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February 2008

Biswajit Padhi Khariar (Orissa)

THE joys of being a mother were shortlived for Rebati Harijan. When her post-delivery bleeding didn’t stop, she was taken to the nearest government- run community health centre at Khariar road. Anaemic, like most of her counterparts in the district and still bleeding, the doctor advised her blood transfusion and referred her to the district headquarters hospital 10 km away. Rebati’s family, instead of taking her to the hospital went back home because they didn’t have money. She bled and died seven days later. One woman dies every week of pregnancy related causes in Nuapada, going by the statistics of 2006-07. Studies have confirmed that poverty is one of the major causes of maternal mortality and morbidity, says Haridas Patel, Assistant Coordinator of the White Ribbon Alliance in Nuapada district. Eighty-five per cent of the district’s population lives in rural areas and 78 per cent are below the poverty line (BPL).

Even after the Janani SurakshyaYojana was launched, only 39 per cent of pregnant women have gone in for institutional delivery. With 52 maternal deaths a year, and all preventable with a little social and medical intervention, the alliance has formulated multifarious strategies to reduce not only mortality but also morbidity, added Patel. The maternal and peri-natal death inquiry conducted by Srusti, an NGO working here, revealed that out of 52 deaths, 12 were in hospitals. Most women were dying at home. Family members confirmed that they couldn’t afford a hospital delivery. There were geographical barriers. The Janani Surakshya Yojana promulgated under the aegis of the National Rural Health Mission (NRHM),every pregnant woman going for institutional delivery is given an incentive of Rs 1,400, has an inherent drawback, said Pabitra Pradhan, coordinator of Srusti. The money is given only after delivery and doesn’t help meet the pre-delivery supplementary nutrition needs of the women, she added. Finance being a major issue, Srusti along with its partner Ngoyar formulated a new strategy. “The day a pregnant woman is identified, we give her a small savings box to save for her delivery,” said Badhia Tandi, coordinator. “We encourage women to save Re 1 per day in the first month and ask them to keep doubling the amount till the ninth month, and they save Rs 1, 350,” said Tandi.

This has not only ensured availability of ready cash with pregnant women during crucial times but also increased their confidence. “Now that I have ready cash with me, I will go in for an institutional delivery,” said a beaming Rama Bag, who is in her seventh month of pregnancy. The government machinery has matched the efforts of the alliance. Continuous malnourishment and poor food habits result in most women being anaemic. Sickle cell anaemia and malaria compound the problem. In such a hostile environment, there have been cases of pregnant women with as low a haemoglobin count as 4.8 gm. Pregnant women are expected to have between 12-14 gm of haemoglobin and anything less than 8 gm could be fatal, according to Dr B Mishra, a gynaecologist. The problem is compounded in cases of ante-partum or post-partum haemorrhages, added Dr Mishra. The cost of blood transfusion being a barrier to accessing the life saving intervention, Srusti took it up with the district administration.

The Nuapada collector, Dr Mrinalini Darswal, herself a medical doctor, could gauge the pregnant women’s woes. She has now decentralised the process of assistance to the needy from the Red Cross fund by placing money with the Tehsildar of Khariar for poor patients of three blocks. The people of remote Sinapali, Bodenand Khariar, who were unable to source Red Cross assistance, can avail of this fund to meet emergencies. A private hospital in Khariar with blood transfusion facility has been roped in to provide cashless assistance for blood transfusion to anaemic mothers. The mission hospital has not only brought down its rates at par with government facilities but now claims the amount from the Red Cross society instead of from the patients, said Patel. Within a couple of months of its implementation, seven needy mothers have availed of this facility, which means seven lives were saved, said a beaming Pabitra Pradhan.

Contact: Biswajit Padhi. Ph: 91 6671 232110 or 9437072910 FAX: 2324

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