Safe delivery

The 230 delivery huts set up by the government in rural Haryana have, literally, brought forth a heartening response. More and more expectant mothers in villages are now stepping out of their homes to opt for free medical care under trained hands and in hygienic conditions. Ruchika M. Khanna reports

Delivery huts: A big step towards better maternal and child care

THIS is the biggest success story of the Haryana Health Department. Mooted just seven months ago, the decision to set up Prasuti Greha (delivery huts) all over the state has substantially increased the institutional delivery rate, and helped in bringing down the maternal mortality rate (MMR) and the infant mortality rate (IMR).

Though still in its gestational stage, the Prasuti Greha scheme is quietly promoting institutional deliveries—mostly in the backwaters of Haryana where dais (traditional midwives) and deliveries at home are preferred to doctors and hospitals. Even in a place like Mewat, where Meo Muslims are rooted to their traditions, the scheme has been widely accepted. In the nine delivery huts that have been established there so far, 147 deliveries have been conducted.

Says Lalita, a resident of Jharsa village in Gurgaon, "My son was delivered at home by the village dai. Since the delivery was done in unhygienic conditions, I developed a lot of post-delivery complications. But now that a delivery hut has been established in the village, I delivered my daughter in the hut on March 3, and within a few days I was back to normal."

Dr Neeraj Yadav, Medical Officer, Primary Health Centre, Wazirabad, and in-charge of this delivery hut, says that a large number of women from Jharsa and nearby villages have benefited with the setting up of the delivery hut. "With the opening up of the hut, we are conducting 35 to 40 deliveries a month here. Earlier, no deliveries were being done here, and residents had to rely on home deliveries, or had take the expectant mothers to hospitals or nursing homes in Gurgaon," he informs.

In a state known for dichotomy in growth (high GDP, but poor social indicators of growth), the success of this scheme has come as a delight to socio-economists. Not only is the scheme helping to reduce the MMR and the IMR but it is also ensuring a 100 per cent ante-natal and birth registration, and immunisation of the newborns against polio and BCG. Nutritional and dietary consultation is also given to pregnant women visiting the Prasuti Greha.

Till date, 230 delivery huts have been established and 2578 deliveries conducted in them. "The scheme has been successful beyond our expectations. In rural areas, where institutional deliveries were the prerogative of only the elite or the literate class, the setting up of delivery huts, especially in the interior villages, has received a very good response. In the delivery hut at Faridpur (near Gharaunda), we have a number of old women now bringing their daughters-in-law for deliveries," informs Dr S S Dalal, Civil Surgeon, Karnal.

Fearing expensive treatment, most villagers shy away from coming to hospitals for childbirth, thus risking the life of the mother and the baby. Most babies in the state are delivered by unskilled midwives, which has led to an IMR of 65 per cent in rural areas and 56 per cent in urban areas of the state.

Says Dullo Rani, 35, who has recently delivered her third child at the delivery hut at Barwala in Panchkula, "I stay in Bhoj Tipra in Morni, and my earlier two deliveries were done at home by a neighbour. When my mother-in-law learnt about the free delivery at a health centre, she brought me here so that my child could be born in hygienic conditions." Quips her mother-in-law, Satwanti, "Since hospitals are so far away, the Prasuti Greha has come as a godsend for women, who can now have safe deliveries."

Says Urvashi Gulati, Commissioner, Health, and the brain behind the scheme, "Till the launch of the Prasuti Greha scheme, Haryana had a poor institutional delivery rate. Only 23 per cent of the deliveries were being done in health institutions, while a whopping 77 per cent of the deliveries were being done by unskilled midwives. With an aim to reduce the MMR and the IMR, the Health Department, Haryana, decided to set up 300 Prasuti Greha all over the state. We propose to reduce the MMR from the present over 300 per 100,000 to 100 per 100,000 live births, and decrease the IMR from 58 to 30 per 1000 live births."

In fact, over the years, subsequent governments in Haryana have been making concerted efforts to increase institutional childbirths. In 2004, the state government had started free deliveries, even for caesarean cases, in government hospitals. Patients do not have to pay bed charges, are provided free medicines, and arrangements are made for blood, if required. This was started in 40 General Hospitals and Community Health Centres (CHCs) all over Haryana. "The aim was to sensitise people about institutional deliveries. The Prasuti Greha scheme, however, ensures that each expectant mother gets access to health institutions for safe deliveries," says Gulati.

The government has earmarked Rs 3 crore for the scheme — Rs 1 lakh for each delivery hut. The scheme was launched in August last year in those health subcentres or primary health centres (PHCs) that were located within the phirni of a village and where an auxiliary nurse and midwife (ANM) was staying.

Given a grant of Rs 1 lakh for each hut, the district health authorities were asked to use it on the renovation of the building and equipment such as delivery tables, autoclaves and sterilisers.

"The reason for the success of the scheme," says Dr K.K. Kapoor, Deputy Director, Health, "was to make the implementation as simple as possible. The ANMs in these delivery huts were initially given Rs 10,000, which are deposited in a bank. The savings account is jointly operated by the ANM and a woman panch/sarpanch to ensure that there is no cash crunch for buying medicines or repair of equipment needed for safe delivery. All women who deliver their children in these huts are given 100 tablets each of Vitamin B-complex, iron and calcium. We also allocated a sum of Rs 5000 per annum for each hut, which could be used to arrange for transportation of patients to hospitals in case of an emergency. As a result, we have had 217 cases referred from the delivery huts across Haryana to hospitals," he says.

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