Against all Odds: Saving mothers and newborns in rural Telangana

WaterAid/Ronny Sen

Padmaja* announces excitedly that her daughter is set to be married soon. “She will be moving to New Zealand after the wedding with her husband!” she exclaims and shows off the engagement pictures. A 45 year old auxiliary nurse midwife in the Nizamabad district, she cannot remember how many babies she has delivered in her 16 year career. “I have been working in the village sub-centre and the Primary Healthcare Centre in this mandal for five years. I really cannot tell you how many babies!” she laughs. Eyes full of mirth and with a strong poise, her warm smile masks many concerns and trials she undergoes at work.

Water Woes

Primary Health Center. .Tadwai, Errapahad. .Nizamabad District.
Auxiliary Nurse Midwives run an immunisation programme at the Public Healthcare Facility in Nizamabad
WaterAid/Ronny Sen

The PHC where Padmaja works looks serene, with whitewashed rooms surrounding a spacious courtyard. Under the Janani Suraksha Yojana (a safe motherhood intervention under the National Rural Health Mission of Government of India), poor women in India are being encouraged to deliver at institutions like health centres to reduce maternal and neonatal mortality. The PHC in its verdant green surroundings has been devoid of water supply for five months now. The water table has dropped too low for even the bore wells, which they were dependent on so far, to function. The toilets and washing points have been rendered dysfunctional. The village head has arranged for a tanker to deliver water around the village once a day, including to the PHC. “The trouble is, the tanker comes in after it has finished going around the entire village. If we are lucky, we get 100 litres for the entire day. Or we make do with 50 litres. Do you know how many litres it takes for one delivery? Hundred!” says Padmaja in exasperation.

Water, Women and Safe Deliveries

“Water is essential to facilitating deliveries. When you administer an enema for instance, it helps the mother push the baby better. Or there is the danger of the baby being born among faecal matter and catching an infection as soon as it is born,” Padmaja explains. But the gravity of water shortage is such that sometimes, they do not have the mug or two of water required for even administering an enema. She recalls a stark case, “Once, I was sitting with my hands covered in blood, fresh after delivering a baby, and the district collector walked in. What could I tell her? That we did not have water to wash up, let alone deliver babies?” The PHC was promised that the overhead tank at the PHC would be filled up every day. Two months later, they are yet to see the promise fulfilled.

There are tough choices Padmaja faces some times with the lack of water. A woman recently came in with severe labour pains. Padmaja administered an enema but could not send her to the toilets in the facility because not only were they Indian commodes, which made squatting unthinkable in her condition, but also because there was no water to clean up. Taking a tough call between sending the crying mother out into the open versus the defunct toilets, Padmaja chose to take her out of desperation into the labour room, put her on the table and made her ease herself, cleaning her up and then inducing labour.

She adds that it is not just mothers and newborns who need water at healthcare facilities, “Nizamabad also has increasing instances of cervical cancer among women. Can you imagine, we do not even have water for sterilising speculums to examine women at times at the village sub-centre.”

Improper Disposal of Bio Waste at Primary Health Care Centre, errapahad, Nizamabad
Medical waste is often disposed in a well behind the PHC, increasing danger of ground water contamination in the vicinity
WaterAid/Ronny Sen

Powering Through

But Padmaja does not let the pressure and stress bog her down. “People hush me up. I speak my mind and they dislike it. But unless I speak up, how else will the crisis here get solved?” At least twice in a month cases of late night and early morning deliveries come in. Padmaja declares she is lucky because she has a car and manages to drive down to the PHC. For her, saving two lives at once is priority. She routinely has to pay people to get her water, or send out assistants to help collect water, bowl by bowl from neighbouring homes for midnight deliveries.

Primary Health Center. .Tadwai, Errapahad. .Nizamabad District.
“We work for eight to nine hours in a day, or more, without being able to access a clean toilet.” A midwife at the PHC informs
WaterAid/Ronny Sen

“We work for eight to nine hours in a day, or more, without being able to access a clean toilet.” A midwife at the PHC informs. Not easing oneself periodically, can often lead to urinary tract infections among women. These toilets at the PHC have been lying unused for five months due to lack of water. 

“I worry sometimes. I am capable of handling stress, and I always make sure to keep smiling because I want the mother to be as relaxed as possible during the birthing process even though all factors outside are against her. But not everyone can function under pressure and lack of facilities like this. I may be transferred soon, but I worry for the midwives posted here after me,” signs off Padmaja.

WaterAid India and its partner LEPRA undertook an assessment of the primary and community health care centres and district hospitals in Telangana’s Nizamabad district to understand the status of safe water, sanitation and hygiene (WASH) in these health facilities. Through Village Health Sanitation and Nutrition Committees, WaterAid India and LEPRA are working to build long term behavioural changes towards WASH and conduct trainings for different stakeholders, including healthcare facilities. Through its new Healthy Start campaign, WaterAid India aims to highlight the critical role of WASH in ensuring better health for pregnant mothers and a healthy start for newborns. 

*Name has been changed to protect identity.