In Rural UP, Lack of Toilets is Forcing New Mothers to Squat in the Open

While there is no dearth of maternal healthcare intervention schemes, it seems absurd issues such as accessible toilets will continue to set rural health back.

“This door is locked, see?” said a visibly perturbed Sharda as she stood in front of the attached bathroom in the maternity ward of the primary healthcare centre (PHC) in Mahoba’s Jaitpur. Having accompanied her pregnant daughter Rita to the centre for her delivery, Sharda met with some unexpected complications – which had nothing to do with the pregnancy.

“If she has to go to the bathroom, where should she go?” she demanded, anger evident in her voice. “She can barely walk, she is in pain, she could fall. She’s just recovering from the delivery, and now this additional trouble.”

The PHC in Mahoba has one other bathroom adjacent to the delivery room, but it is a virtually impossible walk for a woman who has just had a baby or is about to have one. It’s also a common bathroom, meant for anyone and everyone in the centre.

According to the Indian Public Health Standards (IPHS) guidelines for PHCs, it is “essential” for waiting rooms, labour rooms and wards to have attached bathrooms – separate ones for men and women.

“I had to go outside to use the toilet because the one here is locked,” said Rita, lying in bed. She had delivered her baby just that morning. “If we have to go, we have to go out in the open, because there are no other provisions,” she added.

“People were looking at me because I was relieving myself in the open. I was angry, but I had no choice.”

Rita’s admission is also telling of UP’s open-defecation free status, one that has been loudly cited by the state and Central government alike because it shows the success of Modi’s pet project, Swachh Bharat.

In this case, not only did a governmental facility not have accessible toilets, but the only available option to Rita was that of open defecation. This means, there is a clear lack of public toilets in Jaitpur, one of the 97,641 ODF villages in UP.

One other option available to Rita, explained by Narvada, the local ASHA worker, was not a viable one. “We can’t afford to take her from here to there. There is risk involved.”

Post delivery, women often suffer from vaginal bleeding and tears. There is also the risk of postpartum complications, all of which necessitates rest – a toilet being handy is a clear must.

As of 2017, the latest available data, there were 3,621 functioning PHCs in UP. The fact that there is no compiled data available about the construction or maintenance of toilets in rural healthcare centres speaks volumes.

“If it’s blocked, how will you use that bathroom?” asked Archana, the ANM (auxiliary nurse midwife) who works at the PHC and maintains that the toilet was locked because the flush was broken. “Only when it is cleaned can it be opened.” According to her, the toilet had remained shut only for 2-3 days – a claim that the patients vehemently disagreed with. Upon asking her what the holdup was, even if it was about having it cleaned, Archana looked away, refusing to answer.

“I actually did not know until now that the toilet is shut,” said Dr Sunita, the main healthcare physician of the PHC. “If it is true, then I will find out and investigate.” Promising to look into the matter, she added: “We have only found out this information today, so we will do our best to resolve the matter to ensure that the women who have recently delivered children do not have to suffer.”

A bright signboard outside the maternity ward says: ‘The Jachcha Bachcha ward is open for 24 hours, it is essential that one stays in the hospital for 48 hours after delivery’. It is one of the many signboards in and around the ward that have instructions for expectant and new mothers, information about welfare schemes and encouragements for institutional birth.

While there is no dearth of maternal healthcare intervention schemes, all with the clear mandate to improve rural maternal and infant health, it seems like absurd issues such as locked toilet doors will continue to set our nation’s villages back. And continue to fail mothers in rural areas.

Khabar Lahariya is a rural, video-first digital news organisation with an all-women network of reporters in eight districts of Uttar Pradesh.