Women’s Health on the Backburner in Bihar’s Poll

Women’s Health on the Backburner in Bihar’s Poll

  • Health
  • by Pratiush Prakash
  • 14 May, 2019

Election campaigning for the 17thLok Sabha elections has reached a feverish pitch in Bihar. At the time of writing the piece, four phases of elections were over, alliances were forged, brothers stopped being brothers, a veteran leader addressed his vote bank in an open letter from behind bars, Shotgun moved camp, the Chief Minister received a vote of confidence from his deputy, and a young student leader pitched himself against a seasoned politician. Clearly a lot has been happening in Bihar — it is after all, perhaps after UP, a key deciding factor of who comes to the centre. Amidst all of this, campaigning continues in full fervor. 

The candidates from across political parties are promising everything under the sun — education, jobs, and farmer loan waivers are the buzzword — but there is absolutely no discussion, leave alone a sliver of commitment, on quality primary healthcare for mother and child. Safe motherhood, family planning and neo natal care is not something that parties have either in their poll promises or overall strategy, were they to come to power. 

Though, Bihar in the past has taken some progressive steps towards women empowerment such as 50% reservation in Panchayat Raj Institutions, Mukhyamantri Nari Shakti Yojnaand 45% reservation in Government jobs, yet women’s right over quality health care is still out of bounds. Infact, Nitish Kumar’s ambitious programme ‘Saat Nishchay’ (Seven-point agenda) misses out on the health front in terms of providing quality health care such as safe motherhood and improving nutritional status of mother and child.

And why should women’s health be the focus? Consider these numbers from the fourth round of National Family Health Survey (NFHS) and the impact it has on women and children. In rural Bihar, only 46.4% women are literate, this increase their chances of being forced into child marriage (40.9% women aged between 20-24 years are married before 18 yrs) and subsequently, high risk pregnancy. These young women give birth to underweight children resulting in high Infant Mortality Rate (IMR) (40 per 1000 live births) and Under-5 Mortality Rate (U5MR) (60). Only 3% of rural women (overall 6.6%) receive full antenatal check-up and this cannot be expected to reduce the MMR and IMR. The SDG targets —IMR 12 and U5MR 25 — thus remains a farce. 

Healthcare was not on the priority list of the present government either, and the results of this neglect reflects in the under nutrition of women and girls and high Maternal Mortality Ratio. The National Family Health Survey 4 (NFHS 4) data reveals a socio-economic divide in the health status of vulnerable groups such as minorities (especially Muslims), Scheduled Castes (SC) and Scheduled Tribes (ST). The data suggests that the mandatory four antenatal checks is as low as 8.6% among SCs in comparison to those in the General category at 24.4% and Other Backward Class (OBCs) at 14.2%. Muslims, in particular, lag behind in seeking health care services at public health facilities mainly due to discrimination they face at the hands of the service providers.

Lakhs of women die every year due to pregnancy-related disorders such as obstructed labour, post-partum and internal haemorrhage, hypertensive disorder, infection and anaemia. Delay in service delivery, lack of proper transport (ambulance) and obstetric care plague Bihar’s public health facilities. Primary Health Centres (PHC) which act as First Referral Units lack basic infrastructure, specialist MBBS doctors, and medicines. Bihar Government has failed to fill vacant human resource positions — nearly 62% posts of MBBS doctors, 61% Grade A nurse and 55% ANM posts remain vacant (as per Bihar Economic Survey, 2018- 2019).

At the core of the global agenda for 2030 lies the principle of universality. ‘Leave No One Behind’ focuses on equity but the chances to meet the goals remain bleak until more realistic and tangible measure are taken by the government to reduce maternal and infant deaths. Thus providing access to quality maternal & child health services at PHC level is the first step.

A more comprehensive and holistic approach towards women’s healthcare is required. One that focuses on nutritional requirements of women and adolescents, provides a basket of choice for family planning (contraceptives), ensures safe and secure pregnancy, and safe delivery for every pregnant woman. The present government is expected to build a robust public health system where quality continuum of care is accessible until the last mile. India can only meet the SDGs (IMR 12 and U5MR 25 per 1000 live births) if Bihar, which is among the EAG states, improves and for this the Government is expected to take concrete steps.

But no political party or its leader is talking about providing quality primary healthcare and nutrition in equitable manner to all its citizens. With so much data to suggest the dismal healthcare situation in the state, it is either in the blind spot of policymakers or healthcare is the hot potato that no party wants to touch. 

Though it is missing from the public discourse, attempts are being made by Oxfam India and a network of civil society members to generate public momentum towards bringing these topics to the fore. Through discussions, debates, and show of commitment by signing pledge cards, civil society members are trying to sensitize the community to seek their right of quality healthcare from the government. It will be interesting, if in the remaining days of campaigning, any candidate dares to pick up this hot potato, make a commitment to set things rights, and then walk the talk. 

The author, Pratiush Prakash, is currently working as a Programme Coordinator at Oxfam India. He can be reached at pratiush@oxfamindia.org


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