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 DecemberVenue: Indian Social Institute, New Delhi