-Originally published in the UNICEF India website(2007)
Maternal death reviews spur communities to action in Purulia
Purulia, West Bengal: A visit to Badakhula village in Purulia district can be an eye-opener. Badakhula has no electricity, no land or cellphones – one among the several ‘no connectivity villages’ in a country emerging as a global hub of information technology.
To get to Badakhula in Bandwan block in south-east Purulia, you have to drive through dense teak forests, down mud tracks. Most people in this impoverished pocket live off forest produce or are marginal farmers. Women in labour have to trudge a mile to get to the nearest health sub-centre. From there, they can hire a jeep to take them to the block primary health centre. Those who are not physically in a condition to walk that distance are carried in a ‘duliya’ (a string cot) by able-bodied men in the village.
But this April, there was a buzz in Badakhula with the arrival of a “van rickshaw”, a locally manufactured innovation to make it easier for expecting mothers to reach a hospital.
Twenty year old Balika Singh, a member of a self-help group in the village, is excited. Standing beside the van rickshaw, she exclaims in delight. “I am eight months pregnant. The big day is drawing closer. The van rickshaw will be very helpful. I do not have to walk. It will take me to the nearest point, from where my family can hire a jeep. ”
Purulia is among the poorest and most backward districts in West Bengal. Female literacy in the district is 20.4 percent as against the state average of 47.3 percent. A staggering 74 percent of women who marry are below 18 years of age. Aptly, this was the first district in the country to pilot the Maternal and Perinatal Death Inquiry & Response, MAPEDIR.
This initiative is part of the UNICEF Maternal Mortality Advocacy Project funded by United Kingdom’s Department for International Development (DFID).
The preparatory phase spanned almost an year, from July 2004 to June 2005. Maternal death inquiries started on a regular basis in the district from 1st July 2005. Pre-designed proformas in Bengali were field-tested by technically qualified coordinators from the R G Kar Medical College in Kolkata and the UNICEF state office.
These were further modified, incorporating feedback from the grassroots. Kalyan, a local NGO, was closely involved with the MAPEDIR roll-out in the district.
Till date, a total of 166 maternal deaths have been reviewed from 20 blocks in the district. And the broad findings are being shared with the community.
“Earlier, we thought ‘development’ was synonymous with road building. Now we realize, it is also about health and education. On the last Saturday of every month, each panchayat or village council holds a meeting to discuss health-related issues. Since last year, these meetings have devoted a lot of time to maternal and infant deaths. It made me realize that a key issue in saving mothers is to get them safely to a health centre or hospital for delivery. If we can achieve this, we can prevent many maternal deaths. As I talked about this with others, the idea of a van rickshaw emerged,” says Shankar Prasad Singh, a high school teacher and pradhan (Head) of the Dhadka village council in Bandwan block, under which Badakhula falls.
Meeting of a women’s self-help group in Badakhula village, Purulia
Singh did not waste time translating idea into action. “I realised I could tap into the “untied funds” available to the gram panchayat (village council) to buy the rickshaws .I got 2 such van rickshaws at a cost of a little over Rs 12,000 (US$ 294). They were made by local people. In Badakhula, village, one such van rickshaw has already been placed with one of the local women’s self help groups. We are fortunate to have UNICEF help and guide us in our efforts,” he adds.
Singh was the first gram pradhan (GP) (village head) to visualize a community-level transport arrangement to help expecting mothers from remote villages reach health facilities in time. But the buzz in Badakhula had a ripple effect. Soon, other gram pradhans were calling him to find out how best they could finance similar initiatives.
“The gram pradhan of Kuchia consulted me. We never really went to the media. But word of mouth publicity has made us famous! Leaders of other village councils want to know which funds they can use to arrange such referral transport for expecting mothers,” says Singh.
The van rickshaws in Purulia’s remote Bandwan block are examples of local action triggered by MAPEDIR in a poor, backward district in India
The long-term success of such initiatives, however, will depend on the extent to which the local villagers participate in the operational aspects. One critical element is the extent of involvement of the local women’s groups in such community-led schemes.
“Womens’ self-help groups (SHGs) can play a very important role. For example, in villages where they are active, they can start little thrift societies with revolving funds. When a woman requires instant cash for emergency expenses to go to the hospital or on the way or afterwards, she should be able to tap into the SHG’s emergency funds. Reimbursements from the government come in later. Sometimes you need money immediately and if communities want their mothers to live, they would have to work out mechanisms to deal with these details also,” says Dr Khynn Win Win Soe, UNICEF Project Officer for Safe Motherhood in India.
And in Pakistan, they turn their sorrows into songs.