New Delhi: Less than half of pregnant women in rural India eat nutritious food and majority are deprived of quality healthcare, revealed an independent survey done by three researchers associated with Indian Institute of Management-Ahmedabad and Ranchi University.
The survey titled Jaccha-Baccha Survey (JABS) was conducted by Jean Dreze, professor, Ranchi University, Reetika Khera, associate professor, IIM Ahmedabad and Anmol Somanchi, research associate with IIM-A in six states i.e. Chhattisgarh, Himachal Pradesh, Jharkhand, Madhya Pradesh, Odisha and Uttar Pradesh.
In each state, the survey teams visited 10-12 randomly selected anganwadis (spread over two blocks in the same district) and interviewed as many as possible of the pregnant and nursing women registered at those anganwadis: 342 and 364 respondents respectively.
According to the survey, only 22% of the nursing women reported that they had been eating more than usual during their pregnancy, and just 31% said that they had been eating more nutritious food than usual. The main reason for not eating more is that many pregnant women feel unwell or lose appetite. The proportion of nursing women who reported eating nutritious food (e.g. eggs, fish, milk) “regularly” during pregnancy was less than half in the sample as a whole, and just 12% in UP.
“Poor diets lead to low weight gain during pregnancy. Compared with a norm of 13-18 kg for women with low BMI, the average weight gain in the sample was barely 7 kg (in UP, just 4 kg). Pregnant and nursing women are acutely deprived of quality health care. Many of them receive some basic services (e.g. tetanus injections and iron tablets) at the local anganwadi or health centre, but they get very little beyond the basics,” said Khera.
“Small ailments easily become a major burden, in terms of pain or expenses or both. At the time of delivery, women are often sent to private hospitals when there are complications. A significant minority also report rude, hostile or even brutal treatment in the labour room,” she said.
Stating that there is an urgent need for radical expansion of quality health care close to home, the researchers have also pointed out that there are two signs of hope. First is high rates of institutional delivery and second widespread use of public ambulance services.
Delivery as an Economic Contingency Institutional deliveries are supposed to be available free of cost to all women in public health centres. “In practice, we found that nursing women had spent close to ₹ 6,500, on average, on their last delivery. This amounts to more than a month’s wages for a casual labourer, in the survey areas. One third of these women’s households had to borrow or sell assets to meet the costs,” said Khera.
“The economic risks associated with pregnancy and delivery adds to other arguments for universal maternity entitlements. Denial of Maternity Benefits Under the National Food Security Act 2013 (NFSA), all pregnant women are entitled to maternity benefits of ₹ 6,000, unless they already receive benefits as formal-sector employees,” she said.
The researchers have argued that the central government ignored this for more than three years, before launching the Pradhan Mantri Matru Vandana Yojana (PMMVY) in 2017. “Women in the unorganized sector have been completely invisible in the debate on maternity benefits. The meager benefits ( ₹6,000 per child) that they are entitled to under the National Food Security Act (NFSA) 2013, have been whittled down to almost nothing. In a violation of the NFSA, the PMMVY arbitrarily reduces it to ₹5,000 for just the first child. The application process is complicated, and these problems are compounded by the Aadhaar payment system. Using data obtained through an RTI, we estimate that in 2018-19, only 22% of pregnant women got any PMMVY money,” said Khera.