LUCKNOW: The right to safe motherhood continues to be a distant dream for many women in several villages of Uttar Pradesh. More than 32% of women are still delivering babies at home. Many of these women could even be going to quacks or faith healers.

The National Family Health Survey (NFHS) (2016) data shows that the total number of institutional births in a year in UP was 67.8%, including childbirths in both government and private health facilities.

Safe motherhood refers to a woman’s right to safe and dignified childbirth. It encompasses access to care and childbirth at a recognized government or private health facility assisted by trained and qualified personnel and respectful treatment by the health staff so that labor becomes a positive experience.

Health activist Bobby Ramakant said that the statistic that one in three women delivers at home suggests that the most significant norm of safe motherhood is being violated in the state.

Women who reach a health facility also face challenges. A study by Sangeeta Bhattacharya and colleagues (2015) from London School of Hygiene and Tropical Medicine noted that problems of inadequate physical infrastructure such as irregular supply of water, electricity, shortage of medicines, lack of a gynecologist and anesthetist to manage complications and out-of-pocket expenditure were common.

NFHS data also mentions out-of-pocket expenditure at government health facilities. The average such expenditure per delivery at a government facility in UP was Rs 1,956.

Specialist in health at UNICEF, UP, Dr Kanupriya Singhal, mentioned that the issue of safe motherhood is directly related to neonatal mortality, maternal mortality and rate of stillbirths. She stated that many lives would be saved if issues of access and quality of care are addressed. On a global level, 36% of neonatal deaths and 46% of maternal deaths within 24 hours of childbirth and 40% of stillbirths bear a direct link with the quality of care, she said, citing data from Lancet.

Bhattacharya and colleagues also noted that dignified treatment was lacking at the facilities. Problems like difficulty in maintaining privacy, lack of skill for post-delivery counseling and interpersonal behavior were noted.

Social policy specialist, Piush Antony, stated that it is not very difficult to ensure dignity to an expectant mother. She suggested that an easy way is to include men in all discussions related to their wife’s pregnancy. Another way is to allow companions, preferably husbands, inside the labor room. Health workers also need to be trained to handle patients sensitively.

General Manager for Maternal Health in National Health Mission, Dr Usha Gangwar, said that UP was at the threshold of change. She mentioned that a program called Laqshya has been launched by the Union government that aims to improve quality of care in labor room and maternity operation theatre. This involves guidelines and protocols to improve access, quality and fight mindset barriers related to childbirth to ensure dignified labor. In all, 277 high-case-load facilities of UP have been selected under the program. She stated that the change for the better has begun.