By Prachi Salve
New Delhi: This week, as Prime Minister Narendra Modi announced – quoting the World Health Organisation (WHO) – that India was free of maternal and neo-natal tetanus, the state of maternal health in the eastern state of Jharkhand indicates the long road still ahead in the country's dark spots.
Modi was speaking at the just-concluded 24-nation Call to Action Summit, which discussed how to end preventable maternal and infant deaths, particularly in high-risk areas globally, including Jharkhand.
Since its birth in March 2000, Jharkhand has seen its maternal mortality ratio (MMR), or maternal deaths per 100,000 live births, improve from 261 in 2007-09 to 219 in 2011-12 due to improved access to healthcare.
But this is 41 points higher than the national MMR average of 178 in 2011-12, worse than Myanmar and Nepal and about the same as Laos and Papua and New Guinea, according to WHO data.
Jharkhand is a part of a group of eight poor states, called the empowered action group (EAG), which includes Bihar, Chhattisgarh, Madhya Pradesh, Orissa, Rajasthan, Uttaranchal and Uttar Pradesh. The EAG was formed by the central government following the 2001 Census to contain the population explosion in these states.
The real maternal and infant-health problems in Jharkhand are revealed when we compare the state's health indicators with other EAG states, such as Chhattisgarh and Bihar.
Jharkhand does not fare well on any of the nine key indicators including government schemes, such as the Janani Suraksha Yojana (Mothers' Protection Programme).
The JSY is fully sponsored by the central government and provides cash incentives, including out-of-pocket expenditure incurred by pregnant women: Rs 1,400 for rural women and Rs 1,000 for urban women.
Jharkhand has the lowest ante-natal care coverage with only 60 percentof women receiving such facilities. Compare that to Bihar with 85.4 percent and Chhattisgarh with 91.8 percent.
Mothers who opted for institutional deliveries in Jharkhand were also low at 23.6 percent, compared to 39.5 percent and 29.2 percent in Bihar and Chhattisgarh, respectively. The women who do use state-run health institutions receive poor quality care.
Seen from the view of those who provide healthcare, they work at substandard facilities and there are too few of them.
The gulf between targets and reality in India's dark areas
At the Call To Action Summit, Prime Minister Modi talked about how India had achieved 75 percent institutional deliveries nationwide, a significant factor in improving maternal and infant healthcare.
But as Video Volunteers' ground reports reveal, absolute numbers are not enough: The quality of healthcare is an important draw for women in remote, rural areas. If infrastructure is crumbling, centres lack medical staff and patients must pay out of their pockets-apart from being treated badly-they are unlikely to use institutions.
The idea behind the JSY is to encourage women to deliver babies at health facilities by making these services free and available, especially in rural areas.
Of Jharkhand's 24 districts, there is a significant urban bias among the bottom five districts, based on maternal-health indicators.
In general, mothers in urban areas received better maternal care in Jharkhand, including facilities under JSY, emphasising the point that poor facilities attract fewer women.