Young Women Dying Despite Janani Shishu Suraksha Yojana: case studies from Pratapgarh, Rajasthan

Dear Friends,

In the midst of starkly different figures of maternal mortality ratio churned out by the same agency for the same period through different surveys, deaths of young mothers is not stopping despite all kinds of claims of guaranteed and cashless services provided to all women under the Janani Shishu Suraksha Karyakram. (JSSK). In the recently released data of the SRS, the MMR of Rajasthan during the period 2010-12 has reduced to 255 per one hundred thousand live births while the Annual Health Survey which claimed to has the largest sample size of the world for such kind of surveys presented 331 (2010-11) and in freshly released data of 2011-12 of the AHS of course has posted 264, just 11 points more than the SRS. One is intrigued by this fact that Rajasthan has shown decline of 67 points in maternal mortality ratio in one year between 2010-11 and 2011-12.  But, the facts reveal different story.
 
In a recently held investigation by a team of Prayas, it found five maternal deaths which occurred within last one and half months beginning from 15th December 2013 in two PHCs – Mungana and Naya Boriya of Dharyawad sub-division of newly created Pratapgarh district of Rajasthan.  What is very bewildering is all these women in the age group of 20-25 years had accessed health care services and died owing to horrifying manner they were shifted from one health facility to another with no relief from anywhere. The women who died are Hira Meghwal aged 25 years a mother of one living child and one still borne resident of village Khedi, Kamla Meena aged 22 years and second gravid of village Hazariguda, Bhairki Meena aged 20 years and primigravida of village Likniya, third time pregnant Kesar Meena aged 25 years of village Uzadkheda and first time pregnant Ganga Meena aged 20 years of village Sarangiya. They were all illiterate and lived in kutcha mud houses but all of them had accessed public health system during their pregnancy and for delivery. The other ironical posturing is that none of them had any pre-existing ailments and nor were they classified into high risk group when they were subjected to incomplete ante-natal care which was limited to two injections of tetanus toxoid and distribution of iron folic acid tablets.  While Heera, Kesar and Ganga died in the Government M.B. Hospital attached to Medical College Udaipur, Bharaki died while transported in Government ambulance after being referred from Mungana PHC to 40 kms. away district hospital, Pratapgarh. It was only Kamla who died at home because the nearest sub centre where she went after labour pains asked her to go to district hospital, but there was no public vehicle available to transport her and private vehicles operators were unwilling to go for fear of looting.  To add insult to the grave injury, the medical college hospital Udaipur did not provide the families of deceased any documentation including the death certificate, so it is difficult to ascertain the immediate and underlying causes of deaths.  The cause of death of Bhairaki was very clearly severe post partum heamorrhage. While Ganga was eight months pregnant and did not deliver and so was Bharki, however other three delivered still born babies.
 
Earlier most deaths were either at home or during transit between home and the health facility for which it was easy to attribute fault to family or the community, but now after the JSY and JSSK in operation, these are happening either in the facilities or while in transit between first facility to second and sometimes from second to the third facility. It seems even medical college hospitals are not equipped to handle obstetric emergencies.
 
The investigation was conducted by a team of Narendra, Ritesh, Shilki, Vijay Pal, Maya, Lyra and Raya.  

Best regards,

Chhaya
09828416876
Chhaya Pachauli
Senior Programme Co-ordinator

Prayas, Centre For Health Equity,Flat no.- 202, 158 S.B.Vihar, Swage Farm,
New Sanganer Road, Sodala, 
Jaipur, Rajasthan, INDIA
Tel : +91.141.2290593
URL : www.prayaschittor.org