On October 31, 2011, Danica May Camacho was welcomed as the world’s seven billionth baby with a chocolate cake in Manila, Philippines, and a gift certificate for free shoes. While Russia declared a boy named Alexander, born in Petropavlovsk- Kamchatsky city on the same day, as their seven billionth baby, in the Indian state of Uttar Pradesh the birth of Nargis at a Community Health Center (CHC) in Mal was greeted by her parents, several non governmental organizations and state officials and accorded a ‘symbolic’ status of the seven billionth baby of the world.
For all these babies thrust in the limelight, October 31 will be more than just their birthday. They will be feted when they turn one, given more freebies and be forever tracked by the media as they map the progress of the seven billionth baby. But what about the hundreds of other children who were born on the same day in India without this hype? In Bihar, many of them were lucky just to have been born, considering that the child sex ratio in the age group of 0-6 has been on the decline. It dropped from 942 in 2001 to 933 in 2011 according to the latest census. Twins Chotu and Choti are among the fortunate ones who made it into the world on October 31. Born at a private hospital in the state capital Patna, the pair (a boy and a girl), were taken home by their mother within a couple of hours of their birth. In fact, the hospital did not even record the name and address of the mother.
Fighting for Survival
So will Chotu and Choti survive? The first 24 to 48 hours are crucial for the survival of the mother and child. But a majority of women tend to leave the hospital within six to eight hours of giving birth, increasing the vulnerability of both the newborn and the mother. Motivating women to stay longer in the hospital and reducing maternal and infant mortality are among the biggest challenges for the state health department. According to Mr Sanjay Kumar, Executive Director, State Health Society, it was imperative to lower the infant mortality rate (IMR) and maternal mortality rate (MMR) because these deaths were preventable.
“We declared 2010 as the year of the newborn and 2011 as the year for safe motherhood to give special attention to the mother and child. We also realize that only when we are able to prevent children from dying will parents consider having less number of children and help to lower the state’s fertility rate. Population stabilization needs to be a priority. That is why we are also in the process of revising our population policy,” he says. (See interview) According to Dr. Ajay Shahi, State Programme Officer, (FP & IEC), State Health Society, while the decline in the decadal growth of population in Bihar (3.5 percent decline as per the census of 2011) was a good sign, the total fertility rate (TFR) needs to be brought down so that the population variation between the districts could be stabilized. For example, the TFR of Gopalganj, the district which recorded the lowest decadal growth, is marginally lower than Madhepura which saw the highest decadal growth. The TFR of Gopalganj is 4.4, while that of Madhepura is 4.8.
The Power of Counseling
In Bihar’s most populous district of Patna, well known gynecologist Dr. Sharika Rai runs a thriving private practice. About 250-300 children are born every month in her hospital that is located in the city. Dr. Rai’s clients hail from all strata of society. Women still throng to her private hospital despite the delivery charges. Only if the woman is very poor does Dr. Rai reduce her fee. Even then, it is not free. Dr. Rai claims that she counsels them on family planning but not on a regular basis. However, her way of asking them to go in for family planning is unconventional. She tells them to go on producing children because then they will keep coming to her for deliveries and make her rich. “I tell them that if they stop, I will lose money. So they should keep on being baby producing machines even if they have delivered three children already,” contends Dr Rai. This negative approach, according to Dr. Rai, works better then telling them to go in for terminal methods after two children. However, she doesn’t have any cases or figures to prove that this has helped. But family planning is essential for limiting the number of children, especially for women who have to take a disproportionate load of the reproductive burden, says Dr. Abhijit Das, director of the Delhi based Center for Health and Social Justice. “In reality, women do not choose when or who to marry, and when and how many children to have. It is thus of utmost priority that women get education, so that they become autonomous at least in decisions that affect their own lives. Women’s empowerment needs to be central to all policy efforts,” he contends.
Making Family Planning Easier
There is an effort to focus on women in the various programs initiated by the State Health Society (SHS), including during the population stabilization fortnight. A set of four comic books has been developed by it with the help of UNFPA, related to birth spacing, age at marriage, menstrual hygiene and behavioral changes during adolescence. These will be given to all girls studying in the ninth and tenth standard. Health officials believe that in the same manner that bicycles given to girls under the Chief Minister’s Bicycle Program has increased the number of girls enrolled in high schools and delayed the age at marriage, this set of comics, to be given free of cost, will also empower girls by equipping them to understand their bodies better. While SHS officials are hoping that their initiative to link the Accredited Social Health Activists (ASHAs) to their social marketing of condoms by giving them one rupee for a packet of three condoms sold, will improve family planning, they are also looking at promoting a basket of choices. In keeping with this, the SHS has asked UNFPA to undertake an assessment study of the factors prompting usage of intra uterine devices (IUDs) and the extent of client satisfaction in five districts.
Once the data is in strategies to promote IUDs will be formulated. Greater focus is also being given to post partum family planning (PPFP). The districts selected for PPFP services include East and West Champaran, Begusarai and Darbhanga. A pool of trainers in PP IUD has also been selected. Another novel strategy being employed is to rank each district according to a set of health indicators. This helps the health department to focus on poor performing districts. While Nalanda district has topped the charts consecutively for the past nine months, Kishanganj district is one of the poor performers. With about 200 medical officers in charge (MOIC) currently being sensitized on how to go about improving indicators, health officials are hoping that this strategy inspires and motivates all districts to compete amongst themselves for the top spot.