Braving the odds

Every year in India, 1.05 million infants die, making the country account for more than 26 per cent of the world’s neonatal mortality rates. Within this, more than 56 per cent of deaths happen in the first 28 days of life, and nearly three-fourths in the first week of life. The statistics do not end here. For every 100,000 live births, 174 new mothers die during or soon after giving birth.  According to a 2015 report by WHO and UNICEF, the presence of water, sanitation, hygiene (WASH) in healthcare facilities and the simple practice of hand hygiene by birth attendants can reduce maternal and neonatal mortality drastically from preventable infections such as sepsis. The brunt of these deaths is borne by mothers and infants from the poorest and most economically marginalised backgrounds.

WaterAid India, in association with its on ground partners conducted preliminary assessments on the status of WASH in 343 primary, community and district level healthcare facilities across 12 districts in 6 states across India. Here is a look at the WASH challenges, pregnant women, newborns and even healthcare staff may face in a rural setting for a Healthy Start

Mamata, 22 years from Tadwai Mandal, Nizamabad district, is five months pregnant. "My mother-in-law passed away a while ago. So the task of fetching water has fallen upon me. My stomach aches all the time from carrying heavy pots.”

P Kaveri, carries her nine day old son in a newborn intensive care unit at an area hospital in Nizamabad district. Born with jaundice, he was placed under phototherapy. The attendants and staff place high care on cleanliness, but the damp on the wall in the monsoons puts the unit under risk for mould and respiratory diseases.

K Satyamma, is a cleaner at a Primary Healthcare Centre in Nizamabad. Shortage of staff and a fund crunch often leads to people taking on multiple roles in smaller health centres, as opposed to area centres which have designated staff, “I sweep and swab the floors here. But I also assist the midwives with deliveries. I administer enema, clean the newborn and anything else asked of me.” Any gap in the personal hygiene of the attendants can often place the patient at risk for infection such as sepsis or tetanus.

Swarupa, 24, the mother of 3 month old Niharika. Instances of anaemia due to lack of WASH and nutrition are very high among women in India. “I was anaemic. So we had to buy two bottles of blood at Rs 3000/- during my daughter’s birth, and my husband earns 5000 a month. Swarupa also lacks a toilet at home and goes out to defecate. “We would like a toilet at home. But we live on rent, and the landlords are not letting us build one.

Sudha Chakravartula, a Surgeon at an Area hospital in Nizamabad district, washes her hands after delivering a baby at a station equipped with elbow taps. Hand-hygiene is critical for reducing maternal and neonatal infections and mortalities drastically.

Fatima, a staff nurse; and Padma, an Auxilliary Nurse Midwife, stand in a general labour room at an Area hospital in Nizamabad district. Colour coded bins for waste segregation and other facilities at par with expensive private hospitals exist. Standing opposite this room is the Septic Labour Unit where HIV positive pregnant mothers come in where both staff and patients need greater hygiene facilities. But the room, perhaps because of stigma associated with HIV, is maintained in poor form.

Aruna, an Auxilliary Nurse Midwife worries about the weak monsoons and depleting groundwater resources in a remote village in Nizamabad district. "Water is crucial to the delivery process. Especially after administering enema to faciliate the birthing process. Where will the poor mothers go without water in the toilets?”

A 20 minute old boy adjusts to the bright new world in his grandmother Peeramani's lap at an Area hospital in Nizamabad. Swaddled in a grubby cloth brought from home, his family was waiting for his mother to be shifted into the ward from the theatre. “We presumed wiping the baby with a wet cloth, and not bathing the mother (because of the stitches from a caesarean) for the first week was alright. If the healthcare staff teach us otherwise we are willing to change this.”