of Uttar Pradesh, something we’d done a dozen times in the past few days. As we walked through the village entrance, I hoped that, this time, we’d find a professional health care worker here.
More women in India die from pregnancy than anywhere in the world, in part because of its large population. Uttar Pradesh has the country’s most dismal figures related to maternal mortality, or death from childbirth.
The Indian government recognizes the problem and spends millions trying to eradicate it. But women continue to die here in record numbers.
I was investigating why. I had sat with families, listening to husbands who lost wives and parents who lost daughters.
Why the Gap between Funding and Care?
But I hadn’t yet heard these stories from health care professionals. Most health workers are difficult to locate, either in the field vaccinating children against polio and filarial, or visiting patients. I was getting anxious. Interviewing medical professionals was the key – their information could help explain the gap between funding and care. I began chasing them from village to village, hoping someone would take a break.
We walked through the village to the home of a local matriarch, and she promised to introduce me to the town’s ASHA, a health care worker appointed by the village head. I had waited in the courtyard for 40 minutes when the ASHA finally arrived. Her name is Trishna, and she wore her off-white sari draped around her head. At first, she was hesitant to open up. Eventually she told me her concerns. I would later learn that some of her problems were shared by many Indian health care workers – the power struggles between nurses, the workers who charged impoverished people for services that were supposed to be free. She spoke of nurses taking bribes in exchange for treatment.
We talked for two hours.
I soon met with other health workers, and the picture of maternal mortality in Uttar Pradesh became clearer.
•Rural clinics, although a positive innovation, were overcrowded.
• Sometimes, two pregnant women shared a bed, or women would sit on the floor.
•Some rural clinics frequently went without electricity.
•In emergencies, clinics generally had no means to transport women to hospitals, and blood transfusions couldn’t be given on site.
•Rarely were any of the health workers trained in obstetrics and gynecology.
I learned that official figures on death due to pregnancy couldn’t be trusted. Most women who gave birth in clinics were sent home within a few hours or the next day, with no follow-up care. Some of the women died days later. I met village health care workers who had never learned that when a woman dies within a week of giving birth, it’s still considered maternal mortality.
Falling Short of the Mark
It became clear that, while the Indian government had the best intentions in establishing clinics and guidelines for maternal health, its efforts fell short of the mark. Yes, the program succeeded in having more women give birth in clinics, but the hoped-for impact – lives saved – wasn’t there.
Money wasn’t the only problem. Millions of dollars in government funds for health care in Uttar Pradesh go unspent each year, according to one study by the Indian Planning Commission.
The real issue is accountability.
Rural villagers need someone to complain to if they feel they’ve been mistreated at a rural clinic, or if their family members die as a result of childbirth. Their complaints need to be investigated, and those responsible need to be held accountable.
Also, every death from pregnancy should be accurately recorded.
Backed by the right policies, both Sri Lanka and Malaysia have managed to halve their maternal mortality numbers in five or six years. By putting in place the right measures, India may be able to do the same.
Photographer Susan Meiselas and reporter Dumeetha Luthra traveled with Human Rights Watch to India to retrace the steps of one woman who died after giving birth to a son. This Webby Award-winning story was produced by Magnum in Motion with Human Rights Watch.