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India's silent tragedy

Jameen Kaur
5 December 2007

A shockingly high maternal mortality rate reveals government inaction on halting preventable deaths. Jameen Kaur asks, where is the delivery of rights for India's "invisible women"?

India's most famous monument, the Taj Mahal, is recognised the world over. Built by Moghul Emperor Shah Jahan in 1631 in memory of his wife Mumtaz Mahal, it represents a particular poignancy, as Mumtaz Mahal died giving birth.

Today, India suffers the world's highest toll of maternal mortality deaths - 117,000 - amounting to 20 percent of the global maternal death toll of 535,000 each year. People all over India continue to grieve for the avoidable deaths of countless Mumtaz Mahal's who die each day. Why does the world turn its back on their stories? Where are their monuments? Where is the ‘human dignity' for the Indian woman?

A right to health

Looking at past documents with reference to protective declarations, conventions and action programmes signed by states to protect the rights of the human, there are two words that stand out over and over; ‘human dignity'. So, if this is our starting point, where is the protection for the human dignity of women who risk death to give life?

This article is part of a series on openDemocracy marking the "16 Days of Activism against Gender Violence" from 25 November - 10 December, an annual mobilisation aimed at heightening global awareness of violence against women

Also in openDemocracy on the 16 Days theme, part of our overall 50.50 coverage, a multi-voiced blog where women around the world contribute

Roja Bandari, "Iran's women: listen now!"

Rahila Gupta, "The UK's modern slavery shame"

Takyiwaa Manuh, "African women and domestic violence"

Anne-Marie Goetz and Joanne Sandler "War and sexual violence"

Rebecca Barlow, "Women and conflict"According to the World Health Organisation maternal mortality is defined as "the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy or its management but not from accidental or incidental causes." (Maternal Mortality 2005, pdf) The United Nations Population Fund reports that there are five direct causes which account for 80 percent of the world's maternal deaths, namely; haemorrhaging during delivery - which can be related to the lack of adequate services available and the lack of blood transfusion and resources - leading to women bleeding to death, sepsis, unsafe abortion, obstructed labour, and hypertensive disease of pregnancy (which includes associated indirect conditions such as malaria, anaemia and heart disease representing 25 percent of deaths).

Despite the evidence of a huge paper trail that cites and reiterates over and over the importance of the right to health, over half a million women continue to die around the world each year. One woman each minute of the day suffers an easily avoidable pregnancy-related death. Why is there not an international outcry that families, communities and societies are being robbed by the deaths of whole generations of women?.

Invisible women

Like many other human rights violations, it is the poor and the most vulnerable sectors of our communities, who are paying the heaviest price; 99 percent of all maternal deaths take place in the developing world.

The denial of economic, social, cultural, civil and political rights and entitlements restricts and isolates women from fully claiming their basic human rights. The denial of basic amenities such as access to the right to water, the right to food, and the right to adequate housing are all interrelated, and fuel the feminisation of poverty. Women now make up 70 percent of the poorest of the world's poor. The effect is to further imprison and silence women, disempowering them from participating in the discussions and decision-making processes which most affect and impact on them personally.

Also on openDemocracy on maternal mortality, Jessica Reed blogs the Women Deliver conference, October 2007

In India, it is no coincidence that women are viewed as most invisible, when it comes to the state implementing practical measures which will reduce the maternal death toll of the sub continent. The state acknowledges women when it comes to implementing measures of population control, yet they are ghosts when it comes to ensuring access to the most basic of rights.

India, along with 156 other states around the world signed and ratified the International Covenant on Economic, Social and Cultural Rights, Article 12 of which states; "everyone has the right to the enjoyment of the highest attainable standard of physical and mental health". It further states that the right to health extends not only to timely and appropriate healthcare but also to the underlying determinants of health, such as access to safe and portable water and adequate sanitation, an adequate supply of safe food, nutrition and housing, healthy occupational and environmental conditions and access to health-related education and information, including on sexual and reproductive health.

Statistics released by the International Women Deliver conference in October 2007 indicate that maternal mortality worldwide could be cut by nearly three-quarters by improving women's access to comprehensive reproductive health services, including family planning. These services should be offered within the broader context of efforts to promote human rights, poverty reduction and gender equality.

Sri Lanka and Vietnam are cited as success stories, having substantially reduced maternal mortality despite gross national incomes equal to other countries with high maternal mortality rates. Egypt, Honduras, Malaysia and Thailand have all halved their maternal mortality ratios over the last several decades. So why not India?

Delivering rights

The right to health is the fundamental human right, which so many other rights and freedoms spring from, and is directly linked to the enjoyments of all other human rights. The right to health for a woman begins with the right to control her own reproductive health rights; the right to determine how many children she will have, when she will have them, and if she wants them. These rights can be delivered through the access of many practical measures, which will directly reduce material mortality ratios and deaths not just in India but worldwide. The right to control her reproductive health is a vital tool in a woman's chances of survival.

There are many challenges which face the women of India and worldwide in making this right a reality. As International Human Rights lawyer Rebecca Cook has stated "If international human rights law fails to address women's susceptibility to suffer discrimination and oppression through their inability to control the very functions that differentiate women biologically, such law fails to address half of humanity and mocks any pretensions to universality."

Beyond numbers

At a deeper level, what do maternal mortality figures truly tell us? What do they indicate about the value placed upon women as human beings?

To examine states' pledges with reference to their commitment to truly protect and advance societies one must look at the treatment of the most vulnerable in our societies, namely women and girls, and how they are (un)able to access rights. If in 2007, women are still dying in their millions with so much legislation in place, what does that tell us about state-level integrity? It is an act of violence in itself, that women are suffering avoidable deaths due to negligence and failure of state parties to respect, fulfil and protect the duties they have signed up to. Where is the delivery of rights for women? For women in India, and worldwide, the saying if ‘you don't have your health you don't have anything' literally means life or death.

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