Concerted efforts to improve women’s health in Uttar Pradesh in the last 10 years have failed to yield expected results. While other States have shown improvement in maternal mortality rate (MMR), figures continue to rise in the State.
MMR in UP is highest compared to the entire country with 44,000 women dying every year because of pregnancy-related complications. Roughly one out of every 15 maternal deaths worldwide takes place in UP.
Sample the statistics: According to the State’s Sample Registration Survey (2003), the Maternal Mortality Rate (MMR) in UP is 707 on per 1,00,000 live births which shows a significant higher rate than the national average of 398.
Out of more than 54 lakh pregnant women, only 2.25 lakh women receive full check up and care during pregnancy. Over 40 lakh women deliver without help of a skilled attendant and over 45 lakh deliver babies at home.
National family Health Survey-3 (2006) revealed that half of all the pregnant women in UP are anemic. Less than 20 per cent women visited a community health centre for regular check up during pregnancy.
In a survey conducted in 2005 Uttar Pradesh State Planning Commission identified lack of accountability and responsibility of the State towards the general public within the entire health system, absent doctors, poor management, inadequate infrastructure and no community participation as major causes for this appalling state of affairs.
According to the UP Health Watch report, projects like USAID supported Innovations in Family Planning Services, Reproductive and Child Health Project Phase 1 and 2, World Bank-aided UP Health System Development Project and the latest National Rural Health Mission have been implemented in UP and crores of rupees along with around 1,000 million dollars, have been invested in the State, but the ground realities are still scary.
Meanwhile, the Sample Registration Survey Report 2006 on causes of maternal mortality that indicate a decline in MMR in India as well as in UP invited several questions on the credibility of the report.
According to the report, there has been ‘substantial decline in maternal mortality’ from 398 to 301 in India and in UP from 707 to 517.
Health expert, Jashodhara Dasgupta from Sahayog said the report appeared to have occurred in the context of a very slow rise in the rate of institutional births from 7.8 per cent in 1999 to 10.1 per cent in UP in 2003 and 25.4 per cent to 28.3 per cent in India.
Yet the report does not investigate how maternal deaths may have reduced without recourse to institution-based care, and concludes with recommendations that “there should be rapid expansion of institutional and skilled birth attendance” especially in UP, added Dasgupta.
The National Health Policy 2002 set the goal of reducing MMR to below 100 by 2010. The latest policy announcement is the National Rural Health Mission (NHRM launched in April 2004) echoes this target and aims to reduce IMR to 30 on 1,000 live births.
Centre for Health and Social Justice, New Delhi conducted a review of NHRM in UP and found that the awareness about the programme was dismal in almost all the districts and major advocacy was needed.