A mid term 2007 MDGs report by civil society organizations in Madhya Pradesh,India bring the state into focus, as here the situation of children is grim as compared to other states of India. So, the State seeks urgent attention, if the goals are to be met by 2015.
JULY 7 WAS the mid point for evaluating the progress towards achieving Millennium Development Goals (MDGs), set by all the countries of world. These MDGs range from halving extreme poverty to halting the spread of HIV/AIDS and providing universal primary education, all by the target date of 2015.
National Social Watch Coalition in India, a network of civil society partners came out with a national report on India’s progress on MDGs. Civil society groups in the State of Madhya Pradesh came out with implementation audit report on seven out of eight MDGs on July 9, 2007.
The civil society groups contributing to this report used available data sources to evaluate the State’s progress and presented some case studies to show the implementation status on the ground. The report suggests an urgent need to strengthen implementation and increase the focus on the monitoring of the situation on ground, which is a challenge. The report brought out analysis of various indicators on the progress of MDGs, which are at different levels of human development.
The report stated that the situation of children in Madhya Pradesh is a cause for concern as compare to other states of India. It was hard one and brought attention on the need of effective implementation and increased monitoring of the goals set by the world’s countries to achieve by 2015 in the area of human development. The report brought Madhya Pradesh into spotlight; where there is an urgent need to increase focus on the progress of these goals, if India wishes to achieve them. But augmented focus does not mean pressure on the system only, in fact there is an urgent need to increase resources, strengthen capacity and increase real engagement of communities. Especially the poor class and the section, which does not participate in decision-making process for human development in the State, should be included and this is something very important.
Civil society partners coming out with this report was an indicator of increased mobilization and concern among them. The increased involvement of civil society in monitoring the progress on the issues, which impact human development, is in line with ’Universal Declaration of Human rights’. This right calls on each individual to strive for securing human rights and these goals are barometers of progress towards fulfillment of these rights. Civil society has a role of duty bearers and needs to ensure that all the promises made by the countries at start of this millennium are met. There is a need to keep a constant vigil on the progress towards achieving the goals and the indicators set up for achievement of these millennium development goals.
It is not for first time when civil society in Madhya Pradesh has shown the increased concern. if one looks back, for last few years the networks of non governmental organizations, media advocacy groups and social activists have been using various forums and multiplicity of methods including media to bring issues of survival and development to forefront. Be it malnutrition among children, poverty, maternal mortality, and female foeticide, impact of displacement or challenges faced in guaranteeing education for all, civil society has always strongly advocated these issues with evidences.
It is a welcome sign as we work in the age of ’accountability’, which demands for the process where ‘systems’ are answerable to its constituencies. This also signifies growing influence and participation of civil society regarding human rights.
Madhya Pradesh State has seen increased civil society participation in State’s effort but still the major input by the NGOs is at the level of delivery or supporting delivery systems of the State. There still exists a glass ceiling when it comes to making decisions, which impact them and the people, which civil society represents. This is important both for civil society and State, as no mobilization of public opinion is perhaps as powerful as that of involvement of people including excluded and poor section.
By Anil Gulati
Friday, November 9, 2007
Saturday, September 1, 2007
Media and maternal mortality in M P
Increased coverage meant increased visibility for the issue and more public statements on maternal and infant deaths.
The media can be useful in raising the visibility of an issue, helpful in influencing the climate of public opinion; offer a chance to respond to official definitions, and influence media's own attitudes towards an issue. That function of media is perceptible in the state of Madhya Pradesh in last one and half year in raising concern on the issue of maternal mortality. This trend in the print media has brought the issue of maternal deaths not only on forefront of media but onto the political framework in the central Indian state.
Generating and sustaining media interest in an issue like maternal mortality was not an easy one. It was efforts of media advocacy groups such as Vikas Samvad in engaging print media professionals, media dialogues by various civil society organizations such as Madhya Pradesh Jan Adhikar Manch, Madhya Pradesh Voluntary Health Association and various social activists which provided the much needed evidence to raise the issue. An effort which was duly complemented by many newspapers in the state.
Earlier for the media and for many of us the maternal mortality ratio was just a figure (498 per 100,000 live births). According to official definition the maternal mortality ratio (MMR in short) is calculated as number of maternal deaths per one lakh live births, which is not newsy, for media. But the moment civil society groups and activists worked out a figure based on the government’s Family Health Survey and put out a statement that 13,000 women die per year in the state during and after delivery (approximately 35 women per day) - that made the statement which clicked with media. This then led to a number of stories - first on the numbers of course with official and political quotes (which did not deny the fact). Then the numbers were clubbed with case studies, issues like gaps in delivery system, lack of health facilities and accountablility in the state started featuring. It was not just the news, this provided the peg for features, op-eds and Navabharat ( a leading Hindi newspaper in MP) wrote an edit on the issue.
This raised concern was quite evident by the increase in number of public statements by political leaders, civil society groups and activists on the issue of maternal and infant deaths in public and media. It was unprecedented that an issue like this could make headlines or on to main page, which reflected an achievement on the part of media advocacy & civil society groups and activists working on the issue. This effort brought the agenda of maternal mortality and safe motherhood high on to the political normative framework in the state.
During this process an interesting angle which came up for the first time in the state was whether a serious issue like this matters to our legislators or not ? The Hindustan Times and The Hindu initiated the debate based on evidence i.e. a report by a civil society group which had analyzed that no questions had been raised in state assembly on the issue of maternal and infant deaths in the state. This trigger led too many articles by newspapers like The Pioneer, Rajya Ki nai Dunia, Danik Jagran, Nai Dunia, Deshbandhu (state newspapers) and op-eds by Danik Bhaskar, till the time issue finally made it to the state assembly.
This inference of increased visibility and its impact was echoed by a recent study undertaken by Centre for Research and Education, (CREED) an organisation based in Hyderabad and Bhopal to determine coverage given to maternal mortality and related issues by the newspapers published from the state of Madhya Pradesh. The report had analyzed the media coverage for the year 2005 and points out that there has been significant increase in reporting in the print media in the year 2005 especially if one compares it with the year 2004. They had tracked 723 stories on the issue and had analyzed 234 stories to evaluate its content. If one looks at the space which has been generated on the issue it was roughly equivalent to 61,161 square centimetres. If one compares the same to 2004, though no study was done just on the visibility factor there was a significant increase.
Looking at the press coverage for earlier years, the issue of maternal mortality was only visible around safe-motherhood day i.e. April 11, or else whenever the maternal death was reported it was visible in small columns on inner pages of the newsprint. The situation has changed now, significant benefits have accrued due to sustained and concerted media efforts by media advocacy and civil society networks which drew adequate response from the print media. This piece and even the reports by CREED mainly analyses media discourse in print and that too of the newspapers published from the state capital Bhopal and some from Gwalior and Indore. This does not account for district level issues which are being raised in the state, which, means the ripple effect would have trickled down and if one accounts for the same, may be it would show a much larger picture. This is not an end of the process but a beginning which has helped to raise the visibility of the issue of high maternal deaths in the state, and which needs to be carried forward.
(The views expressed in this piece are personal)
The media can be useful in raising the visibility of an issue, helpful in influencing the climate of public opinion; offer a chance to respond to official definitions, and influence media's own attitudes towards an issue. That function of media is perceptible in the state of Madhya Pradesh in last one and half year in raising concern on the issue of maternal mortality. This trend in the print media has brought the issue of maternal deaths not only on forefront of media but onto the political framework in the central Indian state.
Generating and sustaining media interest in an issue like maternal mortality was not an easy one. It was efforts of media advocacy groups such as Vikas Samvad in engaging print media professionals, media dialogues by various civil society organizations such as Madhya Pradesh Jan Adhikar Manch, Madhya Pradesh Voluntary Health Association and various social activists which provided the much needed evidence to raise the issue. An effort which was duly complemented by many newspapers in the state.
Earlier for the media and for many of us the maternal mortality ratio was just a figure (498 per 100,000 live births). According to official definition the maternal mortality ratio (MMR in short) is calculated as number of maternal deaths per one lakh live births, which is not newsy, for media. But the moment civil society groups and activists worked out a figure based on the government’s Family Health Survey and put out a statement that 13,000 women die per year in the state during and after delivery (approximately 35 women per day) - that made the statement which clicked with media. This then led to a number of stories - first on the numbers of course with official and political quotes (which did not deny the fact). Then the numbers were clubbed with case studies, issues like gaps in delivery system, lack of health facilities and accountablility in the state started featuring. It was not just the news, this provided the peg for features, op-eds and Navabharat ( a leading Hindi newspaper in MP) wrote an edit on the issue.
This raised concern was quite evident by the increase in number of public statements by political leaders, civil society groups and activists on the issue of maternal and infant deaths in public and media. It was unprecedented that an issue like this could make headlines or on to main page, which reflected an achievement on the part of media advocacy & civil society groups and activists working on the issue. This effort brought the agenda of maternal mortality and safe motherhood high on to the political normative framework in the state.
During this process an interesting angle which came up for the first time in the state was whether a serious issue like this matters to our legislators or not ? The Hindustan Times and The Hindu initiated the debate based on evidence i.e. a report by a civil society group which had analyzed that no questions had been raised in state assembly on the issue of maternal and infant deaths in the state. This trigger led too many articles by newspapers like The Pioneer, Rajya Ki nai Dunia, Danik Jagran, Nai Dunia, Deshbandhu (state newspapers) and op-eds by Danik Bhaskar, till the time issue finally made it to the state assembly.
This inference of increased visibility and its impact was echoed by a recent study undertaken by Centre for Research and Education, (CREED) an organisation based in Hyderabad and Bhopal to determine coverage given to maternal mortality and related issues by the newspapers published from the state of Madhya Pradesh. The report had analyzed the media coverage for the year 2005 and points out that there has been significant increase in reporting in the print media in the year 2005 especially if one compares it with the year 2004. They had tracked 723 stories on the issue and had analyzed 234 stories to evaluate its content. If one looks at the space which has been generated on the issue it was roughly equivalent to 61,161 square centimetres. If one compares the same to 2004, though no study was done just on the visibility factor there was a significant increase.
Looking at the press coverage for earlier years, the issue of maternal mortality was only visible around safe-motherhood day i.e. April 11, or else whenever the maternal death was reported it was visible in small columns on inner pages of the newsprint. The situation has changed now, significant benefits have accrued due to sustained and concerted media efforts by media advocacy and civil society networks which drew adequate response from the print media. This piece and even the reports by CREED mainly analyses media discourse in print and that too of the newspapers published from the state capital Bhopal and some from Gwalior and Indore. This does not account for district level issues which are being raised in the state, which, means the ripple effect would have trickled down and if one accounts for the same, may be it would show a much larger picture. This is not an end of the process but a beginning which has helped to raise the visibility of the issue of high maternal deaths in the state, and which needs to be carried forward.
(The views expressed in this piece are personal)
Maternal Mortality - Civil Societies Call for Action
Munna was nine months pregnant. She did experience pains few days back, when her husband and mother-in-law rushed her to the nearest primary health centre in Kushwai of the District Shahdol in the State of Madhya Pradesh in India. They had to make her travel by bus from their village, and then in pain Munna had to walk, which she could barely to reach the health centre.
But unfortunately the Kushwai health centre, where they had come with lot of hopes, did not had a medical doctor for last one and half years. One male health worker mans the centre. Though, he puts in his best but that may not be enough for women like Munna and others who need medical support.
Inspite of reaching the primary health centre, she did not get any help. She has to travel another eight kilometers to Burhar, the place where there is a community health centre. The centre is fortunately newly built and has facilities for delivery. Munna did develop some complications during the delivery but fortunately survived to see her new born.
She was lucky but thousands of women which die in the state are not. App 10,000 women die every year in Madhya Pradesh during pregnancy or within 42 days after pregnancy. Majority of these could be prevented. Medically these deaths may be due to hemorrhage, infection, eclampsia or unsafe abortion or any of three delays. But fact is there exists a yawning gap in our health system which stands in between life and death of women in the state. This gap has linkage to availability and access to health services, infrastructure, awareness among communities of not only the services but even recognizing danger signs, issue of how where they can access the services etc. Studies also tells us that for every maternal death in India, 20 more women suffer from the impaired health.
But if the situation at ground is like this, and has been there. What is the state’s response to an issue like this? Does it impact the political leaders, their discourse? Does issue of women dying in the state is debated in discussions where funds are allocated or decisions are made? Does state’s machinery care for it? Does civil society raise its concern?
The year 2004
To answer some of these questions a dip stick assessment was done in year 2004 at various levels within civil society, debates in the state assembly, media analysis. Outcomes were revealing. First of all the issue concerned only few in health department. There were only handful of civil society partners, and their major role was to support service delivery system. As such there was no push or urgency to bring change. Interestingly, the issue had never being debated on the floor of the state assembly, a place where elected representatives ‘of the people, for the people and by the people’ decide. It did not impact them, many of them were not even aware of the fact that state has this high number of maternal deaths? An issue like this was never raised by the political leaders in the debates which happen there – an issue of total neglect at the highest political body. Media covered ‘event news’ around the safe motherhood day, probably they never got the right information too.
Present
That was a starting point, but nevertheless situation has changed today. Today state recognizes it as a major issue when it comes to women and children. State calls for an action. It is on high priority list of the political head of the state, state party is being questioned on the number of deaths, gaps on the infrastructure and many related points. Today more than 150 civil society organizations are raising concern on the issue and demanding urgency and urgency of action in the state.
How it happened and what does it impact and what strengths does it generate? Movements don't just happen; the energy that underlies them must be marshaled, channeled, and focused. The principal means by which this is achieved in our society, and within our political tradition, is through advocacy networks and coalitions.
Networks like Madhya Pradesh Voluntary Health Association, Madhya Pradesh Jan Adhikar Manch and Collective for advocacy, resource and training, Madhya Pradesh Samaj Sewa Sanstha, Mahila Chetna Manch, and many others have not only contributed to help bring the issue at an individual level but as a part of informal collation added to that force which helped bringing the agenda on political normative framework. Some of the strengths which this informal network helped bring were the numbers of civil society partners raising concern on the issue spread across different regions of the state. From a handful few now it is more than 150 civil society partners in the state working in all divisions to bring the issue to forefront. The turn around is also in their way of working from being a service delivery partners or a social mobilization partners in supportive and submissive role in a new avatar of advocacy partner. In this new role civil society speaks on the issue of right to health, its violation, demands state’s accountability to provide for safe motherhood. In this new business influencing people who make decisions which impact human lives is the key.
The primary target of the civil society was to bring the issues which impact lives of women at the villages, blocks and districts to the agenda of the people who make or influence decisions, i.e. state assembly debates, political leaders, members of legislative assembly, ministers, media, rights commission etc. They had been to some part successful. Expression of this concern was undertaken by directly meeting and sensitizing political leaders. The evidences highlighting gap were shared with political leaders, urging them to rise above politics and give a strong call for action. These non governmental organizations wrote memorandums, shared information and collected evidences for the same purpose. Media engagement also supported by providing an enabling environment for change. Strong evidences i.e. case of maternal deaths which can be presented, health system gaps were highlighted which added pressure on the state and the leaders to react. Resultant of this solid gains achieved. Today questions on maternal mortality are being raised in the state assembly, the highest policy making body of the state. It is not just few many voices are being publicly heard on the issue. There is a increased concern within media.
From nowhere it came to a point where state publicly acknowledge the problem, and its commitment to act. Many new polices and schemes have been announced and that too in the rapid succession. This amount of concern and even expressed publicly by leaders had never been seen earlier in the state on the issue of maternal mortality. But that is not enough today empowered civil society and media is always looking with eagle’s eye on the new measures of the state and vocally points out the gaps This is a positive sign, where people are voicing their opinion. But it is not easy as said. Political leaders have started picking up real cases of deaths, gaps in infrastructure in the state, violation of rights, gaps in policies and seeking answers to what is being done by the state to response to the situation.
Advocacy experts tell us that ‘people centered advocacy’ is the best, i.e. position when people who suffer can speak for themselves. A step has been taken in the same direction by the engaged networks. Madhya Pradesh Jan Adhikar Manch in their work with communities helped to bring the issue to debate in various gram sabhas which were held by panchayats in Gwalior – Chambal division. Similarly women who had participated in various women conventions hosted by Madhya Pradesh Samaj Sewa Sanstha came forward and wrote about the problems women face in rural areas when it comes to issue of safe motherhood and why do women die in their villages while giving birth. As per sources of Madhya Pradesh Samaj Sewa Sanstha more than 200 women have written to the Chief Minister. On a simple fifty paise post card, they wrote by themselves and it was send to the Chief Minister. It looks simple but powerful, if it gets to his eyes. Recently a large number of women from villages across Madhya Pradesh have joined a signature (or thumb-impression) campaign to press for their right to health and to call upon the Government to ensure that the dream of safe motherhood becomes a reality. As a part of a special drive to raise concern on this crucial issue, more than 20,000 women from different villages of the State are now in the process of signing (or placing their thumb impression) on a various banners demanding the right to health and calling upon the State to ensure that the dream of safe motherhood becomes a reality. Madhya Pradesh Voluntary Health Association, Madhya Pradesh Samaj Sewa Sanstha are the civil society partners who are collecting these signatures/thumb impressions of women. They say that they do so after they are adequately sensitizing them on the issue of maternal mortality. Then if they feel that some concrete action is needed to improve the situation, they come and sign. Plan is to present the banners with their signatures to policy makers.
One might say that this is good effort, which indeed it is to bring the agenda of maternal mortality on to the political and action framework but it is still a long way to go. This is true. But if one looks back one and half years where there was hardly any concern, hardly anyone called for action, except few that too ‘within the box’. The focus was limited. From nowhere it has come somewhere, which is an important achievement by any means. Need of the day is to provide possible answers to the state, which is willing to listen. Answers which can help deliver results, within the context of the field realties and socio – cultural aspects – a new call to many !
December 24 2006
Anil Gulati
But unfortunately the Kushwai health centre, where they had come with lot of hopes, did not had a medical doctor for last one and half years. One male health worker mans the centre. Though, he puts in his best but that may not be enough for women like Munna and others who need medical support.
Inspite of reaching the primary health centre, she did not get any help. She has to travel another eight kilometers to Burhar, the place where there is a community health centre. The centre is fortunately newly built and has facilities for delivery. Munna did develop some complications during the delivery but fortunately survived to see her new born.
She was lucky but thousands of women which die in the state are not. App 10,000 women die every year in Madhya Pradesh during pregnancy or within 42 days after pregnancy. Majority of these could be prevented. Medically these deaths may be due to hemorrhage, infection, eclampsia or unsafe abortion or any of three delays. But fact is there exists a yawning gap in our health system which stands in between life and death of women in the state. This gap has linkage to availability and access to health services, infrastructure, awareness among communities of not only the services but even recognizing danger signs, issue of how where they can access the services etc. Studies also tells us that for every maternal death in India, 20 more women suffer from the impaired health.
But if the situation at ground is like this, and has been there. What is the state’s response to an issue like this? Does it impact the political leaders, their discourse? Does issue of women dying in the state is debated in discussions where funds are allocated or decisions are made? Does state’s machinery care for it? Does civil society raise its concern?
The year 2004
To answer some of these questions a dip stick assessment was done in year 2004 at various levels within civil society, debates in the state assembly, media analysis. Outcomes were revealing. First of all the issue concerned only few in health department. There were only handful of civil society partners, and their major role was to support service delivery system. As such there was no push or urgency to bring change. Interestingly, the issue had never being debated on the floor of the state assembly, a place where elected representatives ‘of the people, for the people and by the people’ decide. It did not impact them, many of them were not even aware of the fact that state has this high number of maternal deaths? An issue like this was never raised by the political leaders in the debates which happen there – an issue of total neglect at the highest political body. Media covered ‘event news’ around the safe motherhood day, probably they never got the right information too.
Present
That was a starting point, but nevertheless situation has changed today. Today state recognizes it as a major issue when it comes to women and children. State calls for an action. It is on high priority list of the political head of the state, state party is being questioned on the number of deaths, gaps on the infrastructure and many related points. Today more than 150 civil society organizations are raising concern on the issue and demanding urgency and urgency of action in the state.
How it happened and what does it impact and what strengths does it generate? Movements don't just happen; the energy that underlies them must be marshaled, channeled, and focused. The principal means by which this is achieved in our society, and within our political tradition, is through advocacy networks and coalitions.
Networks like Madhya Pradesh Voluntary Health Association, Madhya Pradesh Jan Adhikar Manch and Collective for advocacy, resource and training, Madhya Pradesh Samaj Sewa Sanstha, Mahila Chetna Manch, and many others have not only contributed to help bring the issue at an individual level but as a part of informal collation added to that force which helped bringing the agenda on political normative framework. Some of the strengths which this informal network helped bring were the numbers of civil society partners raising concern on the issue spread across different regions of the state. From a handful few now it is more than 150 civil society partners in the state working in all divisions to bring the issue to forefront. The turn around is also in their way of working from being a service delivery partners or a social mobilization partners in supportive and submissive role in a new avatar of advocacy partner. In this new role civil society speaks on the issue of right to health, its violation, demands state’s accountability to provide for safe motherhood. In this new business influencing people who make decisions which impact human lives is the key.
The primary target of the civil society was to bring the issues which impact lives of women at the villages, blocks and districts to the agenda of the people who make or influence decisions, i.e. state assembly debates, political leaders, members of legislative assembly, ministers, media, rights commission etc. They had been to some part successful. Expression of this concern was undertaken by directly meeting and sensitizing political leaders. The evidences highlighting gap were shared with political leaders, urging them to rise above politics and give a strong call for action. These non governmental organizations wrote memorandums, shared information and collected evidences for the same purpose. Media engagement also supported by providing an enabling environment for change. Strong evidences i.e. case of maternal deaths which can be presented, health system gaps were highlighted which added pressure on the state and the leaders to react. Resultant of this solid gains achieved. Today questions on maternal mortality are being raised in the state assembly, the highest policy making body of the state. It is not just few many voices are being publicly heard on the issue. There is a increased concern within media.
From nowhere it came to a point where state publicly acknowledge the problem, and its commitment to act. Many new polices and schemes have been announced and that too in the rapid succession. This amount of concern and even expressed publicly by leaders had never been seen earlier in the state on the issue of maternal mortality. But that is not enough today empowered civil society and media is always looking with eagle’s eye on the new measures of the state and vocally points out the gaps This is a positive sign, where people are voicing their opinion. But it is not easy as said. Political leaders have started picking up real cases of deaths, gaps in infrastructure in the state, violation of rights, gaps in policies and seeking answers to what is being done by the state to response to the situation.
Advocacy experts tell us that ‘people centered advocacy’ is the best, i.e. position when people who suffer can speak for themselves. A step has been taken in the same direction by the engaged networks. Madhya Pradesh Jan Adhikar Manch in their work with communities helped to bring the issue to debate in various gram sabhas which were held by panchayats in Gwalior – Chambal division. Similarly women who had participated in various women conventions hosted by Madhya Pradesh Samaj Sewa Sanstha came forward and wrote about the problems women face in rural areas when it comes to issue of safe motherhood and why do women die in their villages while giving birth. As per sources of Madhya Pradesh Samaj Sewa Sanstha more than 200 women have written to the Chief Minister. On a simple fifty paise post card, they wrote by themselves and it was send to the Chief Minister. It looks simple but powerful, if it gets to his eyes. Recently a large number of women from villages across Madhya Pradesh have joined a signature (or thumb-impression) campaign to press for their right to health and to call upon the Government to ensure that the dream of safe motherhood becomes a reality. As a part of a special drive to raise concern on this crucial issue, more than 20,000 women from different villages of the State are now in the process of signing (or placing their thumb impression) on a various banners demanding the right to health and calling upon the State to ensure that the dream of safe motherhood becomes a reality. Madhya Pradesh Voluntary Health Association, Madhya Pradesh Samaj Sewa Sanstha are the civil society partners who are collecting these signatures/thumb impressions of women. They say that they do so after they are adequately sensitizing them on the issue of maternal mortality. Then if they feel that some concrete action is needed to improve the situation, they come and sign. Plan is to present the banners with their signatures to policy makers.
One might say that this is good effort, which indeed it is to bring the agenda of maternal mortality on to the political and action framework but it is still a long way to go. This is true. But if one looks back one and half years where there was hardly any concern, hardly anyone called for action, except few that too ‘within the box’. The focus was limited. From nowhere it has come somewhere, which is an important achievement by any means. Need of the day is to provide possible answers to the state, which is willing to listen. Answers which can help deliver results, within the context of the field realties and socio – cultural aspects – a new call to many !
December 24 2006
Anil Gulati
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