Brief:Unless India actually counts all the women who die during childbirth, it won't be able to prevent these thousands of unnecessary deaths. Accountability might seem like an abstract concept, but for Indian women it's a matter of life and death, says Aruna Kashyap, South Asia researcher in HRW's women's rights division

Details :Tens of thousands of Indian women and girls are dying during pregnancy, in childbirth, and in the weeks after giving birth, despite government programmes guaranteeing free obstetric healthcare, Human Rights Watch (HRW) said in a report released recently.

The 150-page report No Tally of the Anguish: Accountability in Maternal Health Care in India documents repeated failures both in providing healthcare to pregnant women in Uttar Pradesh in northern India and in taking steps to identify and address gaps in care. Uttar Pradesh has one of the highest maternal mortality rates in India, but government surveys show it is not alone in struggling with these problems, including a failure even to record how many women are dying.

The report cites numerous examples of cases in which breakdowns in the system have ended tragically. Kavita K, for example, developed post-partum complications but the local community health centre was unable to treat her, according to her father, Suraj S, who said the family then tried to take her to government hospitals in three different towns.

From Wednesday to Sunday -- for five days -- we took her from one hospital to another, he told Human Rights Watch. No one wanted to admit her. In Lucknow, they admitted her and started treatment. They treated her for about an hour, and then she died.

India created a flagship programme, the National Rural Health Mission, in 2005 to improve rural health, with a specific focus on maternal health. The programme promises concrete service guarantees, including free care before and during childbirth, in-patient hospital services, comprehensive emergency obstetric care, referral in case of complications, and post-natal care. But the system is not working as it should, HRW research shows.

The report identified critical shortcomings in the tools used to monitor the healthcare system and identify recurring flaws in programmes and practice. While accountability measures such as monitoring how and why women die or are injured, or how many pregnant women with complications can use the government's emergency obstetric facilities, may seem dry or abstract they are critical to intervening in time to make a difference and saving the lives of women.

Major gaps in the system as identified by Human Rights Watch include:

* Failure to gather necessary information at the district level about where, when, and why deaths and injuries occur and whether women with pregnancy complications in practice get access to emergency obstetric care.
* Absence of accessible grievance and redress mechanisms, including emergency response systems.

India has recognised that thousands and thousands of its women are dying unnecessarily, and it could be leading the world in reversing that deadly pattern, says Aruna Kashyap, South Asia researcher in HRW's women's rights division. But for all India's good intentions, the system still leaves many women at risk of death or injury.

Research for the report was conducted between November 2008 and August 2009, and included field research and interviews with victims, families, medical experts, officials and human rights activists in Uttar Pradesh and elsewhere in India. Researchers reviewed government surveys and reports by local and international non-government organisations.

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http://www.hrw.org/en/news/2009/10/07/india-too-many-women-dying-childbirth, October 2009