India's tetanus story: Fewer babies dying but moms neglected

Lowering tetanus deaths to less than one per 1,000 births in India is phenomenal because of the sheer numbers of babies -- 26 million -- born each year. Instead of carrying out massive vaccination campaigns, India used a medley of strategies that included providing cash incentives to families for delivering the baby in a health centre or hospital, training more skilled birth attendants, and vaccinating all pregnant women attending antenatal care with the tetanus toxoid vaccine.

Kanchan Devi's baby girl, a bit underweight at 2.1 kg but otherwise healthy, was born on Thursday, the day India announced it has eliminated mother and newborn tetanus that killed 1.6 lakh babies less than two decades ago.

While Devi is oblivious to India's win against tetanus -- which anyway got lost in the unfolding Mukerjea murder saga that has seized the nation's collective mind with its fantastical Hitchcock-meets-Harold Robbins-inspired plot twists -- she is one of the many new mothers who now don't risk losing their babies to the dreaded infection.

The fragile Devi, 20, from Gorakhpur district in eastern Uttar Pradesh, is among hundreds of women who come to Safdarjung Hospital's massive maternity ward in New Delhi each month for the delivery. Devi has lost two children -- one was stillborn and the other died of "lockjaw", the popular name for tetanus, within two months of birth -- and is here because she feared she would lose the third.

She believes she's cursed because she walked under a Peepal tree after dark when she was pregnant. The village health-worker Kaushalya Yadav, 39, knew better: Devi was malnourished (she weighs 39 kg for her 4'11" frame) and severely anaemic (her haemolytic count was 4.7 fm/dl against the normal range of 12-15 gm/dl for women) and had delivered her first two babies in the tiny two-room home she shares with her in-laws, husband and his three younger siblings. Hygiene there is less than optimal, with an old neighbour who doubles as a traditional midwife doing both deliveries armed with a sharp knife and a piece of used string to tie up umbilical cord.

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Suspecting malnutrition and infection killed Devi's first two children, Yadav spent weeks convincing her husband Ramesh Singh, 25, to take her to a hospital for delivery. Luckily for the baby girl, he listened.

The tetanus bacteria thrives in dirt. It is among the leading causes of childbirth-related deaths, causing wrenching muscle spasms beginning at the jaw which, if untreated, cause death.

Lowering tetanus deaths to less than one per 1,000 births in India is phenomenal because of the sheer numbers of babies -- 26 million -- born each year. Instead of carrying out massive vaccination campaigns as was done to eradicate polio, India used a medley of strategies that included providing cash incentives to families for delivering the baby in a health centre or hospital, training more skilled birth attendants, and vaccinating all pregnant women attending antenatal care with the tetanus toxoid vaccine.

Devi's daughter is gaining weight quickly but needs to toughen up faster to fight for her share of food and care in the extended family of seven where her father is the only one bringing money home.

"Gender is the biggest social determinants of health inequality, along with income, ethnicity, geographical location, among others," says Geeta Rao Gupta, Deputy Executive Director, UNICEF, who is in New Delhi for the Call to Action Summit 2015, where Prime Minister Narendra Modi announced that India had eliminated maternal and neonatal tetanus. "India is among a handful of nations in the world where the under-5 deaths are higher among girls than boys even though girls have a biological advantage and their survival the world over is better than boys," says Gupta.

In India, 53% of the children who die before the age of five are girls, mostly because of neglect. "Getting girls treated is simply not a priority in many homes. Despite foeticide leading to a skewed sex ratio where more boys are born than girls, data from Unicef's newborn care units in India shows that only 40% infants being brought for treatment are girls," says Gupta. "The treatment is free, so it's not lack of money keeping parents of young girls away. They are not getting girls treated out of choice."

What India needs, says Gupta, is a national multisectorial programme to address gender inequality. "It's not just a women's issue that can be addressed through health, education and nutrition. It's a human rights issue, where everyone is culpable. All sectors, including labour, law, finance, commerce... must participate," says Gupta.

And keeping girls in school is not a favour being done to anyone as women participation in the workforce drives economic growth. "History has shown us. Take World War II, when women were sent to work because men were fighting. When the war got over, women didn't stop working and helped rebuild post-war economies in developed countries," says Gupta.

"Social attitudes change, but you need to create the legal, economic and social environment to make it happen," she says.