A little feminism goes a long way in parts of rural India where the number of women who die in labor has been cut by 90 percent
The message is written on a poster, hung between trees that offer shade but little relief from the shining sunlight. It spells out what has been achieved in this rural Indian village:” We no longer succumb in childbirth .”
For the women of Purabgaon, in the Amethi district of Uttar Pradesh, expectations had always been clear. Get married young, then have back-to-back pregnancies. Those newborns would be delivered in unsanitary conditions at home by a dai , a village midwife with no training and many superstitions.
” Even if a woman was taken to hospital for the birth, half an hour subsequently she would be bundled home to do the chores, feed the cattles and cook ,” told Gulab Yadav, research projects manager in Amethi for Save a Mother.
The maternal mortality rate( MMR) in Amethi has been one of the highest in the world- 451 deaths per 100,000 live births, according to a 2008 government survey. Anaemia is one key problem: around 55% of Indian women are anaemic, and rural women’s diets are often poor.
Save a Mother aims to educate rural girls about pregnancy, nutrition, immunisation, delivery and care of the child.” We told them to delay having the first baby and leave a three-year gap between pregnancies to keep mom and child safe and healthy. And they understand that delivery in hospital is safest because complications such as heavy bleeding can be treated ,” said Gita Gupta, a Save a Mother team leader.
Gupta leads a group of 20 female” change agents” in Purabgaon. Each of the 360 villages in Amethi covered by the scheme has a team of 20 agents- local women trained to educate other women.
Gupta sometimes changes the lyrics of romantic folk song to refer to iron supplements, intrauterine devices( IUDs) and breastfeeding.” They find it easier to remember what I’ve told them if they sing it ,” she said.
Beginning with 20 villages in Amethi 10 years ago, Save a Mother has expanded to 1,100 villages in the states of Uttar Pradesh, Karnataka and Telangana. The maternal mortality rate for those working villages has been reduced by 90% and infant mortality is down by 60%.
Last year in Purabgaon , not a single mother been killed in childbirth. Nationwide there are five maternal deaths in childbirth every hour, but the mortality rate has been falling steadily, from 280 per 100,000 live births in 2005 to 174 in 2015 and 130 in 2016.
Shiban Ganju, a Chicago-based doctor, founded Save a Mother after a visit to rural Uttar Pradesh.” As a physician I knew[ the high mortality rate] could be solved by a dedicated group working with the community ,” he said.
Ten years on, he said he had learned two key things. Firstly, that changing social behaviours is the most effective and least expensive way to reduce the impact of illnes. And secondly, that the Indian government should increase its public health expending from the present 1.1% of GDP- one of the lowest proportions in the world- to 2.5%.
Some of the older women in Purabgaon talked candidly about the relentless pressure they were put under to give birth.” I had five children in quick succession, my mother-in-law kept telling she wanted a grandson. Then I wedded off my eldest daughter at 15. That was wrong ,” said Urmila Devi.” I know better now. My youngest girl won’t get married before 20 and I will tell her to control her pregnancies .”
The village remains highly conservative, but the project had an effect: many women can now leave the house and attend meetings without requiring the permission of their husband or mother-in-law. Moreover, empowered by the information they have absorbed about pregnancy and childbirth, they have some leverage in family discussions.
” They tell their spouses that if they want a healthy baby … the mother has to eat well. If they aren’t dedicated fish or meat, they drink two glass of milk instead. And they insist on a hospital delivery ,” told Gupta.
In the past, tradition has dictated that girls wait for a clergyman to announce an auspicious moment to start breast-feeding the newborn. While waiting, often for up to three days, they fed goat or cow milk to the baby, causing diarrhoea.” Now we breastfeed at once. We don’t wait for the priest ,” said one of the mothers, Kanti Devi.
Seema Agrahari’s three children , now six, three and one, are always being implemented in hospital.” I had an IUD for my family planning. It’s the best thing I did. I felt well during each pregnancy ,” she said.” But I could have been one of those who died in childbirth. Datum saved me .”
This article is part of a series on possible solutions to some of the world’s most stubborn problems. What else should we cover-up? Email us at theupside @theguardian. com