Lure of cash aids India's efforts to reduce number of women dying in childbirth

By Emily Wax
Thursday, July 15, 2010

BRAMHA DASPUR, INDIA -- Urmila Rawat gave birth to her first two children in her thatched-roof home, as Indian village women have always done. Now eight months pregnant, Rawat assumed she would deliver her third baby at home as well.

Indian government officials see that traditional mind-set as an obstacle to the prosperity and health of a rising economic powerhouse that still has one of the world's worst rates of maternal mortality.

So the government decided to lure Rawat -- and millions of other village women -- to give birth in the cleaner, safer environment of a hospital with the most effective enticement it can think of: a cash payment of $30, or several weeks' wages for her farming family. And it seems to be working.

"The payment would be very helpful," said Rawat, 26, as she sat in the shade, her ankles swollen and her back aching. "We would use the money for food and clothes for the new baby."

India's high maternal mortality rate, while reduced by half in the past 20 years, remains a national embarrassment. Mothers dying in childbirth also create broken families that are an economic impediment.

India's rate of 254 deaths per 100,000 live births puts it in grim company. According to a recent report in the Lancet medical journal, more than half of all maternal deaths in 2008 were in just six countries: India, Nigeria, Pakistan, Afghanistan, Ethiopia and the Democratic Republic of Congo.

India's rate is about 10 times that of China, which has focused for decades on improving rural health care, according to the World Health Organization. The rate in some Indian states, including Rawat's home of Uttar Pradesh, is twice the national average, and in some areas, government statistics show that a woman dies in childbirth every hour.

Such dismal statistics, in a nation striving to be known more for technological innovation than for mothers dying preventable deaths on dirt floors, have spurred Prime Minister Manmohan Singh to promote the cash giveaway to mothers who deliver in hospitals.

It is just one aspect of a gargantuan effort to overhaul India's drastically uneven and overburdened health system and bring basic services to the most vulnerable of India's 1.2 billion people.

The WHO has ranked India 71st out of the 175 countries in the world in public health spending. Singh's government has promised to increase that from less than 1 percent of India's GDP to up to 3 percent by the end of this year. Health advocates say that's still just half the rate at which countries with comparable per capita incomes fund their health sectors.

Five years ago, Singh launched a National Rural Health Mission to revamp a rural health system lacking in equipment and trained health professionals. Still, a recent survey found that nearly 150,000 rural health centers do not have a doctor, according to India's health ministry.

Adding to the maternal mortality problem is a lack of properly trained midwives in rural areas. Skilled midwives who are based in villages have been one of the most important factors in dramatically decreasing maternal mortality in countries such as Sri Lanka and Thailand. India has several national programs underway to train more midwives.

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