InnovationAloneIsnttheSolutionIndiasMaternal

CareCrisis

ByMeeraVijayann

NituPaswan,a25yearoldresidentofKhambalpada,Dombivalli,wasinherfourthmonthof
pregnancywhenacommunityorganiserfromSNEHA,aMumbaibasedsocialenterprisethat
worksinwomensandchildrenshealth,savedher.Paswancollectedscrapforalivingandher
husband,Rajesh,wasadailywagelabourerwhosufferedfromalcoholism.Withnosupport
fromherfamily,Paswanslifewouldhavebeenatrisk.ButwiththehelpfromSNEHA,she
deliveredababyboythroughanemergencycaesareansection.

ManywomenlikePaswan,whocomefromvulnerablecommunitiesinIndia,sufferseverehealth
risksandcomplicatedpregnancies.Theyalsohavelittleornoknowledgeofpregnancyor
childbirth.Socialstrugglessuchasdomesticviolence,dowryharassmentandearlymarriage
stillcontinuetoaffectthousandsofwomenruralandurbanpoorcommunities.However,new
approachestotacklingMMR(maternalmortalityrate)andIMR(infantmortalityrate)areslowly
gainingground.Notsosurprisingly,communityledinterventionsareprovingwhylargescale,
topdownsolutionsarefailingIndianmothers.

Thelifecycleapproach

VanessaDSouza,ChiefExecutiveOfficeratSNEHAtalksaboutthenewapproachthatthe
socialenterpriseistakingtotackletheproblem.Since2000,wehaveworkedonmaternaland
newbornhealthanddomesticviolence.Butwerealisedthatwealsoneededtoworkonthe
healthandnutritionofchildrenupto3years.shesays,Forthis,wehadtoworkonalifecycle
approach,whichmeantthatwehavetointerveneateachpointinthewomans,adolescents
andchild'slife.Thesolution,therefore,isacontinuum.

ThisnovelapproachtouchesuponkeyloopholesinhealthcareaccessinIndia.Socialprogress
remainsanissuethathasbeenlargelyunresolved.

Despiteeffortstoprovideyoungmothersaccesstobasichealthcare,Indiahasoneofthe
highestnumberofchilddeathsintheworld,withnearly1.2milliondeathsin2015alone.Dr
RobertBlack,professorattheJohnsHopkinsBloombergSchoolofPublicHealthinBaltimore,
recentlysuggested
thatthiscouldbebecauseinfectiousdiseasesremainanimportantcause
forchilddeathsinthefirstmonthsincebirth.Blacksconcernisntunwarranted.Butthefact
remainsthatholisticcaretomothers,isinextricablylinkedtoreducingchilddeathsandonethat
continuestobafflemany.SNEHAsworkinthearearevealsthattoinvolvewomenlikePaswan,
thecitizensectorandgovernmenthavefailedindeliveringacrucialservicetowomen:trust.

Whetheryou'reworkingonchildhealthormaternalhealth,youhavetobuildarapportwiththe
mother.Sheisnotgoingtoimmunizeherchildorgetahealthcheckupotherwise.Usuallyit
takesalittlewhilebeforethewomangetscomfortabletotalkaboutdomesticviolence.Vanessa
goeson,It'snotsomethingthatwomentalkaboutinthefirstcoupleofvisits.Wedidacohort
studyon1000childrentotrackreductioninmalnutritionover12months.Wefoundthatinthe
smallpercentageofchildrenwhohadnotmovedoutofmalnutritionevenafter12months,there
wasaprevalenceofdomesticviolenceintheirhomesoralinktodysfunctionalfamilies.We
thenrealizedwehadtoincludepreventionandaddressalofdomesticviolenceinallour
interventions.

HealthcareforIndiasinvisiblepeoples

Buildingtrustisanimportantfocusforothersocialenterprisestoo.DrPavitraMohan,CEOof
AmritClinics
,aninitiativestartedbetweenAajeevikaBureau(AB)andBasicHealthCare
Services(BHS)thatprovidesprimaryhealthcaretotribal,migrantcommunitiesinrural
Rajasthan,talksatlengthaboutwhywomentendtofallthroughthecracksofthehealthcare
system.

Ourcentresarelocatedwithinsuchcommunitiesandaremanagedbyskilledfemalenursesso
womenfeelcomfortablecomingtous.Useofsimpletechnology,andsupervisionbyaphysician

enablesthenursestoprovidequalityhealthcaretothesepopulations.hesays,Wealsohave
communityvolunteers.Womenfacehugeconstraintsbecauseoftheirlimitedautonomyintheir
homes.Sincehealthcarefacilitiesaremanagedbymaleproviders,womenhaverestricted
accesstosuchservices.

DrMohanpointsoutthatwithmigrantfamilies,mentendtotravelandmovefrequentlyforwork
makingitdifficultforwomentoaccesscareontheirown.Migrantworkersalsofacesevere
healthchallengesbecauseofpovertyanddiscrimination.Womenaresubjectedtophysical,
verbalandsexualabusewhilechildrenaresometimesforcedtoparticipateinlabour.This
stronglyinfluenceshighratesofmalnutrition,illhealthandcommunicablediseases.Aajeevika
BureauestimatedthatinRajasthanalone,therewere

over200,000undocumentedmigrant
workers
.

AmritClinicsalsointegratesalifecycleapproachtotheservicesitprovides.Usuallya
womanshealthisthefocusonlyaroundchildbirthbutweneedtotakeintoaccountawomans
wholelifecycle.DrMohanargues,Someofthebiggestcausesofdeathsamongwomenhere
arediseaseslikemalariaandtuberculosis.Manychildrenandyoungadultsarepushedtowork
inlabourmarketearlyon.Coupledwithearlymarriage,thisnotonlyperpetuatesthecycleof
malnutritionandillhealth,butalsoputsthesefamiliesathighriskformaternalandinfant
deaths.Amritsuseoftechnologytoprovideteleconsultationsforpatientsinareaslikeisa
newwaytocounterthelackofresourcesinremoteareas.

AstheUnitedNationsunveileditstrilliondollarplantoendpovertyandhungerwith17
SustainableDevelopmentGoals(alsoknownas

Agenda2030
)amonthago,thecitizensector
hasraisedtoughquestionsaboutitsenactment.AcauseforworryisthatcountrieslikeIndia
hasfallenbehindonreducingchildmortalityand

maternalmortality
whiledespitelowincomes,
Niger,Rwanda,Mozambiqueandafewotherlowincomenationswereabletomeettheirtarget.
Thiscallsforsomeretrospection.