GUWAHATI, Jan 19 - Child bearing at an early age � a burning issue in many Indian states � is no less a concern for Assam, a situation in stark contrast to the common belief of non-existence of child marriage practice in the State.
Topping the Maternal Mortality Rate (MMR) list in the country for the tenth consecutive year, Assam needs a paradigm shift in the interventions of maternal healthcare in many fields, including pregnancy at a tender age, according to experts.
Surviving childbirth, the fundamental right of an expectant mother, is jeopardised due to a number of factors in Assam, according to Dr Aparajita Gogoi, executive director of the Centre for Catalyzing Change, who has 20 years of extensive experience in defining approaches and strategies for policy issues in population.
�Child bearing at an early age is one of the burning issues in India, where the bleak figures keep on telling the tragic story of young mothers. Assam too is not in the pink of health when it comes to maternal healthcare. As per the National Health Family Survey, around 15 per cent of women aged between 15-19 years have already become mothers or pregnant in the rural rungs of Assam,� says Dr Gogoi.
The scenario can be gauged by the fact that Assam has the highest maternal deaths in the country. As per the latest Sample Registration Survey (SRS July, 2013-15), the MMR in Assam is 300 per 100,000 live births. Compared to the corresponding national figure of 167, Assam�s MMR is almost double that average.
Despite the fact that MMR in the State has fallen from 568 in 2001-2003 to 300 currently, Assam has consistently recorded the highest MMR in the country for the last ten years, an alarming proposition for those at the helm of affairs, and calling for some serious counteractive steps.
�There are many reasons for high mortality rates in Assam. Assam is still grappling with challenges like difficult terrain and inaccessibility to health services. We have not been able to make services accessible to many, for example, those living in the chars or the tea communities where the population still is considerably socially isolated. Many maternal deaths take place in these areas,� she explains.
Challenging the common belief of negligible child marriage in the State, Dr Gogoi says the existing data do not allow one to look away from the prevalence of child marriages in Assam. �Although we have laws preventing child marriages, latest NFHS data show that among women aged 20-24 years in Assam, 32.6 per cent were married before the age 18 years. This is unacceptably high, especially for a state like Assam.�
It may be mentioned that Dr Gogoi, the national coordinator of White Ribbon Alliance India, an international organisation working extensively towards the well-being of maternal care, was named as one among the 100 of world�s most inspiring women by the newspaper Guardian of UK.
Under her supervision, her organisation is also implementing projects that address the issue of gender-based violence aimed at impacting attitudes and raising awareness about laws and support services for women/girls facing violence.
Prevalence of anaemia among women in the State is another appalling phenomenon that should not be ignored. As data suggest, among the women in the 15-49-year bracket, 46 per cent are anaemic. A UNICEF study found that almost 96 per cent of pregnant women in tea gardens in Dibrugarh district in upper Assam are anaemic. Severe anaemia contributes to postpartum haemorrhage, the top cause of maternal mortality worldwide. Early marriage and lack of proper nutrition are some other causes of high MMR.
�The fact that women are not accessing services is evident from the latest NFHS data which say that full coverage of antenatal check-ups is still below 50 per cent and only half of all new mothers access post-natal services,� Dr Gogoi adds.
Dearth of doctors, paediatricians and nurses in the State is one of the factors fuelling the situation. A recent release by the Indian Institute of Health Management Research (IIHMR) said that Assam has over 22 per cent shortfall of doctors at the PHC level and nearly 43 per cent shortfall of specialists at the community health centre level. The healthcare infrastructure is being revamped, but how can hospitals run well when there is a lack of health providers?
The government, under the National Health Mission (NHM) has taken a number of steps in Assam. As per the national guidelines, a cadre of female health activists called ASHA, has been placed in each village to increase access to maternal care. Under the Janani Suraksha Yojana, institutional delivery is promoted by integrating cash assistance with delivery and post-delivery care and the like. Schemes like �Mamoni� to provide cash assistance to pregnant women for nutritional support and �Mamata� which seeks to reduce the Infant Mortality Rate (IMR) and MMR, by insisting on post-delivery hospital stay for 48 hours of the mother and newborn are making some difference.
�The rate of institutional deliveries in Assam is now over 70 per cent, which is encouraging, but despite all that, Assam still tops the list in MMR in India. To bring down maternal deaths, what is needed is more accountability around implementation of policies, ensuring that good quality health service is made universally available, that steps are taken to address anaemia, and at the same time social evils like child marriage are addressed,� suggests Dr Gogoi.
