“I don’t blame anyone. The nurses in the hospital said, I should have come earlier. But what has happened has happened,” says Golapi (33), reminiscing her grief of giving birth to a stillborn baby boy through caesarean section. She does not want to relive those days of trauma and pain that followed when her third child was born stillbirth[i]
Golapi never got a chance to go to school. Her life in the remote Jambahali village of Nunpur Panchayat in Kalahandi district, Odisha, rural India, is a mix of household work, occasional farming in the fields and taking care of her husband Bashistha Rana and two children – a 15-year-old daughter and six-year-old son.
Golapi had been diligently following the instructions of the village health worker and had been regularly going for her antenatal check-up visits. In early June 2020, the auxiliary nurse midwife (ANM) had identified hypertension during her pregnancy as a “high risk” condition and had referred her to the nearest community health centre, 30 kilometres away in Tusra, for further check-up. Her family, however, took her to the district headquarter hospital (DHH) in Bolangir. She had given birth to her first child at the DHH and had planned the delivery of her third child too there. She was given medicines for high blood pressure and an ultrasound revealed that the baby was fine and weighed around 3.2 kilograms. After a four-day stay at the hospital, Golapi returned home.
However, a week later, her placenta gave way and she could feel that the baby was not moving. The decision to go to the hospital, followed by locating and hiring a vehicle took more than two hours. The couple set out to the community health centre in Tusra, which took more than an hour to reach. The doctors there referred her to DHH Bolangir, where she delivered by a caesarean section and gave birth to a stillborn baby. The doctors explained to her that she “should have come earlier.”
But, how early could Golapi have come? The nearest community health centre is 30 kilometres away in Tusra and the nearest large, well-equipped hospital – the District Headquarter Hospital – is 70 kilometres away in Bolangir from Jambahali. The road conditions are poor and it takes more than three hours to reach Bolangir.
High blood pressure leading to separation of the placenta in the womb was the most likely cause of stillbirth and could have been prevented if Golapi was able to reach the hospital on time. It could have helped manage her condition of pre-eclampsia leading to separation of the placenta in the womb.
Socially, the reasons for still birth can be traced back to her pregnancy as an adolescent. Early pregnancies usually leave life-long impacts.
India committed to bring down stillbirth rate
“India has made considerable progress in reducing stillbirths in the past few years. It is heartening to see the high-level of political commitment and investment towards ending preventable stillbirth deaths in the country. Every stillborn baby is a tragedy. A vast majority of stillbirths can be prevented through a strong primary health care system. It is our joint responsibility to ensure that every woman is aware of, and adopts healthy behaviours and practices during pregnancy. It is critical that women receive timely access to skilled and quality care before and during childbirth,” says Dr. Yasmin Ali Haque, UNICEF India Representative.
Pre-existing health conditions, adolescent pregnancies, infections during pregnancy, high rates of anaemia among pregnant mothers, conditions like pre-eclampsia, inadequate access to quality services and poverty are some known factors that contribute to the high rate of stillbirths. A majority of the cases occur during delivery or during the last weeks of pregnancy. India has committed to reduce further the number of stillbirths, as part of its agenda to improve maternal and newborn health.[ii]
Arti Senapati, an auxiliary nurse midwife (ANM), who has helped countless women in rural Odisha to have safe pregnancies over the last 32 years, says, “I know of women who get to eat only rice with a small portion of onions, chillies or a few pieces of vegetables. Then there are those, who continue to do hard labour even during the advanced stage of pregnancy. Early marriages and frequent pregnancies also increase the risk of stillbirths.”
Over the three decades of her career, Arti has seen progress in the number of stillbirths coming down. “There have been several initiatives by the government and more women today are aware that they need to go to the local health worker during their pregnancy, take Iron Folic Acid supplements and take the mandatory immunization shots. I also see women wanting to report to the hospital before their due date,” she adds.
“Birth spacing to prevent frequent pregnancies also needs a bigger push. Women in tribal communities also need more support as they report several health issues during pregnancy,” Arti says.
UNICEF India is actively working with the government and civil society organizations to improve the quality of maternal and newborn services at health facilities and at the community level. These are being done through trainings, monitoring and mentoring of health staff, and focused programmes, specifically targeting remote areas and tribal populations.
Golapi, since, has undergone tubectomy. “I already have two children and do not want any more,” she says. While she may have reconciled with the difficult experience and does “not want to relive the trauma,” there are many women who can’t forego the memories of their pregnancy and the trauma of the loss of their child.
As an ANM and a mother herself, Arti understands the deep pain women undergo post stillbirth. She stresses on the need to be by the mother’s side and provide her and the family emotional support. “I remember a young tribal woman who lost her first child and was traumatized by the grief. I stayed in regular touch with her and counselled her. Later she gave birth to a healthy child,” she says.
[i] Stillbirth is an infant who has died in the womb having survived at least the first 28 weeks of pregnancy. A neonatal death occurs in the first 28 days.
[ii] India Newborn Action Plan 2014