Even though the “miracle” of childbirth is a familiar trope that repeatedly manifests itself in Indian culture – celebrated through movies, literature and even religious texts – the reality is a far cry for women who live and experience it, particularly in remote rural areas.

The women of Ajaigarh, a tiny town in the Panna district of MP, were in for a rude shock when they arrived at the local community health centre (CHC) and were not even provided beds to deliver their babies. In fact, beds were a far cry. Most of them did not even have bedsheets as they lay with on the corridor floor their children, in constant fear of a passer-by too engrossed checking WhatsApp squashing their newborn.

CHCs come under the umbrella of the National Rural Health Mission (NRHM), a national-level programme for providing affordable, quality healthcare to rural masses. The NRHM prescribes a three-tiered organisational structure: sub-centres (SC), primary health centres (PHC) and CHC for each district, to be administered by the respective state governments. SCs are intended to be the first point of contact between the public and the healthcare system while PHCs are for consulting qualified doctors and CHCs for providing specialised healthcare. Additionally, CHCs are also intended to handle all obstetric emergencies and surgeries.

﻿

However, the multiplicity of structures accompanied by a lack of accountability makes the ground reality vastly different from what is envisaged and promised. As per the CAG audit report (2015-2016), health infrastructure in the state demonstrates a shortfall of 22% in SCs, 41% in PHCs, and 31% in CHCs. As the Ajaigarh CHC manager, Moolchand Ahirvar points out, “We have 30 beds, out of which 15 are in the general ward while 15 are used for childbirth. Government rules provide that a woman may only be discharged 48 hours post her delivery, in which time we may end up having to deliver 24 babies. Thus, we face a shortage of beds. We also don’t have enough wards and often have to put beds in the gallery for women to sleep. We are reprimanded by inspection officers for doing so.” His words lay bare a pervasive bureaucratic apathy, with officers focussing on achieving quantitative targets rather than making quality healthcare available to the largest possible number.

This problem of inadequate infrastructure is amplified by its abysmal quality and a shortage of human resources. For instance, almost half the SCs do not have electricity supply or examination tables and more than 20% of the PHCs lack the infrastructure to provide post-natal and delivery services.

The Ajaigarh CHC reveals a heartrending picture of a new-born baby bundled up in a flimsy blanket next to her mother Anu, who looks equally grim lying among a pile of clothes on the floor. Anu complains of not having received any kind of assistance since the previous night, “It’s extremely harrowing – I had to bring my own bedsheets to even be able to lie here and I constantly worry that either my baby or I will get stepped on in our sleep.”

CHCs in MP indicate the poorest performance with over 80% not having facilities for conducting surgeries or any gynaecology services, coupled with a matching shortfall in the number of specialists available. Besides, where doctors and nurses are available, many are not skilled birth attendant (SBA) trained.

Childbirth-centric policies are another story. The Janani Suraksha Yojana (JSY) and Janani Express Yojana (JEY), state government schemes auxiliary to the NRHM have also fallen short of achieving their common goal of promoting institutional delivery by providing monetary incentives to pregnant women and ASHAs. Only 70% of deliveries in the year 2015-2016 were carried out in public institutions, with the 48-hour discharge rule being flouted in over 30% of them. This inadequacy was attributed to the lack of timely referral transport combined with the failure of ASHAs in motivating women to give birth in public health centres, which is not surprising considering it may mean delivering and nursing your baby on the floor!

MP, a part of the Empowered Action Group (EAG) states, has some of the poorest health indicators which are further marred by gross intra-state inequities where rural and tribal populations are concerned. The state’s MMR of 178 is significantly higher than the national average of 130. Despite high anti-natal and post-natal care registrations indicating an increasing awareness amongst rural women, those actually receiving quality healthcare is relatively low, such as the pregnant women of Ajaigarh who are demanding their rights. In such a scenario, there is a pressing need to put in place adequate physical infrastructure and human resources to be able to respond to the needs of new mothers.

It time the country stopped romanticising childbirth and focussed instead on filling the gaps in the maternal health infrastructure.

Khabar Lahariya is a rural, video-first digital news organisation with an all-women network of reporters in eight districts of Uttar Pradesh.