Inside the CHC of a small town in Panna district, where women in labour and new-borns fend for space and fight for just another inch of the hospital floor
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.
Like the women of Ajaigarh, a tiny town in the Panna district of MP, who were in for a rude shock when they arrived at the local community health centre (CHC) and were not even provided with beds to deliver their babies. Beds in fact were a far cry, most of them were not even provided with bedsheets as they lay with their children on the floor in the corridors, in constant fear of their new-borns being squashed by a passer-by too engrossed in checking his What’s App.
CHCs come under the umbrella of the National Rural Health Mission (NRHM), a national-level programme for providing affordable, quality healthcare to the rural masses. The NRHM prescribes a three-tiered organisational structure of Sub-Centres (SCs), Primary Health Centres (PHCs) and CHCs 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 are 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 only 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 up to 24 deliveries. 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. But then we get 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 SBA (Skilled Birth Attendant) 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 MMR of 221 is significantly higher than the national average of 178. 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 rightfully demanding their rights. In such a pitiful scenario, there is a pressing need to put in place adequate physical infrastructure and human resources so as to be able to respond to the needs of mothers.
It’s definitely time our country stopped romanticising childbirth and focussed instead on filling the gaps in the maternal health infrastructure.
This Khabar Lahariya article first appeared on The Wire.