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Maternal health

Investing In Women (The Times of India-4 August 2010)

We must focus attention on the lacunae in maternal health in India

As a community health physician in India, i am regularly confronted by the challenges that

women face when they try to bring a child into this world. Trained healthcare professionals,
medicines and transportation to the nearest clinic are often in short supply, increasing the risk for
complications or life-threatening situations.

While there has been progress in recent years to improve the health of girls and women in India,
too many still die of causes that are almost entirely preventable. Every year, 68,000 women in
India die from pregnancyrelated issues, more than any other country. An additional 74,118
women die from cervical cancer, the leading cause of cancer-related deaths in India.

We have the knowledge, resources and tools necessary to keep women and girls healthy. With a
few key investments, we can avoid a significant number of these deaths. For example, cervical
cancer is both preventable and treatable if women can get screened in time.

For maternal health, we have seen that simple solutions such as access to family planning
services can save both money and lives. There is now clear evidence that investments in family
planning yield a positive return – every Rs 100 spent on family planning saves Rs 140 in medical
costs due to the prevention of unintended pregnancies and, ultimately, maternal deaths.

These investments are also necessary to ensure that India meets the United Nations Millennium
Development Goal Five (MDG 5) to improve maternal health and achieve universal access to
reproductive health. As India bears a disproportionate share of worldwide maternal deaths, the
achievement of MDG 5 by 2015 in India is critical to meeting global targets.

To meet these ambitious goals, health delivery systems must be strengthened so that facilities
provide women with the quality services they need to stay healthy during and after pregnancy. In
recent years, the government's Janani Suraksha Yojana (JSY) programme has
successfully raised the number of births that are attended by trained healthcare professionals for
poor women in largely rural settings. The government's flagship National Rural Health Mission
has contributed to improved health services in rural India by setting up village-level voluntary
health and sanitation committees and employing Accredited Social Health Activists (ASHA),
who are tasked with, among other things, accompanying pregnant women to ensure they receive
the services they need. These progressive and encouraging initiatives now need to be
strengthened and replicated across India.
In addition to basic healthcare services, new life-saving technologies need to be available to all
Indian women. For cervical cancer, HPV testing identifies high-risk types of the human
papillomavirus (HPV), the virus that causes cervical cancer. The test allows women to learn their
risk of developing cancer earlier so they can receive appropriate treatment before problems arise.
The promise of HPV testing to prevent cervical cancer has already been demonstrated here in
India. Scientists from the International Agency for Research on Cancer conducted a study of
130,000 women in Maharashtra and found that a single round of HPV testing significantly
reduced the numbers of advanced cervical cancers and deaths when compared to other screening
methods.

A version of the HPV test has been developed for low-resource settings and does not require
highly trained personnel, running water or electricity. Soon even women in rural India, who may
have never had access to any other screening methods in their life, could have access to state-
ofthe-art HPV screening.

Additionally, the drugs controller general of India has approved new HPV vaccines. Providing
women with access to these vaccines would ensure protection for the next generation of women
as well.

However, new technologies alone are not enough. We need to integrate these tools into our
existing reproductive health services, train healthcare workers, and ensure that implementation of
screening and vaccination is affordable and accessible to all women.

At the recent Women Deliver conference – with more than 3,500 participants coming together in
Washington DC – women's health, cancer and business organisations issued the Declaration for
Universal Access to Cervical Cancer Prevention, which called for increased political and
financial resources from countries worldwide to fight cervical cancer. All sectors in India must
work together to make sure that India answers this call as urgently as it has been given.

We can only achieve progress by working in partnership. Civil society must continue to deliver
critical maternal health services, advocate for political support for women's health initiatives and
share best practices with other organisations and sectors. International donors and national
governments, even in economically troubling times, must recognise that investments in women
will return large dividends. Finally, the private sector must also help to deliver critical services
and partner to make their life-saving technologies available to all women.

As i have seen in communities throughout India, improvements in healthcare can be slow and
uneven. But some successful programmes and new technologies show us that there is hope and
promise for improvement, if we commit ourselves to making change and spreading progress. Our
daughters and mothers deserve nothing less.

The writer is regional director for South and East Asia at the Population Council.
Mothers in rural areas often risk death for want of simple remedies