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Resource centre on India's rural distress
 
 

At health centres, moms miss human touch -GS Mudur
-The Telegraph

In a primary health centre in eastern Jharkhand, the angry shouts of a nurse punctuated the occasional wails of a woman in her early-20s who was in labour pain and only minutes away from delivering her baby.

Each time a uterine contraction evoked a yell or a wail or the woman sought a more comfortable position during labour, the nurse or other health workers admonished her, asking her to shut up and be done with it.

The woman from a village in Jamtara district, who later narrated her experience to public health experts, is among a growing number of rural women across eastern and northern India breaking away from tradition and opting to give birth at health centres.

A Union health ministry initiative called Janani Suraksha Yojana (JSY) launched seven years ago, promising Rs 1,400 to parents for a delivery in a health centre, has reduced India’s proportion of home births from 47 per cent in 2005 to 27 per cent in 2010.

But a survey in Jamtara suggests that while the government has bolstered facilities in health centres, it may have overlooked what some health experts say are the universal needs of mothers-to-be: comfort, privacy, some kind words.

“The JSY is in dire need of soft skills, a human touch,” said Sanghita Bhattacharyya, a researcher with the Public Health Foundation of India (PHFI), a public-private institution in New Delhi, and co-author of a report describing the survey’s findings.

The survey probed the experiences of 500 new mothers from villages in Nala block of Jamtara and found that 12 per cent who had delivered in PHCs reported that they were shouted or screamed at by health staff during labour. Nearly 40 per cent of 225 women who had given birth at home appeared convinced that they would be more comfortable and have greater privacy at home than in a PHC.

Another woman in her early-20s from a household in Nala block gave birth at home, then ferried the newborn, only a few minutes old with its umbilical cord still in place, to the nearest PHC to register an “institutional” delivery.

A nurse at the PHC cut the umbilical cord and registered the birth, and the parents earned Rs 1,400 under the JSY, according to PHFI researchers who interviewed the woman during the survey.

The researchers say the survey, conducted by the PHFI, the London School of Hygiene and Tropical Medicine and the University of Aberdeen in the UK, has revealed the gains from and the gaps in the JSY.

“More parents in rural areas now want their children to be born in health centres — with or without the JSY incentive, but there’s often no transport,” said Aradhana Srivastava, a research associate at the PHFI. Eighty per cent of women who had initially planned to deliver in an institution but eventually gave birth at home cited lack of timely transport as the only reason they remained at home.

The study observed that while the government has pledged free institutional delivery whether routine or complicated, parents who visit PHCs often had to pay for medicines and at times encountered demands for mithai-money from nursing staff.

“One woman was asked to pay Rs 600 after the birth,” Srivastava said. The findings from Jamtar appear consistent with another survey of maternal health services in 11 districts of Uttar Pradesh earlier this year.

The Uttar Pradesh survey by a non-government women’s health group, Mahila Swasthya Adhikar Manch, had found that among 410 women, 263 had to pay “informal fees” to the health staff — the least amount spent was Rs 20, the highest Rs 2,000.

A woman on average has to spend Rs 1,277 to get Rs 1,400 provided under the JSY scheme, said Jashodhara Dasgupta, co-ordinator with the women’s health group. The minimum spent was Rs 49, the maximum Rs 3,880.

“These women didn’t get the free care they were promised,” Dasgupta said.

The PHFI report has recommended that health staff at PHCs should be trained to behave respectfully towards their patients, desist from scolding women in labour and allow a trusted person to comfort them. Bhattacharyya said actions to correct the deficiencies in the JSY need to be urgently corrected. “We don’t want a ripple effect to negate its gains.”