By IANS,
New Delhi : One in 43 women in South Asia is likely to die at childbirth, reflecting the abysmal reproductive health care situation in the region, a World Bank report said Thursday.
The report, titled ‘Sparing Lives: Better Reproductive Health for Poor Women in South Asia’, analysed the current state of reproductive health in five South Asian countries namely Bangladesh, India, Nepal, Pakistan and Sri Lanka. It called for a single window for the complete package of essential reproductive health care services for women, especially adolescent girls.
The report said that South Asian women face hundred times greater risk of dying during childbirth than women in the industrialized countries that average a risk of one death in every 1,000 childbirths.
“This report finds a common thread of problems in the nations. In India while there are positive strides in the areas of fertility and infant mortality, maternal mortality ratio, immunization coverage and malnutrition remain a cause for concern. Other countries have succeeded in reducing fertility like Bangladesh; raising marriageable age like in Pakistan and reducing maternal deaths like in Nepal and Sri Lanka,” said Robert Zagha, World Bank’s director in India.
The report cites challenges in reducing the rich and poor divide in access to health care services as a major constraint.
“In India, the number of poor women having access to antenatal care is half that of the rich. In Bangladesh, Nepal and Pakistan it is one-third,” the report said.
The report, however, ranks Sri Lanka on the top of reproductive health care ratings among the five countries because of “strong outreach initiatives”.
Relative parameters like highest institutional births, least socio-economic differences in infant mortality and fertility rates, and equitable use of antenatal care in poorest and richest strata, put Sri Lanka at the top of the ladder when compared to the remaining four countries, the report states.
While India figures mid way in most categories, the statistics reflect even more sadly in Pakistan, Nepal and Bangladesh in various parameters.
In Nepal, Bangladesh and Pakistan for example, institutional births was below 25 percent. In India this was about 90 percent in urban regions and 40 percent in rural areas. In Sri Lanka over 90 percent of childbirths were institutional.
The lead author of the report, Meera Chatterjee, who is also a senior social development expert at the World Bank, explained the significance of the report in the Indian context citing suggestions that apply across all five countries.
“Women’s low education and poverty are consistently associated with low use of reproductive health services. It is a myth that there is no demand for quality health care by women just because they don’t go to the poor quality services available. There needs to be skilled outreach.
“If we want to break the cycle of poverty we must improve reproductive health care because poor reproductive health undermines the survival of individuals, the wellbeing of families and results in transmission of poverty from one generation to the next,” Chatterjee told reporters.
Among other suggestions, the report calls for a single window for the complete package of essential reproductive health care services.
Poor women “don’t have time, money or power” to approach separate health care providers especially adolescent mothers, the report said. The report also advised �innovative financing’ for better access via vouchers and insurance and for efficient allocations to target health care in �poor regions’.
“There are enough funds in the government in the health care sector here. India’s National Rural Health Mission launched in April 2005 is a good framework to address India’s concerns in reproductive health. However, one must emphasize the need for accountability from absenteeism of health care workers and their behaviour towards clients and the need to improve as you expand the numbers of health care resources,’ Chatterjee concluded.