New Delhi: A new countrywide assessment for the National Human Rights Commission (NHRC) looks at sexual and reproductive health and the compliance of various laws around it.
This is the first national inquiry into sexual and reproductive health and human rights undertaken by the NHRC.
It looks at various issues such as non-discrimination on accessing health services for queer people, adolescents, sex workers and people with disabilities and the issue of HIV/AIDS prevention. It also looks at maternal health, contraception, abortion, child marriage and gender-based violence.
The report has also made recommendations for the NHRC to look into, on strengthening the law, improving access to healthcare and the capacities of healthcare providers, and better accountability and quality.
The report was prepared by the Sama Resource Group for Women and Health and Partners for Law and Development.
Maternal health needs attention
“Poor maternal health continues to be an unjustifiable, but significant problem in India. This is in spite of the issue garnering significant attention and being the focus of policies and programmes of the GOI as well as international bodies,” says the report.
The Indian government spends only 1.2% of the country’s Gross Domestic Product (GDP) on health. But Indian patients have one of the highest out-of-pocket expenditures on health.
The government’s spending comes to about Rs 1,300 per capita. But if a patient is hospitalised, their average out-of-pocket expenditure comes to about Rs 18,268, according to the government’s NSSO data.
It is women and girls who experience the worst impact of this broken public health space, especially on their reproductive health, says the report. Only 17.3% of women in India have come in contact with a health worker, according to government data. Only 17.9% of primary health centres in India offer the services of a woman doctor.
The maternal death rate has always been seen as an indicator of India’s maternal health status. The maternal mortality rate (MMR) has improved over the years but it still is a high number – it has dropped from 212 to 167 between 2007-2009 and 2011-2013.
But there are still large and concerning inter-state differences which “reflect the existing inequalities in access to factors that determine maternal health, including health care services.”
For example, Kerala’s MMR as of 2011-2013 is 61, Maharashtra’s is 68, Tamil Nadu’s is 79 and Andhra Pradesh’s is 92. But at the other end, Assam’s is 300, Uttar Pradesh’s is 285 and Bihar and Jharkhand are both at 208.
Women also do not receive full antenatal care during their pregnancy. In states like Bihar, Uttar Pradesh, Jharkhand, Rajasthan and the northeastern states of Nagaland, Arunachal Pradesh and Tripura, less than 10% of women receive full antenatal care. This goes up to 66.4% in Lakshadweep and 61.2% in Kerala.
As public health provision of maternity services is low, women spend high amounts of money out of their own pockets on maternity care. In states like Manipur, this is as high as Rs 10,076. In Delhi it is Rs 8,719, in Andhra Pradesh it is Rs 7,782 and in Kerala it is Rs 6,901.
The report has examined a number of schemes run by the Central government for maternal health. These include the Reproductive, Maternal, Newborn, Child and Adolescent Health, Janani Suraksha Yojana, Janani Shishu Suraksha Karyakram, Pradhan Mantri Surakshit Matritva Abhiyan and Pradhan Mantri Matritva Vandana Yojana.
The report says that the government should pay attention to these issues, and have an approach that is inclusive, responsive and transparent. The government should look to set up mechanisms to monitor, review and uphold accountability.
The report says all of this is important to ensure that India’s most marginalised communities are cared for and healthcare reaches people in rural, tribal and even urban settings, and that Adivasis, Dalits, migrants, people with disabilities and queer people have access.