As the entire nation is grappling with the surge of COVID fatalities, Meghalaya in the north eastern region is contending with an astonishing figure of high infant mortality.
The ground reality is grim- a large number of expectant mothers (mostly in the rural areas) do not go for any institutional delivery, which is translating to high rates of morbidity and mortality in the mothers and neonates. It has been reported that around 877 newborns and 61 pregnant women have died in Meghalaya since April 2020 due to lack of medical attention, pneumonia and birth asphyxia.
It is indeed a matter of grave concern that the infant and maternal mortality rate has risen sharply as the entire state health machinery has been diverted to fight the COVID-19 pandemic. So whose fault is this? According to the state health minister Al Hek many pregnant mothers in Meghalaya do not come forward for institutional delivery.
"Many pregnant women in rural areas do not want to go for institutional delivery. They deliver at home and when they deliver at home there are complications. Sometimes these complications happen with the mother and sometimes these occur with the new born. Hence increased infant mortality and delivery related deaths cannot be blamed on the government or health department. The dhai (local traditional woman assisting deliveries) are still preferred in rural areas," says Al Hek.
The government or health department cannot be blamed as the dhai (local traditional woman assisting deliveries) is still preferred particularly in rural areasSo why have hundreds of women opted for home delivery by traditional birth attendants (TBAs)? Is it just a question of strong faith on their skills? Financial constraints, fear of unmanageable out-of-pocket expenditures, ignorance of available schemes, unavailability of transport, bad roads, and distant hospitals were found to be important causes for this choice. Also it was found that home delivery apparently offered more privacy to the woman along with the opportunity to attend to their household chores and older children. Moreover, the perceived need for institutional delivery is low among rural households. Sometimes, the attitude of health care staff and unnecessary referrals had an impact on the choice of place of delivery.
Corroborating these facts Hek commented, "Yes these things are happening. Although controlling maternal mortality rate in the state is the priority of the government no success has been achieved so far." The neonatal mortality rate in rural areas is obviously much higher. The state has an infant mortality rate of 34 deaths per 1000 live births. Pneumonia and asphyxia are the major causes of deaths. Incidentally the government has been spreading awareness on this issue and the Asha workers have also been conducting door to door awareness campaigns. Even incentives have been provided for institutional delivery (to pregnant ladies) but despite all these efforts an increasing number of women in the rural areas particularly are still opting for the traditional delivery setups. The situation in previous years was not very different.
Meghalaya had launched the MOTHER programme in August 2019 to improve maternal and child health. MOTHER stands for Meghalaya's Outcome Oriented Transformation in Health, Nutrition, Education and Rural Development. There are 12 big hospitals in the state capital, including six that are privately owned. The state has a total of 28 community health centres and 139 public health centres. Besides, there is a government-run civil hospital in each of the 11 district headquarters.
National Commission for Women's Chairperson Rekha Sharma, in a letter addressed to the Meghalaya Chief Secretary MS Rao has reiterated that the fatalities are a matter of serious concern. "It is a matter of serious concern and the Commission has taken note of the lapses by the hospitals at a time when the Government of India is emphasizing on the implementation of an institutional delivery mechanism across the nation," Ms Sharma wrote in the letter.