A Proud Moment...

Dead Women Talking : Launch of the Report

 

24th September 2014 was a proud day for the CSOs who work in the field of health. Yesterday when Dead Women Talking : A Civil Society Report on Maternal Deaths in India  released by Dr Syeda Hameed, former member of Planning Commission in New Delhi  fulfilled the aims of a rigorous group's several months works on recording  and analysing the maternal death happened in the Country. The launch was organised in the  India International Centre Annexe, New Delhi.

The report is an outcome of a coordinated civil society effort led by CommonHealth, a national level coalition working on maternal-neonatal health and safe abortion. Twenty one  civil society and community based organizations including NAMHHR compiled stories of 124 maternal deaths occurring over a two year period across 10 states of the country.

The Meeting was cherished with the presence of the eminent panellists like Professor Lakshmi Lingam, Professor and Deputy Director, Tata Institute of Social Sciences, Hyderabad Dr Sridhar Srikantiah, public health specialist and Dr Ritu Priya, Professor, Centre of Social Medicine and Community Health, Jawaharlal Nehru University. The Audience included Leading Public health Activists, Researchers, Civil Society Organisations reporters  and NAMHHR members Dr. Sebanti Gosh, Priya John, Jayashree Velankar and Jashodhara Dasgupta and representatives  from the  leading media. Please find the News article came in Indian Express Pune edition : http://epaper.indianexpress.com/344712/Indian-Express-Pune/25-September-2014#page/23/1

Please find the links for the report : 

1. Dead Women Talking - Report
2. Executive Summary of the Report
3. Dead Women Talking - Table

Maternal Health and Nutrition in Tribal Areas - Report Launch

Maternal Health and Nutrition in Tribal Areas 

 Report Launch 

Beside the governmental data on Declining  Maternal death Rate and improved maternal health; there are massive gaps when it come to the reality . To find out the reality, a team comprising of Vasavi Kiro (ex member of the Jharkhand Women’s Commission), Dr. Abhijit Das (Member of Advisory Group on Community Action, NRHM) and Jashodhara Dasgupta from  NAMHHR, along with other civil society members undertook a fact finding from 20th to 23rd of November 2013 in Sunder Pahari block, Godda District. The team also tried to explore issues of service provisioning and suggest alternate strategies to improve health and nutrition services in the area  in the tribal areas of Jharkhand.

The FFM team visited three villages selected on the basis of different tribal communities,  varying distance from the block CHC, as well as different accessibility to roads. The team also visited one Community Health Centre (CHC), one First Referral Unit (FRU) and the Godda District Hospital; where the health providers and managers were asked about their assessment of barriers and challenges. 

The Fact-Finding Mission Report was launched in Godda on 1^st September 2014 by the D-RCH (former Civil Surgeon) Dr. Pravin Chandra, WHO representative and the Medical Officers in Charge of the Sunderpahari CHC and Mahagama FRU. During the District Dialogue attended by tribal women, Sahiyas and civil society activists of Santhal Parganas, the doctors admitted some continuing challenges like vacancies and lack of skilled staff in the CHC, and the problem of live-saving blood transfusion, which could not be provided in the entire district. The Report was also  shared with the different media in Ranchi and MLA Bandhu Tirkey also joined us and he also did a launch with the media people. 

The profile of the visited area

Godda district is part of the Santhal Parganas division of Jharkhand which is dominated by tribal communities. Sundarpahari is a backward block in Godda.  The block has an entirely rural population, with 79% belonging to the Scheduled Tribe category, and more than half the villages are inhabited by particularly vulnerable tribal groups (PVTGs). Nearly 50% of land in Sundarpahari block is forested and hilly and most habitations are not connected to the few roads that exist. The literacy rate in Sundarpahari is 27%, and AHS 2011-12 data indicates that childbirth at home is 75.2% for district Godda

Summary Findings

• ·         Giving Birth at home

All the women had given birth at home even though some had complications and near-miss experiences. There was also a maternal death in one of the villages. Yet the women did not consider going to the local health facilities as an option, and had no information about JSY or JSSK. 

• ·         No Access to Basic Health Facilities

These women did not have access to basic health services such as ANC, and even immunization services for children was unavailable  in the case of PVTG communities.

• ·         The ANMs did not go to the villages

The ANMs did not go to the villages for either ante-natal care or for home births; the health sub-centres were not easily accessible for many hamlets in the village, and the VHND was not taking place in even half the villages of this block owing to shortages of human resources and transportation issues.

• ·         No functioning of  blood storage and transfusion facility

In the entire district although a large number of the pregnant women present with high anemia and  comprehensive emergency obstetric care had to be accessed (by those who could afford it) in Bhagalpur Medical College in Bihar. In other blocks where ante-natal care is provided, it is not identifying any danger signs such as anemia, malnutrition or pre-eclampsia.

• ·         Free supply of grains- traditional Practices were neglected

 The PDS does not incorporate the local grains that are richer in nutrients and instead provides the standard cereals that are given all over the country. The traditional food patterns of the tribal communities which were linked to the forests and the robust practice of mixed organic farming has been disturbed by the introduction of PDS grains. Local practices and resources have been ignored and women have been asked to take iron-tablets during pregnancy instead of promoting consumption of local iron rich foodstuff.

• ·         No efforts to integrate the tribal health system

Given the geographical situation of Godda district, it is difficult for health services to reach communities located deep in the forests. The tribal communities are seen as ignorant and uneducated, and their practices are looked down upon. The health system has made no efforts to integrate the tribal health system (based on local herbs) and integrate some of the good practices so that the tribal feel less reluctant to use the health facilities.

• At health facilities in tribal areas 
• Inter-departmental convergence
• Re-orientation of community and facility health providers
• Integration of healthcare with the nutrition services
• Community Monitoring and Accountability by strengthening the capacity of members of Village Health, Sanitation and Nutritional Committees

The Report of the meeting and Press clippings are attached in this blog post; please find the links below. 

1. CSO Action Plans
2. Godda Report Chapter - 5- Hindi Translation
3. Participant List
4. Meeting Minutes

A Stepping Stone!!

A Stepping Stone!! 

NAMHHR filed a petition on July 1st week by human rights lawyer Anubha Rastogi—with technical support from the Center for Reproductive Rights—on behalf of the National Alliance for Maternal Health and Human Rights (NAMHHR). Justices Navin Sinha and Rangnath Chandrakar of the High Court of Chhattisgarh at Bilaspur issued an order on July 18 to the Chhattisgarh Government to address allegations that women in the state lack sufficient access to safe abortion services.

Please read the Press Release here: http://reproductiverights.org/en/press-room/indian-high-court-orders-chhattisgarh-government-to-address-allegations-of-denying-women-access-to-abortion-services

Working with HRBA

Working with HRBA

NAMHHR conducted a Strategic Development Workshop named " WORKING WITH THE HUMAN RIGHTS-BASED APPROACHES FOR PREVENTION OF MATERNAL MORTALITY AND MORBIDITY IN INDIA" on  24^th June, 2014 at India Habitat Centre in  New Delhi. In this significant meeting there were in-depth discussions on the Technical Guidance Note (https://drive.google.com/file/d/0B-fynPVsu-vxTXJaeXoyUmc5YzA/edit usp=sharing ) which is a United Nations document that provides technical guidance to governments on implementing policies and programmes to reduce maternal mortality and morbidity in accordance with human rights standards. The objectives of the meeting were: to develop a shared understanding of the relevance of using human right base approach (HRBA)  for preventing MMM , to brainstorm on ways of using human rights-based tools such as the Technical Guidance and the UPR process with senior officials of the  Health and Family Welfare department, Parliamentary Standing Committee, National Human Rights institutions and /or Judiciary and Civil society and research institutions

In course of the discussions held in four sessions, the participants developed an understanding of the Technical Guidance note, an overview of the situation of maternal health in India and the Universal Periodic Review process (http://www.ohchr.org/en/hrbodies/upr/pages/BasicFacts.aspx)The workshop was attended by twenty seven distinguished guests from eighteen organizations. 

To read the full report please Click the link: https://drive.google.com/file/d/0B-fynPVsu-vxTm92R0xiVk9MUTQ/edit?usp=sharing

To access the presentations of the workshop please follow this link:

1. OCHR Technical Guidance on preventing MMM- Jasodhara Dasgupta 
2. https://drive.google.com/file/d/0B-fynPVsu-vxdXFvc3pzZEM1Smc/edit?usp=sharing
3. Presentation on the Situational Analysis

Maternal Near Miss meeting in Aurangabad

Maternal Near Miss meeting in Aurangabad (3^rd – 5^th July)

    The Expert group meeting for " Drafting technical and operational guidelines for some maternal health issues such a Routine USG in pregnancy, Screening for Hepatitis and Syphilis in pregnancy, Maternal near miss and Cesarean section by surgeon" took place  on 3rd  to 5th July 2014  at Aurangabad. This meeting was organized by the Government of India and Maharashtra government and funded by UNFPA. The Government Of India invited NAMHHR to attend the expert meeting and Dr.Archana Kahrayal, Research Officer  from SAHAYOG  attended the meeting and shared her experience with other participants. 
      The 1st Expert Group meeting took place in the month of May (4th to 5th) 2014 at Nagpur for framing the guidelines for "Routine Ultrasonography  during pregnancy, screening for syphilis & Hepatitis B, preparing curriculum for Surgeons for conducting C –sections and Maternal Near Miss" with the help of experts in these fields which includes doctors and people from international organizations like UNICEF and UNFPA. 
     There, the experts from various fields related to health  had in depth discussions on maternal near miss cases , In that they discussed the  Facility based Maternal Near- Miss tool of Government of India, including criteria for maternal near miss cases. As a positive feedback they changed a few gaps in the tool.  The tool also includes gap analysis section in which apart from social gaps they have facility gaps also. This was also decided that now there will be Maternal Near- Miss committee combine with the MDR committee in all states according to the MDR Guidelines. 
In This meeting senior persons from Avni foundation also displayed maternal death tracking software which will be used in the future by government for tracking maternal death. 

National Convention on Maternal Health

 

National Convention on Maternal Health: Agenda for Second Generation Priorities in Maternal Health Programming

NAMHHR in collaboration with OXFAM

Making Maternal Health a Matter of Priority for the Nation: Drafting of a new road map for second generation priorities in maternal health.

Speaking at the National Convention on Maternal Health Shri Satyabrata Pal, Ex-member of the National Human Rights Commission stated that, “Women as a whole are marginalized and therefore their lives and health is not a matter of priority for the nation.”He called for putting an end to the abdication of responsibility between the state government and the Central Government.

The preventable tragedy of maternal deaths in India was comprehensively discussed at the National Convention on Maternal Health in India entitled “Agenda for Second Generation Priorities in Maternal Health Programming’, held in New Delhi on the 20-21 March organized by the National Alliance for Maternal Health and Human Rights (NAMHHR) in collaboration with Oxfam India. The group felt that the unacceptable high rates of maternal mortality in a middle income country like India, needs to become a national priority.  Maternal health cannot be the problem of only the Ministry of Health and Family Welfare; it needs the coming together of different departments such as Roads and Transportation, Agricultural (as food policies affect food security), Science and Technology, Environment, etc to save the tens of thousands of lives of women in our country who die of preventable causes during maternity.

India’s maternal death rate was supposed to decrease by one-third to 109 per 100,000 live births by 2015. The nation stands on the threshold of this deadline with an average maternal mortality rate of 178 per 100,000 birth in 2010-2011, down from 254 in 2004-2006. But there is great variance even amongst these figures, with maternal mortality rates per 100,000 live births being as low as 66 in Kerala and 90 in Tamil Nadu, to shockingly high rates of 347 in Assam and 300 in Uttar Pradesh.

Dr. Syeda Hameed, Member of Planning Commission said that, “The recommendations and issues discussed by this group would contribute to the implementation of the 12^th Five- year plan whose motto is inclusive growth. She asked the group to provide these inputs into the midterm appraisal of the Plan.”

Also present at the event was Shri Manoj Jhalani (JS, Policy MOHFW) who said that the ministry agreed with the analysis and concerns emerging and looked forward to the operational road map from such field based organizations who can give practical solutions.  He also highlighted that the government could put in place grievance redress mechanisms but the proper utilization of these by pregnant women needs an enabling environment.

 “The health system should not treat pregnant women just as patients but as empowered and active agents who have the right to choose the location and services that they want”, said Prof Ritu Priya from the Centre for Social Medicine and Community Health, JNU. She added that the Dais, ASHAs and ANMs can together form a team which could work to support women in rural areas throughout maternity.

 “For too long we have been counting maternal deaths without accountability towards the women at risk of losing their lives and the health system needs to learn how to prevent such deaths and make public the action being taken”, said Jashodhara Dasgupta, convenor of the National Alliance for Maternal Health and Human Rights  and the organizers of the event

The meeting brought together practitioners and researchers on maternal health, campaigners on various issues of human rights, public health and health systems experts, lawyers, budget analysts as well as representatives from the government and donors. 

Maternal Health and Nutrition in tribal areas: NAMHHR report on Godda Jharkhand

Since 2005, the Government of India has launched a series of initiatives like the Janani Suraksha Yojana (JSY) and JSSK to address high maternal mortality, and the SRS surveys over the last decade show that maternal mortality has been steadily coming down in all states including in Jharkhand. In August 2013 a paper examining 23 maternal deaths occurring in one year among young, poor women mostly from tribal communities (including Particularly Vulnerable Tribal Groups (PVTG) in just two blocks of Godda District in Jharkhand was published in EPW (Stairway to Death: Maternal Mortality Beyond numbers, Banerjee et al, Economic and Political Weekly Vol XLVIII no. 31, 2013 Aug 3).

In this context the National Alliance for Maternal Health and Human Rights (NAMHHR) conducted a Fact-Finding Mission (FFM) in Godda district of Jharkhand to explore the status of maternal health services and the role of related social determinants of health. The FFM team visited three villages selected on the basis of different tribal communities, varying distance from the block CHC, as well as different accessibility to roads. The team also visited one Community Health Centre (CHC), one First Referral Unit (FRU) and the Godda District Hospital; where the health providers and managers were asked about their assessment of barriers and challenges.

Summary findings

Godda district is part of the Santhal Parganas division of Jharkhand which is dominated by tribal communities. Sundarpahari is a backward block in Godda. The block has an entirely rural population, with 79% belonging to the Scheduled Tribe category, and more than half the villages are inhabited by particularly vulnerable tribal groups (PVTGs). Nearly 50% of land in Sundarpahari block is forested and hilly and most habitations are not connected to the few roads that exist. The literacy rate in Sundarpahari is 27%, and AHS 2011-12 data indicates that childbirth at home is 75.2% for district Godda.

The team met with a large number of women in three villages of Sundarpahari block who had delivered in the last couple of years; all the women had given birth at home even though some had complications and near-miss experiences. There was also a maternal death in one of the villages. Yet the women did not consider going to the local health facilities as an option, and had no information about JSY or JSSK. Due to local health beliefs and the lack of community outreach, the communities visit local informal practitioners, eg. Dom and Ojha and the RMP.

These women did not have access to basic health services such as ANC, and even immunization services for children was unavailable in the case of PVTG communities. The ANMs did not go to the villages for either ante-natal care or for home births; the health sub-centres were not easily accessible for many hamlets in the village, and the VHND was not taking place in even half the villages of this block owing to shortages of human resources and transportation issues. There was no functioning blood storage and transfusion facility in the entire district although a large number of the pregnant women present with high anaemia and comprehensive emergency obstetric care had to be accessed (by those who could afford it) in Bhagalpur Medical College in Bihar. In other blocks where ante-natal care is provided, it is not identifying any danger signs such as anaemia, malnutrition or pre-eclampsia.In the more remote villages there were no Anganwadi centres (AWC), and the Supplementary Nutrition does not reach the pregnant or lactating women. In other villages, the AWC sporadically provided THR, and even then information that THR is available did not reach all the women.

However the PDS (free supply of x kg of grains) was being used by the community even though the concerned distribution centre was far. The PDS does not incorporate the local grains that are richer in nutrients and instead provides the standard cereals that are given all over the country. The traditional food patterns of the tribal communities which were linked to the forests and the robust practice of mixed organic farming has been disturbed by the introduction of PDS grains.

Local practices and resources have been ignored and women have been asked to take iron-tablets during pregnancy instead of promoting consumption of local iron rich foodstuff.Given the geographical situation of Godda district, it is difficult for health services to reach communities located deep in the forests. The tribal communities are seen as ignorant and uneducated, and their practices are looked down upon.

The health system has made no efforts to integrate the tribal health system (based on local herbs) and integrate some of the good practices so that the tribal feel less reluctant to use the health facilities. As it stands now, they avoid using government health facilities until matters have gone too far, and then it is usually too late. Different tribal areas and their health problems need to be seriously studied both within Jharkhand and other areas of Tribal communities. 

The PVTGs or particularly vulnerable tribal groups require socio-cultural studies, to understand their health-related practices and related disruptions which may provide ideas about the underlying reasons for high anaemia and poor health.The report concludes with a detailed set of recommendations. 

Download full report here