India: Drop Charges Against Maternal Death Protesters

(New York) - Indian authorities should drop criminal proceedings against peaceful protesters who sought accountability for maternal deaths in a public hospital in Madhya Pradesh state, Human Rights Watch said today. District officials cracked down on protesters on December 28, 2010, even as the Indian government was celebrating its recent appointment to the new United Nations Commission on Information and Accountability for Women's and Children's Health.

About 1,000 people gathered peacefully on December 28 in the Barwani district to protest the high numbers of maternal deaths at the district hospital there and the lack of accountability for the deaths. Law enforcement officials arrested one protester, threatened to arrest others, and issued a warrant for another participant on charges of rioting, being part of an unlawful assembly, and obstructing public servants from performing their duties.

"It is shocking that even as India takes on an international mandate to strengthen accountability for the health of women and children, back home officials are using the criminal justice system to punish messengers who report maternal deaths," said Aruna Kashyap, Asia women's rights researcher at Human Rights Watch. "Indian authorities should instead secure democratic spaces where such deaths can be reported and investigated without backlash."

The authorities should drop all charges against the protesters and tell the police to stop threatening peaceful protesters going forward, Human Rights Watch said.

In November 2010, activists recorded nine maternal deaths at the Barwani district hospital, even though the hospital is designated a comprehensive emergency obstetric care unit, which should be equipped to deal with childbirth complications around-the-clock. Despite a 2010 national policy mandating states to investigate maternal deaths and take corrective action, the state did not review the circumstances that led to any of the deaths.

Tribal communities in this region face daunting challenges in getting life-saving maternal health care, Human Rights Watch said. The Barwani district recorded at least 25 maternal deaths between April and November 2010. Health rights activists also recorded a number of cases in which pregnant women who sought emergency obstetric care had been turned away from the Barwani district hospital and referred to a larger hospital in Indore city, five hours away.

The December 28 rally was held by tribal communities in this district and activists from the Jagrit Adivasi Dalit Sangathan, a grassroots organization of tribal and dalit communities, because the Indian health system has no mechanism for officially airing and redressing grievances. Instead of listening and responding to the concerns about poor maternal health care in the region, district health authorities brought in the police.

The case of Vapari Bai, 22-year-old woman from the Bhil Barela tribe, highlights many of the problems with access to maternal health care in the region, Human Rights Watch said. Medical doctors who saw her hospital records and spoke to Vapari Bai's family told Human Rights Watch that on November 27, 2010, when she was eight months pregnant, Vapari Bai had a convulsion and needed emergency care.

Because they had no other mode of transportation, her family carried her in a jhuli (cloth sling) more than 10 kilometers on foot to reach an ambulance. By the time she reached Barwani district hospital, the physician activists said, she exhibited clear symptoms of eclampsia, a complication that can cause death.

Despite her condition, doctors at the hospital did not carry out emergency childbirth procedures that might have saved her, the medical advocates told Human Rights Watch. The doctors at the hospital instead administered medication to reduce her blood pressure and left Vapari Bai unattended.

Though Vapari Bai was in severe distress, doctors at the hospital did not respond to repeated requests by her family for further medical attention. Instead, a doctor at Barwani hospital told her family to take her to a medical college hospital in Indore. She died at Barwani hospital before her family could arrange to move her there. Hospital and district health authorities refused to respond to complaints from activists about Vapari Bai's death.

While India has made advances in maternal health in recent years, yawning disparities remain. A 2007 United Nations Children's Fund report revealed that nearly 60 percent of all maternal deaths in six northern states occurred in tribal or dalit (so-called "untouchable") communities. The government's 2009 Bulletin of Rural Health shows that there are many more shortfalls and gaps in health infrastructure and facilities in tribal areas than elsewhere.

"The Barwani deaths are an unfortunate reminder to the Indian government that it still has a long way to go to eliminate disparities in maternal health," Kashyap said. "Reducing these disparities is central to creating an accountable health system."

The National Rural Health Mission, India's flagship program on rural health, aims to address disparities. One of its objectives, it says, is to "improve access to rural people, especially poor women and children to equitable, affordable, accountable and effective primary health care."

The Indian government should immediately ensure that all states are carrying out its national policy to investigate maternal deaths, Human Rights Watch said. The government should also create grievance redress mechanisms that are accessible to communities in which many people are poor and illiterate, Human Rights Watch said. Such systems will ensure that India reduces maternal mortality not only for its urban or high-income populations, but for all populations equally.

"Instead of muzzling people's grievances, the Indian central and state governments should devise accessible and effective grievance redress mechanisms for complaints about health services." Kashyap said. "This will demonstrate to the international community that it pays more than just lip service to accountability."