Capacity Building Workshop on Maternal Death Review

NAMHHR organized a capacity building workshop on Maternal Death Review in collaboration with Commonhealth in New Delhi from 10^th-14^th Oct. The workshop was organized as NAMHHR recognizes the importance of conducting Maternal Death Reviews as a step towards system strengthening and correction that will contribute to a reduction in maternal deaths.  

The objective of the workshop was to enable civil society to build their capacities to use the comprehensive and strengthen MDR tool focusing on medical, social and legal aspects. The MRD tool used for this workshop was designed in a way that captures social determinants which are a major cause of these maternal deaths.  Dr. T.K. Sundari Ravindran, Dr. Subha Sri,  Ad. Anubha Rastogi and Ms. Jashodhara Dasgupta facilitated the workshop. 28 participants from states of West Bengal, Uttar Pradesh, Gujarat, Odisha, Bihar, Rajasthan, Delhi and Madhya Pradesh participated in it.

NAMHHR hopes to contribute further by using the MDRs to promote accountability and health system improvements through supporting civil society capacities to conduct surveillance of maternal deaths, use the MDR tool and analyze the findings.

Chronicles of Deaths Foretold

NAMHHR organised an Advocacy Seminar titled- CHRONICLES OF DEATHS FORETOLD- Using Maternal Death Reviews to prevent maternal mortality and morbidity in India, 9th October 2012 in New Delhi where civil society activists from 12 states came together on a common platform to have a dialogue with the government and technical experts. The Dialogue brought together senior officials from the Ministry of Health and Family Welfare, technical agencies like WHO, UNFPA, UNICEF and donors. 

Civil society members from 8 states across India who have been documenting maternal deaths and studying the causes presented their findings in the seminar. The documentation of maternal deaths in these states raised important questions relevant to the prevention of maternal mortality and morbidity in India. Health activists also presented their recommendations to representatives from the Ministry of Health and Family Welfare, calling for greater attention to home births to make them safer; greater monitoring of the Continuum of Care instead of only JSY; and a systematic process of conducting Maternal Death Review in all states, with a publishing of what learning has been gained from these reviews.

In response to the presentations and recommendations, Dr. Manisha Malhotra, Deputy Commissioner Maternal Health, GOI Ministry of Health and Family Welfare, chair of the session, shared that “ the time had come for civil society and the government to work together to promote quality maternal health services in the country.” She sought civil society collaboration to conduct Maternal Death Reviews in the community to track those incidents that fail to get recorded officially. The event received favourable coverage in the media. 

Please click to read more: http://www.thehindu.com/health/institutional-deathbeds/article3988166.ece?css=print

Indira Gandhi Matritva Sahyog Yojana (IGMSY) Report Dissemination Event

NAMHHR organised an event to share its study on Indira Gandhi Matritva Sahyog Yojana(IGMSY) and launch its report- The Crisis of Maternity: a compilation of two studies on healthcare and maternity protection for women wage workers in the informal sector in India on 19^th September in New Delhi. The book was launched by Dr. Syeda Hameed, Member, Planning Commission.  

The event brought together representative from the Ministry of Women and Children and the Ministry of Health and Family Welfare, journalists from print media and representatives from NGOs, alliances and networks.  

Speaking at the launch, Ms Jashodhara Dasgupta representing NAMHHR welcomed the government’s recent scheme to provide maternity benefits to all women, called INDIRA GANDHI MATRITVA SAHYOG YOJANA (IGMSY or Indira Gandhi Maternity Support Scheme) and hoped the studies would feed into the evaluation of the pilot phase of the IGMSY Scheme. However, she said NAMHHR was very concerned that the preconditions for obtaining the benefit, mainly that the beneficiary woman should not have more than two living children, would unfortunately exclude the 60% of women (aged 15-49) who are either Dalits, Tribals or have least education, and 63% of poor women (Lingam and Yelamanchili, 2011). 

Quoting the findings from the recent study conducted by the partners of NAMHHR: Monitoring IGMSY (pilot phase) from an Equity and Accountability Perspective, Advocate Sashi Bindhani of SODA (Odisha), shared that the study examined in detail the situation of 57 women in four blocks (45 revenue villages) in four states of India, all of whom stand excluded due to the eligibility criteria of the IGMSY scheme: almost all of whom were Dalits, Scheduled Tribes and those who lack other social security benefits. The study found that all of them had gone through three to seven pregnancies, where each episode of maternity exacerbates their vulnerability due to increased impoverishment and high expenses. With high pregnancy wastage and poor availability of health care, they are never sure whether their baby will survive, despite which the state has penalized them for having more than two living children. 

Dr. Sebanti Ghosh of ASHA (West Bengal) pointed out that despite their contribution to the economy of the country, and their productive and reproductive contributions to the community, women wage workers in the informal sector (148 million) remain deprived of full maternity benefits, forcing them to continue with physically strenuous wage work till the eighth month and shorten their post partum rest. In the absence of food security, they are compelled to compromise on their own requirements, even in pregnancy. Supplementary nutrition is crucial at this juncture; however, the Public Distribution System and Anganwadi services were reported to be irregular and inadequate. An ill equipped health system compounds the problem. Pregnancy and childbirth is seen as a period of financial crisis as it may mean increased expenses and several weeks or months away from work. 

Ms Kalyani Meena of Prerana Bharti (Jharkhand) concluded that given the abysmal conditions of women workers in the informal sector, the IGMSY scheme in its very design defeats the purpose that it sought to address by imposing preconditions of parity. She presented NAMHHR’s strong recommendation that unconditional maternity benefits, universal health coverage, and universal food security for all women, without any conditions, is a primary requirement for the improvement of maternal nutrition, reduction of maternal anaemia and prevention of maternal mortality.

Addressing the gathering during the event, Dr. Syeda Hameed stated that the study raised important issues and brought to light the fact that the 2 child exclusionary criteria of the IGMSY was an out-dated concept which needed to be removed in order to enable the most vulnerable women to benefit during the critical period of maternity.

Please read news coverage on:
http://www.thehindu.com/todays-paper/tp-national/article3916547.ece http://kractivist.wordpress.com/2012/10/23/india-maternalhealth-program-blasted-by-namhhr/   

Maternal Mortality and Morbidity in Jharkhand: The way forward

National Alliance on Maternal Health and Human Rights (NAMHHR) in collaboration with Public Health Resource Network (PHRN)  organized a civil society meeting on Maternal Mortality and Morbidity in Jharkhand: Godda and beyond on 4^th August in Ranchi.

27 participants from 16 organizations came together and developed a set of recommendations for Government and planned a follow up strategy. The recommendations were presented to Dr. Sumant Misra, Director, Health Services, Department of Health and Family Welfare, Government of Jharkhand who was keen to take it forward.  Please click here for reading the recommendations developed during the meeting- http://www.scribd.com/doc/111893657/Recommendations-developed-during-the-meeting 

Launch of Bulletin - Standing on the Threshold: Food Justice in India

Institute of Development Studies (IDS) launched a special Bulletin-Standing on the Threshold: Food Justice in India. The event was was organized by OXFAM, CLRA and GROW campaign on 17th-18th July 2012 in New Delhi and inaugurated by Prof. K.V. Thomas, Minister for Consumer Affairs, Food & Public Distribution

The Bulletin brings together the views and opinions of some of India’s leading practitioner-thinkers on the themes of Rights, Justice and Ensuring rights and justice in the face of new threats.  The Bulletin focuses on how gaining rights needs to be translated into justice and discusses new challenges to food security, respecting and protecting food rights, food price speculation and its linkages with climate change.  It also throws open the debate on whose rights  are more important—current, next or unborn generations.

As NAMHHR recognizes Nutrition and the Right to Food as one of the key issues of maternal health and human rights, NAMHHR members, Dr. Sebanti Ghosh & Ms. Aditi Sood attended the meeting and launch of the Bulletin.

The full papers of the bulletin articles are available for download at http://onlinelibrary.wiley.com/doi/10.1111/idsb.2012.43.issue-s1/issuetoc .

For PowerPoint, please click here- http://www.scribd.com/doc/100336166/Haddad-Standing-on-the-Threshold-of-Food-Justice

NAMHHR study on Indira Gandhi Matritva Sahyog Yojana (IGMSY) scheme

NAMHHR partners initiated a study on the Indira Gandhi Matritva Sahyog Yojana (IGMSY) piloted by the Central Government in selected districts of West Bengal, Odisha, Jharkhand and Uttar Pradesh. The scheme aims at providing maternity benefits to women in the unorganized sector. The amount of Rs.4000 promised by the IGMSY is available only to those pregnant women who are over 18 years of age and those who have experienced less than two live births. The disbursal of installments is conditional to registration of the pregnancy at the health centre, immunization of the mother and child, exclusive breastfeeding and growth monitoring of children.

The NAMHHR study focused on those women who stand excluded due to the eligibility criteria  of this scheme. The study explored their increased vulnerabilities in terms of loss of work, health, incomes access to food and rest in the course of maternity. The interviews with selected women from the districts of Bankura (West Bengal), Bargarh (Odisha), Purbi Singhbhum (Jharkhand) and Mahoba (Uttar Pradesh) threw light on how the vulnerabilities imposed by poverty and uncertain livelihoods both worsen and are worsened by the experience of maternity for these women. The conditions of exclusion are unfair especially given that choices pertaining to bearing children and birth control are shaped by the collective experience of child survival and access to health services in these parts.  The study reveals how maternity is embedded within the vicious cycles of poverty, ill health and impoverishment that the women and their families survive in. It underlines the importance of state support in breaking this cycle through benefits, public health care and services ensuring food and nutrition security for the women and their families.

Stories of Excluded women on Motherhood

This is a series of semi-fictionalized accounts of the lives of the women we had interviewed and interacted with in the course of the study of non-beneficiaries of the Indira Gandhi Matritva Sahayog Yojana (IGMSY) in the states of Uttar Pradesh, West Bengal, Odisha and Jharkhand. The IGMSY is a conditional cash transfer scheme that is being piloted by the Central Government in selected districts of the country. The scheme offers maternity benefits to all women, expect those women (or their husbands) employed in the government and the organized sector. However the scheme has certain eligibility criteria. One can be potential beneficiary only if one has less than two children and is over 18 years of age. Thus a large number of very vulnerable working class women are left out of its ambit.

These stories offer a glimpse of the everyday lives of a few women in different parts of these four states.
http://www.scribd.com/doc/98955236/Stories-of-Excluded-Women

Monitoring Free Maternal Health Services in Uttar Pradesh

NAMHHR Founder member Health Watch Forum (HWF), Uttar Pradesh is a network of voluntary organizations and individuals working on reproductive health and rights issues.  On the occasion of International Day of Action for Women’s Health on 28th May 2012, HWF in collaboration with a grassroot womens' Forum named Mahila Swasthya Adhikar Manch (MSAM) organised a state level advocacy dialogue with the NRHM  mission director and other state level health officials. The MSAM is a unique Forum of 11,000 poor, rural and marginalized women spread across 10 districts of Uttar Pradesh and is committed to monitoring and advocating for Women’s rights to health.

The event was organized to present the data collected by MSAM women through a village level survey in 188 revenue villages of 18 blocks of 10 districts, to assess 370 women’s experiences of accessing free maternal health services in Government hospitals (please read the detailed report on http://sahayogindia.org/new1/wp-content/uploads/2012/06/MSAM-Report-of-free-MH-services-in-11-dists-UP-2012.pdf ).  The results of this survey were presented before the panelists which included Chief Guest Shri Mukesh Kumar Meshram, Mission Director NRHM UP, and special guests Ms. Sunita Aron, Resident Editor Hindustan Times, Ms. Arundhati Dhuru, Social Activist,Shri Hari Om Dixit, SPMU NRHM UP, Shri Amod Kumar, Mission Director of Manthan Project and Ms. Jashodhara Dasgupta, Coordinator, SAHAYOG Lucknow.

The Mission Director of NRHM, Mr. Meshram showed interest in the key findings of the survey and felt that strong actions needs to be taken to improve the status of the marginalized women in the state of Uttar Pradesh. Also, he appreciated SAHAYOG 's project Meri Swasthya Meri Awaz which uses mobile phones to track out-of-pocket expenses and informal fees incurred accessing free maternal health services by the women in the districts of Mirzapur and Azamgarh(to learn more please click here-http://meraswasthyameriaawaz.org/).  He felt that this was an excellent way of promoting accountability and expressed an interest in linking this site with the official NRHM website and extending it to other district of the state.

The event was attended by nearly 100 MSAM women and local allies. Representatives of NAMHHR Secretariat Y.K.Sandhya and Aditi Sood attended the event

Workshop on Maternal Deaths: Dead Women Talking

NAMHHR was represented by Jashodhara Dasgupta, YK Sandhya and Sashi Bindhani in a workshop Dead Women Talking, organized jointly by CHAD (CMC, Vellore), CommonHealth and Sama in Chennai on 2nd and 3rd June, 2012.The objective of the workshop was to share the various experiences and cases of maternal mortality from different parts of the country. This sharing set the context for evolving a framework and developing tools that would enable maternal death reviews to be analysed comprehensively from an overarching framework of accountability and move beyond the narrow ambit of medical maternal death audits that were being conducted at present. The meeting was successful in creating a consensus on the need for the modification of the existing tools and process of maternal death audits, to include four thematic areas, namely: i) Exclusion and Power ii) Social Determinants iii) addressing rights within the health system, and iv) health system related issues.

Members from organisations working on the issue of maternal deaths from various state of the country participated in the discussions. NAMHHR participants joined the other feminist and rights-based groups in emphasizing the human rights angle and the issue of social justice in the framework proposed for the analysis of maternal deaths. As a follow up, NAMHHR members will work with other allies to prepare a revised MDR tool and Framework of Analysis that will be used to build capacities of civil soceity groups in September towards carrying out a pilot effort to review maternal deaths across several locations in India.

Chalo Parliament : A Rally organized by SC/ST Budget Adhikar Andolan at Jantar Mantar,New Delhi,9 May 2012

The SC/ST Budget Adhikar Andolan, a coalition of several organisations, held a protest at Jantar Mantar, New Delhi on the 9th of May 2012  to demand that allocation for Scheduled Castes and Scheduled Tribes announced in the Union Budget be adhered to. NAMHHR Secretariat joined the rally as the rights of SC/STs women are part of our agenda.  NAMHHR member, All India Dalit Mahila Ahikar Manch works on the issue of Dalit Rights and was a key organizer of the rally.

The rally was organized to demand for  the shortfall in the amounts under the Special Component Plan and the Tribal Sub Plan to the tune of Rs. Cr. 33,756.74  and Rs. Cr.13,275.95  in the current Union budget 2012-13, be returned and reallocated to schemes with a clear objective of bridging socio-economic gap between SCs/STs and the General population with particular focus on health, education,housing, assignment/acquisition of land, employment, income generation,entrepreneurship and access to basic amenities. There were parallel protests in 6 other states which culminated in a huge mass mobilization on 9thMay 2012 whose war cry was: “Chalo Parliament”.  

Even the scorching heat (temperature in Delhi was above 40⁰C ! )did not deter those who joined the protest march from several other states. The air rent with cries of  “Hamara Haq Leke rahenge”, “SauMein Pachees Haq Hamara” and “Common wealth took our common wealth!”, as the March proceeded from Mandi House to Jantar Mantar.

For further details,please see on http://www.youtube.com/watch?v=JMtA8KxTezk

National Public Hearing on “Rehabilitation of Manual Scavengers and their Children in India” at New Delhi ,28th March 2012

Rashtriya Garima Abhiyan-National Campaign for Dignity and Eradication of Manual Scavenging, has been working intensively for complete eradication of this inhuman practice since 2002.Their key interventions include organizing and capacitating manual scavengers and their children and working towards their holistic development and empowerment by getting out of the practice of manual scavengers. The Abhiyan is working in 50 districts of Madhya Pradesh, Uttar Pradesh, Maharashtra and Rajasthan.

They continuously advocate this issue at state, national and international level. In this connection, Jan Sahas, secretariat of Rashtriya Garima and a member of NAMHHR, organized a one day public hearing to present an overall scenario of the rehabilitation of manual scavengers and their children in India.(For full report,please read on http://www.dalits.nl/pdf/120328.pdf)

The hearing provided a platform to community members from different states to voice their concerns and problems. About 20 women presented testimonies before a Panel of Jurors. Member of National Alliance for Maternal Health and Human Rights (NAMHHR),Ms. Jashodhara Dasgupta was on the Panel of Jurors.The Jan Sunvai was attended by various stakeholders including activists, members of non-governmental organizations, representatives from Commissions and the media. Ms. Aditi Sood on behalf of NAMHHR secretariat also attended the Jan Sunvai.

As a follow up of this Jan Sunvai, NAMHHR organised a personal meeting with Mr Jairam Ramesh, Hono'ble Minister for Sanitation and Water Supply on 2nd April 2012 in which the matter was taken up at the highest level.

"NAMHHR remains committed to the health rights of the most marginalized women, and will in future study their health related issues more closely."

For further details on the Exclusion and Inclusion of Dalit Community in Education and Health, please read more on http://www.dalits.nl/pdf/ExclusionAndInclusionOfDalitCommunity.pdf

Field Researchers’ Capacity Building Workshop for IGMSY Study, New Delhi .

A Field Researchers’ Capacity Building Workshop for IGMSY Study was held in New Delhi from 15-19 November 2011.The objectives of the workshop were:
•To understand the objectives, research design and research tools of the IGMSY Study
•To build skills in conducting and recording qualitative methods of data collection
•To prepare a common protocol and time-line for completion of the research tasks
In the workshop, field researchers from Orissa, West Bengal, Jharkhand and Uttar Pradesh participated. The workshop was facilitated by SAHAYOG.
 On 15th Nov, A discussion was held regarding IGMSY scheme and modalities of its implementation in the four states
 On 16th Nov, the researchers were instructed on the technique of conducting in-depth interviews.
 On 17th Nov, Researchers were familiarized with the study tools through mock interview sessions
 On 18th Nov, Field practice was conducted (within Delhi) to develop skills in interviewing low-income rural women respondents
 The workshop culminated on the 19th Nov with a feedback session of the field practice