Madhuri Ramakrishnasway, a maternal health activist was arrested on the 16th May 2013 outside the court in Barwani, Madhya Pradesh [MP], India. The police had received a complaint from those in charge of a hospital currently under scrutiny for the alleged mismanagement and neglect of maternal health. The background of this complaint is as follows:-
On the night of 11th November 2008, a very poor tribal woman from the village of Sukhpuri came to the Menimata Public Health Centre [PHC] during labour. She was admitted by those in charge who allegedly left her unmonitored all night. The hospital then demanded Rs 100, an amount she could not afford. She was asked to leave and the staff refused to arrange transport. Finally, the patient delivered her baby on the street with the help of the local "Dai" (Traditional Birth Attendant), only covered by a cloth held by her father in law.
Having witnessed the event, Madhuri took the patient to another hospital to receive treatment. A protest was launched against the unacceptable incident that appears to have been one of many. This case was also part of the writ petition filed in the High Court of MP, Indore Bench in which the substandard state of maternal health services was raised - e.g. the 26 maternal deaths recorded in Barwani District Hospital in 2010 over 8 months were mentioned. The compounder of the hospital was suspended after repeated demands for action but was soon reinstated. It is notable that no one was subsequently held accountable for the dozens of avoidable maternal deaths that have taken place in Barwani. The picture is similar across the rest of the state. The finer points of the case are discussed in more detailed by an excellent Indian blogger and can be read here .
"An investigation of maternal deaths following public protests in a tribal district of Madhya Pradesh" [Reproductive Health Matters] states
"We found an absence of antenatal care despite high levels of anaemia, absence of skilled birth attendants, failure to carry out emergency obstetric care in obvious cases of need, and referrals that never resulted in treatment. We present two case histories as examples. We took our findings to district and state health officials and called for proven means of preventing maternal deaths to be implemented. We question the policy of giving cash to pregnant women to deliver in poor quality facilities without first ensuring quality of care and strengthening the facilities to cope with the increased patient loads. We documented lack of accountability, discrimination against and negligence of poor women, particularly tribal women, and a close link between poverty and maternal death"
This whistleblower's concerns were not without merit. She was subsequently witch hunted as the hospital in question filed a complaint against her, the patient and the patient's husband. They received a court notice to appear at Barwani Court regarding this case on the 16th May 2013. Apparently, the police filed a closure report but sadly the court remained unsatisfied with this and the report was refused. Madhuri was arrested from the court and imprisoned in Khargone Women's Jail. The petition completed by her supporters states
"Although the police had filed a Closure Report, it was refused since "clear reasons for closure had not been stated" and Madhuri did not opt for bail since the charges were clearly false[i]; one Section 148 actually refers to "rioting armed with deadly weapons"! She was sent to judicial custody until May 30th 2013"
It goes onto say
"We find unacceptable that the government targets those who work to protect the rights of the poorest Dalits and Adivasis who are suffering due to poor quality of health services; and we demand accountability from the erring officials who are indirectly responsible for thousands of women dying due to preventable pregnancy related causes"
Madhuri Ramakrishnasway is popularly known amongst the tribals of Barwani as " Madhuri Ben" .She is a leader of Jagrit Adivasi Dalit Sangathan (JADS), a tribal and Dalit Rights Collective. Various advocacy groups under them often hold peaceful protests with a view to raising awareness of the substandard healthcare during pregnancy and labour. She has been involved in developing a grassroots movement demanding good care for rural maternal and child health in some of the remotest parts of the district.
In support of Madhuri Ben's concerns, it is notable that last year :
"The study, conducted on 819 deaths of a total of 1,065 probably maternal deaths reported in Madhya Pradesh between April 2011 and January 2012, suggests 132 women died on their way home or to a health facility"[Source - The Hindu ].
While recent news reports ran headlines about the sudden miraculous "improvement" in mortality rate in the state [ Times of India], these reports conflicts with a presentation in the previous year on maternal death reviews in MP. Apurva Chaturvedi, State Consultant, National Rural Health Mission, and Archana Mishra, Deputy Director (NRHM), explained that 32 per cent of the reviewed deaths had occurred in district hospitals, 25 per cent in maternity centres, 13 per cent in sub-centres and 6 per cent in private facilities.
"Only 17.7 per cent of the expected maternal deaths are being reported and analysed while the remaining go unreported. Worse, in 37 per cent of the cases the cause of maternal deaths is registered as 'other'," they said.
The questionable statistics and the reasons for this was argued well by Sachin Jain. The government's position isn't convincing given the reports on the ground. It is therefore time for a legitimate investigation into the serious risk posed to vulnerable mothers in this state. The first task for the government is to cease harassing its whistleblowers who point out their spectacular failings. Then they should apply their minds more constructively to improving healthcare for patients at risk of neglect and death. They may also wish to improve their ability to collect statistics to avoid being embarrassed further.
Click here to Sign the Petition