Hospital births: Saving lives to save a generation

Having a baby in India can be a dangerous experience, especially if you are a woman living below the poverty line in a rural area. Nine women die each hour from complications related to pregnancy or childbirth, adding up to 78,000 deaths a year. A million

babies die annually. Of the mothers and infants who survive, many do so with long-term health damage and poor physical or cognitive skills.

According to the latest National Family Health Survey (NFHS-III 2005-2006) data, there is a direct correlation between the percentage of institutional deliveries and the infant mortality rate; it is apparent that women who deliver their babies in hospitals not only increase their own chances of survival, but also those of their children.

Infant mortality rate Percentage of women who delivered in a health facility

Lowest wealth quintile 70.4 12.7

Highest wealth quintile 29.2 83.7

Mother’s education < 5 years complete

66.0 36.3

Mother’s education 12 or > years complete

29.9 86.4

Unfortunately, ensuring access to health care facilities for all women, regardless of their wealth levels, remains a big problem. As is illustrated in the graph above, only 12.7 percent of women from the lowest wealth quintile deliver their babies in a health facility, as compared to 83.7 percent of women from the highest wealth quintile.

To address this discrepancy, the Indian government has come up with schemes such as the National Rural Health Mission (NRHM), whose goal is to improve the availability of and access to quality health care for those at the lowest rung of the socio-economic ladder. The soon-to-be-launched National Urban Health Mission (NUHM) has also given high priority to the issue of maternal and newborn health for marginalized communities. Additionally, a government program called the Janani Suraksha Yojana gives money to

mothers as an incentive if they opt to have their babies in a hospital, instead of at home.

Yet, despite these schemes, supply gaps and challenges remain. In a country of India’s size, where a maternal death occurs every seven minutes, it requires considerable effort from various quarters to ensure a smooth and successful institutional delivery

for an underprivileged woman.

This effort does not have to be a solo one. In order to ensure that everyone receives the services they need, why not link up those who have the expertise, those who have the funds, and those who have the infrastructure? Public-private partnerships are a way for communities and governments to work together for the good health of their women, their children, and future generations.

Just ask Dr. Vidya Kshirsagar, who has long worked to provide specialized health care to the poor mothers and children of Navi Mumbai. In 2007, she was approached by a project called Sure Start—a five-year initiative based at PATH, an international not-for-profit organization supported by the Bill & Melinda Gates Foundation—that is working to help mothers and their children to survive and stay healthy in the states of Uttar Pradesh and Maharashtra.

With Dr. Kshirsagar’s help, the project assisted with the organization of a public-private partnership between the Navi Mumbai Municipal Corporation (NMMC) and local nongovernmental organizations, community groups, professional associations, medical institutions, and private hospitals. Now, the women of Dr. Kshirsagar’s city have access to services such as

gynecological visits, pediatric care, nutrition consultations, and yoga classes—services that address complications before pregnancy and in the postnatal period for mothers and newborns. Thanks to the joint efforts of all these different groups and individuals, the percentage of women delivering in hospitals has increased from 79 percent to 85 percentin one year.

There are also other innovative ways to give people a hand up, instead of a hand out. For instance, in the informal settlements of Nanded, Maharashtra, more than 200 families have formed a partnership and each contribute a small amount of money (US$5) toward a community-based health insurance fund. The fund is used to meet the specific health care costs of the contributors, including maternity coverage. With the help of community-based and national organizations, the government’s Janani Suraksha Yojana scheme has also been integrated into this program. Should patients require a procedure included in the government’s scheme, the money is mobilized for the contributors.

Initiatives such as these highlight the power of partnership: people working together to change what seemed unchangeable. Indeed, in this age of high-flying health insurance schemes and exorbitant medical bills, there is something wondrous about a group of disparate people coming together to create small miracles with big results.

Sure Start works to educate women in India on maternal and neonatal health. Sure Start, an initiative by PATH, supported by the Bill & Melinda Gates Foundation works to promote safe childbirth practices in India.

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