Update: This case study was updated in November 2012
Kiran Rawat lives with her husband and 3 sons in a small village in the state of Madhya Pradesh, India.
With her home surrounded on all sides by fields of ripening crops, and a shiny new motorbike propped against a wall, Kiran seems comfortably off.
But until recently, she was missing a very valuable resource: knowledge of safe childbirth techniques. This all changed when she came into contact with a UK aid-supported scheme that provides health advice and safe deliveries to mothers.
The jewel in the crown of the scheme is the Janani Express - a fleet of specially equipped vehicles that take pregnant women to hospital round the clock and for no cost. The Janani Express played a decisive role in the birth of Kiran’s 10-month-old son Keshav. Keshav suffered birth asphyxia - one of the three principal causes of neo-natal deaths - and, were it not for the Express getting him swiftly to hospital, it is unlikely he would have survived.
Seeing the benefits
Throughout the ordeal, health worker Rekha Rawat was on hand to provide support to Kiran. Rekha has worked for the scheme for 4 years, going from village to village to raise awareness of the Janani Express and other services being provided, such as free immunisation.
“It can be hard to mobilise women to use these services,” says Rekha. “They don’t have a lot of time, and money is always tight. It makes me particularly satisfied when I can persuade them (to take up services) and they see the benefits for themselves.’
Rekha often forms close bonds with the women she helps - as she has with Kiran - and she also has the trust and respect of the local men. She is changing attitudes across the area towards hospital deliveries, and as Kiran can testify, helping to save lives.
Success breeds success
Safe delivery and newborn care means that 13 more infants per 1,000 now survive in the region. In a state where 37 percent of the population live in poverty, it was almost unheard of for women from the poor rural communities to give birth in hospital. Now the use of emergency and ambulance transport for pregnant mothers has increased from less than one percent of deliveries in 2006-07 to 40% today.
The Janani Express has now expanded, to capitalise on its early success:
- 748 vehicles are now available across the state, including in difficult-to-reach areas.
- a dedicated 46 call centres have been established in each district in the state. They ensure the women in remote tribal areas get to the nearest health facility, who they also alert in advance.
Facts and stats
The Janani Express and related maternity services are part of the Madhya Pradesh Health Sector Reform Programme.
In Madhya Pradesh, safe institutional births in health facilities have increased from half a million in 2005-06 to over 1.2 million in 2011/12.