People’s
Convention on Maternal and Reproductive Health Rights
Organized by NAMHHR, CommonHealth, Scavengers
Dignity Forum & Dalit Alliances, Wada Na Todo Abhiyan, Jan Swasthya Abhiyan
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Over the past 10 years, maternal and child health
has taken centre stage in health policies and programmes in India. In order to
tackle high rates of maternal and neonatal mortality, the government of India
has taken various measures to incentivize institutional deliveries, strengthen
health systems, increase allocations, remove financial barriers, improve
immunization coverage, and implement regular tracking systems. In this time, India
has apparently experienced a decline in its maternal mortality ratio (MMR) from
301 (in 2006) to (178 in 2013) maternal deaths per 100,000 live births, however,
these numbers are likely highly under-reported. Similarly Neonatal and Infant
Mortality continues to be a serious challenge for India. Although rates of
mortality have dropped over the past three decades, one fourth of all deaths of
children under six years of age, occur in India. According to UNICEF, 1.34
million children aged under five, 1.05 million infants, and 0.748 million
newborns die every year in India. Even going by conservative estimates, about
45,000 women die due to childbirth every year in India, and most of these
deaths are preventable. The rates of decline of MMR vary widely between different states with 12%
of global maternal deaths occurring within nine states of northern and eastern
India. Although institutional delivery coverage has
increased over the years, this in itself has been insufficient to reduce MMR.
Critical issues such as quality of antenatal and post natal care, risk
identification, availability of emergency obstetric care, behavior of staff
during delivery, availability of abortion and contraceptive services, continue
to be a challenge. Survey data shows that out-of-pocket expenses for poor
families have not reduced, despite the efforts to reduce financial barriers. Moreover, the government of India is pushing
for privatization of in various modes such as contracting out services via
Public Private Partnerships, for which there is no evidence of increased
equity, but on the contrary they have been known to encourage unscrupulous practices.
Why Should Other Social Movements Care about Maternal and Infant
Mortality
The issue of maternal and reproductive morbidity and mortality is
intersectional in that social location plays a role in determining outcomes for
women and children, and social determinants such as access to nutrition,
sanitation and poverty also strongly influence health. The biggest burden of
maternal and infant mortality falls on women from marginalized communities and
the poor. The latest available national level survey data – the NFHS3 (2005-6)
shows disparities in women’s access to maternal health services – women
belonging to scheduled castes and tribes are less likely to receive antenatal
care and skilled birth attendance. UNICEF also notes that there are gross
disparities in mortality indicators with Scheduled Castes, Scheduled Tribes and
minorities having a higher IMR and U5MR. Further, there are specific problems
faced by women belonging to marginalized communities – such as abusive behavior,
neglect and culturally inappropriate services. Despite overwhelming evidence
that there are disparities in maternal health indicators, the government of
India does not publish disaggregated data on these. In fact datasets from three
rounds of the annual health survey which were conducted in high-focus states
with the express purpose of contributing to meaningful tracking of progress
towards improved health status have not been released and any kind of
disaggregated analysis is rendered impossible. Although maternal death reviews
are meant to fix accountability, they are not being conducted in many cases and
the findings are also not made public. Thus there is a situation of prevailing
silence around issues of equity and accountability, suggesting that it is a
problem that is being wished away rather than tackled. In this situation it is
critical that civil society actors raise the issue in a concerted manner and
facilitated a grassroots demand for accountability.
The Need for A People’s Convention:
Over the course of the Millennium Development Goals, indigenous
civil society organizations have continuously dialogued with the state to
influence its “input” – i.e. policy and program design, to make it responsive
and relevant to women’s realities. Coalitions like NAMHHR and CommonHealth have
systematically documented maternal health rights violations in the field and
repeatedly held policy dialogues at the national level, to impress upon policy
makers the need for rethinking their approach to address emerging issues. The
policy dialogues have received attention from policy makers and elected
representatives, however there is a need to complement this with mobilization
and dialogue with the system, closer to the grassroots to demand accountability
for maternal and child health services. It is critical to make maternal and
child health a core concern of communities, especially marginalized
communities, and grassroots movements that represent them.
Building on these experiences, we perceive the need for greater
synergy among groups working at the grassroots level, to generate a nationwide
campaign to demand maternal and child health rights. Not limiting ourselves to
health rights groups, a wider alliance of political groups (especially those
representing marginalized communities, including dalit rights groups, minority
rights groups, disability rights groups, groups working on other social rights
such as right to food) must be built so that the agenda of maternal health is
owned by us collectively. The Sustainable Development Goals, several of which
address reproductive and child health, are meant to guide the government of
India’s future policy and programmatic priorities and for which India will be
held accountable at international forums; these can become a rallying point
around which communities can be mobilized to demand for better maternal and
reproductive health services, building on such mobilization that has already
begun through networks such as the Wada Na Todo Abhiyan.
As a first step towards building such an alliance, we propose to
host a 2-day “People’s Convention on Maternal and Child Health Rights” in Delhi
in mid-December. This convention would bring together organizations and
movements working on various issues and across different states, to amplify
voices of their constituencies at the national level and develop a common and
synergistic agenda for a grassroots campaign in the future.
The objectives of the convention will be as follows:
1 – To understand the issues of maternal and
reproductive health and its determinants from the life experiences and field
realities of diverse marginalized groups
2 – To explore synergy between
various field-based and issue-based groups and campaigns to generate a
nation-wide collaborative accountability agenda to address preventable maternal
and reproductive morbidity and mortality
3- To strengthen the conversation between rights
groups working at the national and sub-national level, and build intersectional
cross-movement alliances to address maternal and reproductive health
The 2-day Convention will bring together
approximately 100 participants from across the country, who are advocating for
the rights of women and would be interested in taking on board the issue of
maternal and child health in their mobilization. These include grass root
organizations, movements and Networks like Right To Food Campaign, Bebaak Collective, other groups working on Tribal’s
Rights, Right to Education, LGBTQ rights, minority rights, land rights and Rights
of Single Women (Ekal Nari Shakti Sangathan).
Dates: 16- 17 December
Venue: Indian Social
Institute, New Delhi