About six months ago, at the capital of Madhya Pradesh in Bhopal, the state health department had said that it is a major challenge for the government to prevent all the deaths of women due to pregnancy related complications. At the same time, the department had announced that poverty would not be allowed to become the reason of death for women and the government would play the role of natural protector of women.

The policymakers are of opinion that institutionalized deliveries can bring the shocking figure of 45 maternal deaths per day to minimum level. For this purpose the health department has provisioned an amount of Rs 700 for the women living below the poverty line deciding to go for institutionalized childbirth, monetary encouragement of Rs. 600 to the anganwadi worker or health worker who encourage the women to go for such childbirth and Scheme to provide the facilities of transport to the pregnant woman to the hospital for safe motherhood. The objectives are clear and the scheme ambitious. The state government recently celebrated the success in the efforts of safe motherhood by organising a party in a posh hotel in capital Bhopal. But outside the sparkling lights of these celebrations, the lives of the Saharia primitive tribal continue to be steeped into deep darkness.

In the Saharia dominated villages of Sheopur district of the state, the objective and schemes of safe motherhood are looking totally off-colour. When Bhabhuti, the wife of Shivlal of Ranipura village, 60 kms from the district headquarters got pregnant she had no idea that she would have to bear the deep pain of inhuman treatment from the government machinery along with the pain of childbirth. Bhabhuti had seen six women succumbing to the pregnancy related complications right before her eyes, so she was sure that she would bleed so much after the childbirth that she might not remain alive to bear the unbearable pain. But the local health worker told Shivlal time and again that Bhabhuti would give birth to her child at the Karahal Government hospital where she would get the right to live along with the right to safe motherhood.

When the time for childbirth neared, the villagers made arrangements for a vehicle and took Bhabhuti to the Karahal hospital, even as she was bleeding profusely. However upon reaching there, Shivlal could not get hold of a doctor for four hours, even as Bhabhuti was writhing in pain and when the doctor did appear, he referred Bhabhuti to the district hospital without looking at her even once. This put Shivlal in dire straits as he had used up his entire savings to bring Bhabhuti to the Karahal hospital. Still he immediately pawned his land to a local person for Rs 700. The uppermost thought in his mind was that Bhabhuti should not succumb somewhere away from home, because he had no money to take the dead body. When he reached the district hospital, he was asked for the Deendayal Antyodaya Health Card, which was never issued to him. It is one of those 7 health related schemes run by the State government and each of require different eligelibility criteria to be fulfilled by the poor people. Even for “so-called educated” it is very difficult to remember the details and processes of these schemes, and this net leads these schemes to an Un-Productive end.

Along with the birth of his child, Shivlal got curse of a loan of Rs 2500 that is almost impossible for him to repay. Mamta of Gothra Kapura village near Ranipura saw another face of the government scheme. The Janani Suraksha Yojana provisions Rs 700 for the woman immediately after childbirth so that she could get nutritious food along with safe motherhood and so that the woman does not have to undergo heavy manual labour immediately after childbirth for the sake of livelihood. However Mamta was greeted with abusive language by the nurse at the hospital and had to pay Rs 300 each to the nurse and doctor and Rs 150 to the cleanliness worker to get the childbirth process done properly, importantly on time. She had already spent Rs 500 at her own for transport till the hospital (but government is running a scheme for transport and treatment facility for safe motherhood) and her husband had to spend another Rs 330 for purchasing medicines from outside as free medicines from hospital were refused to her. When Mamta asked from the nurse about the financial assistant from government she was told very roughly that “Han, Tum bacche peda karto jao aur sarkar baad me paise deti jayge” (Government would keep paying money as they would keep giving birth to children and that the money would be paid later”.

Mamta had narrated this incidence before the enquiry committee, set up by the Commissioners appointed by the Supreme Court in the writ petition 196/2001 on Right to Food, looking into the malnutrition deaths in Sheopur and upon hearing the incident, the Chief Medical Officer of Sheopur A K Dixit intervened by saying that “Tumne apni marji se hi to paise baaten honge, kisi ne cheene to nahi the” (You might be distributed the money out of joy of birth of your child and no one might have taken the money away forcefully from you). It seems that the field level officials and employees have took up a very inhuman definition of the schemes like Janani Suraksha Yojana – the definition being that the government assistance received by the women should be used for paying bribes to them for availing minimum health and care facilities. The Anganbadi worker from Gothra Kapura, Bilasi said that “the objective is still not pure. She adds that the scheme is meant for the BPL women and at least 14 families in the village facing regular starvation yet they are not considered poor. The women of these families would neither get the benefit of the Janani Suraksha Yojana nor that of Deendayal Antyodaya scheme. While the Saharia tribal are naturally considered very poor, many of the families still don’t have the government approval of being poor”.

As the issue of unsafe motherhood has now come out very much on the soicipolitical agenda after serious efforts of Civil Society Organizations, the pressure on the government to make serious efforts could be felt clearly. During the last one year the government made hasty announcements of five policy-level schemes including the `transport for childbirth scheme’, Vijayaraje Scindia Antyodaya Insurance Scheme and Janani Suraksha Yojana, but the actual effort to implement these schemes with accountability and transparency have been nil. The maximum effort is at fulfilling the targets of institutionalized delivery, but none of the schemes can make the doctors and nurses sensitive at the ground level. The ground level situation of safe motherhood schemes makes it clear that corruption and misbehavior by the health staff is still big challenges.

The analysis of the policy level decisions makes it clear that the government has failed to make any solid work plan for deprived areas like Sheopur and the backward and poor tribes like Saharia. Even today, the implementation of the mobile dispensary and the Dhanwantari schemes are restricted to only one development block of Sheopur district. It is very important that the government makes wider schemes for preventing maternal deaths and not schemes restricted to 50 blocks or five districts. Also review is necessary regarding the eligibility criteria for beneficiaries of such schemes. Till today names of many families that are actually poor do not figure in the BPL lists which mean that they are neither getting free treatment nor medicines. To get protection, the pregnant women have to break through the complications of five schemes. The villagers have never even seen the basic treatment facilities, which are supposed to be present in every village.

Normally it is believed that the rural people go to quacks or registered health workers for treatment, but the people of Ranipura and Gothra are so poor that even quacks do not want to set up establishments there as they would not get enough patients to sustain themselves. Under the transport for childbirth scheme, a vehicle is on contract for every village and the government pays up the vehicle owners, but the Saharia tribal do not have knowledge of any such facility and spend between Rs 500 to Rs 1500 to take their pregnant women to hospital. Under the Janani Suraksha Yojana being run with the support of union government, there is provision of paying Rs 700 to pregnant woman, Rs 1000 to a woman if she survives childbirth and Rs 50000 as insurance amount to family if she succumbs (not for her). However the budget provision of the state government is so little that only 50 to 100 women per development block can benefit from the scheme. This budget has already been used up in first six months of the financial year. Isn’t it possible that the government comes out with a comprehensive policy and safe motherhood scheme that would free the poor people from immense paper work and would make it possible for them to take care of themselves and their newborn?

As for the Reproductive and Child Health (RCH) programme, entire attention of government is on the purchase of implements, which gives a huge scope of corruption. The basic thing is that to ensure the basic right to health, not only hospital buildings are important but also sensitive doctors, other health staff, necessary medicines, diagnostic facilities and good atmosphere for the common people (patients as well as attendants). But the tragedy in state is that neither the health infrastructure improves nor is any display of sensitiveness and humane behavior among the health workers evident.

Sachin Kumar Jain