A white ribbon flutters towards safe motherhood in Rajasthan

Rajasthan has among the highest maternal mortality ratio in India at 335 per 100,000 live births. But a project coordinated by SUMA-Rajasthan White Ribbon Alliance for Safe Motherhood, in partnership with White Ribbon Alliance India and GRAVIS (Gramin Vikas Vigyan Samiti) in 10 villages of Osian block of Jodhpur district, to improve this situation, has started showing results.

Now women like Mamta, Goga, Pushpa and Ganga care. Though they hide their faces behind colourful pink and red odhnis [veils] and laugh shyly over the discussion on pregnancy and childbirth, these women have become aware of the need to eat properly, check their blood pressure and weight regularly, and write down the phone number of the local jeep or van driver to call in an emergency or when birth pains begin.
 
When Goga, in her mid 20s, had her first two children, a son, nine, and a daughter, two, she wasn't aware of the need to take iron tablets, or to get herself weighed every month to ensure that she and her baby were fine. But while carrying her newest addition, a daughter who is now five and a half months old, she paid attention to her diet.
 
'I ate greens, bajra rotis, iron tablets, took tetanus injections. The jaapa [birth] went off well,' she says.
 
Goga, whose husband is a carpenter in Surat, Gujarat, lives in Khetasar village in the Osian bloc. She managed to save Rs 5,000 by putting aside money for her delivery every month. But she didn't have to spend a paisa. In fact, under the Janani Suraksha Yojana of the National Rural Health Mission of the central government, she got a cheque for Rs 1,400 a fortnight after the birth and was also compensated for the Rs 300 she spent on the vehicle to reach the primary health centre at Osian, some 27 km away.
 
In between her first and second child, Goga had three miscarriages, which is common among the women here. She even had to undergo medical treatment at Umaid Hospital in Jodhpur for nine months at a cost of Rs 10,000.

Ganga, who has four daughters, the eldest aged twelve, gave birth to a little boy a few months ago. A resident of Khabada hamlet, set among sand dunes, Ganga also had three miscarriages before the birth of her fifth child. All her babies were born at home. In the case of the last child, Ganga registered with the primary health centre, took her injections on time, and wrote down the important numbers on the calendar.
 
'Attitudes [to birth preparedness] have begun to change, and that is a big thing,' say Smita Bajpai, programme officer of Chetna, an NGO.
 
'In our initial phase of work here, we had to deal with a lot of hostility from family elders. The in-laws would tear up our posters and other material we would bring to educate women, and tell us to go away. It took us some persistence to break through.'

One major change among the women now is that they go for birthing at hospitals, either the primary heath centre or the nearest facility that is equipped to handle births. Earlier, births would take place at home as a norm, assisted by the dais or midwives.

'We followed all the instructions to see that nothing goes wrong for the jaapa this time,' asserts Ganga's mother-in-law.
 
Have the Safe Motherhood measures helped reduce the maternal mortality rates in the villages?
 
Aparajita Gogoi, country director of CEDPA (the Centre for Development and Population Activities), which helped form White Ribbon Alliance India, says the measures may not lead to direct prevention of maternal mortality but are extremely important 'in preventing delays which lead to maternal deaths'.
 
'Women alone cannot take the key steps for birth preparedness, they need their husband's support and the familiy's support in preparing for steps like locating the nearest health centre, arranging transportation and money and blood donors and having emergency numbers handy,' Gogoi said via e-mail.