It was the last week of July. Dalsinghsarai was dealing with a critical issue of maternal and new born deaths. These deaths had instigated a series of investigations like social autopsy, analysis of existing events along with evaluation of the responses by various stakeholders. All this was being done to prevent such future instances by an organisation called Innovators in Health, where I’m currently working. It is the organisation’s third year with 45 wards of Dalsinghsarai. The shocking analysis had not disclosed something new but age-old practices prevalent in the region. Here are some of those, combined with lack of institutional insulation in Dalsinghsarai:
Crisis of Institutionalized Myths and Patriarchy
The major cause of the two deaths was Post-Partum Hemorrhage (PPH)*. Both the women had lost their lives on the way to the closest district governmental hospital in Samastipur. The fact that women have been bearing this fate, has a number of reasons including high prevalence of Anemia in the region. Hemoglobin at 9 gm/dL points is considered to be a good level in this region when it should be between 12 to 16. Most women here have an average weight ranging between 35-45 kg during pregnancy barring a handful of outliers touching the 50 kg mark. They have innumerable myths associated with the low hemoglobin and body-weight, like:
- The child will become heavy and huge in case pregnant women eat too much or too many times.
- The child will be thin and unhealthy (showing bones), if supplements are taken regularly.
Owing to the above myths, women eat only twice a day, once early morning and then late in the evening. They don’t even take the Iron and Folic acid tablets during their pregnancy. Consequently, in case of heavy bleeding after delivery, saving their lives is contestable. This is because due to heavy bleeding, the hemoglobin levels dip to 2-3 g/dl points. It can also be attributed to a few patriarchal traditions, as follows:
- The women eat in the end, after feeding everybody. With little or no food, they satisfy their hunger.
- In case of excessive weakness, when women confess difficulties to their mothers-in-law, they are coerced to think of this as a generic issue around pregnancy for which they are not even taken to the doctors.
The belittling of such important issues is a product of long existing patriarchal beliefs where not just the men but even elderly women, knowingly and unknowingly, become the torch bearers of inequality. As Ani-Di-Franco rightly said,
“Patriarchy is like the elephant in the room that we don’t talk about, but how could it not affect the planet radically when it’s the superstructure of human society.”
Crisis of Healthcare Service Provision and Delivery
A brief glimpse into the healthcare setup of Dalsinghsarai points out to a number of glitches in the public health care system. One of the major reasons for the two deaths due to Post-Partum hemorrhage was the unavailability of blood. Officially, the sub-district does not have a blood bank. This genuine institutional lag in the system incites further inefficiencies. At the time of a high-risk pregnancy due to hemoglobin levels as low as 2 or 3 gm/dL, women have to be rushed to Samastipur district hospital. The time lag is caused mainly because of the following:
- Slow and inefficient referral system causes delay in decision making.
- There are delays in arranging for ambulance and even driver, who mostly treats such cases with a callous attitude.
- Unavailability of doctors even for delivery, when Samastipur district hospital has a cadre of 6 gynecologists in campus.
The question we are trying to answer is: Can a gap in institutional capacity and unavailability of resources like these be compared to loss of life? The answer is most likely negative, but the reality in Dalsinghsarai is completely opposite.
A combination of both these crisis renders the sub-district of Dalsinghsarai incapable of preventing such accidents. The first among the two pronged crisis needs a greater gestation time, since it takes a while for the community to adopt new, healthier practices but the least that can be done is to have some activism around getting a blood-bank in the region.
*PPH is a condition where the pregnant mother experiences excessive blood loss after delivering her child.