Meghalaya in the news but how

Patricia Mukhim

The shocking (?) revelation by Dr Aman War, Meghalaya’s Director Health Services that at least 61 pregnant women and 877 newborns have died in Meghalaya in the four months starting from April this year for want of admission to hospitals and also due to lack of medical attention because of diversion of the health machinery to fight COVID-19 pandemic has jolted the consciousness of the nation. We should thank Dr War for bringing the focus on this crucial topic that has been the bane of Meghalaya for a long time. I am sure a number of webinars will be organised on the topic in the coming days because (a) the statistics debunk the fallacy that women in a matrilineal society are privileged (b) it gives the lie to claims that women here are far more empowered than their counterparts elsewhere.

But let’s take a look at the statistics to see if indeed there are sharp differences between the maternal and infant mortalities figures of last year and this year. The statistics below do not show too large a gap between 2019 and 2020. The differences in mortality of infants of 1-12 months and 0-12 months between 2019 and 2020 are indeed very worrying. The only saving grace is that this year between April to July immunization has gone up by 18%.

Source: Department of Health, Govt of Meghalaya, MCH

After Assam, Meghalaya has always had the highest maternal mortality And there are a combination of reasons for this, arising from socio-economic and cultural factors. Martin Luther Christian University (MLCU) in collaboration with the University of Amsterdam had conducted very intensive research into the reasons for high IMR and MMR and also organised several awareness campaigns across East Khasi Hills. Poverty in Meghalaya is a growing concern and women as single parents bear the worst brunt. Poor maternal nutrition (56% of women in child-bearing years are anemic, NFHS 4), result in poor health of the child in the mother’s womb and that child has very slim chances of survival.

NESFAS has done repeated studies on malnutrition in Meghalaya and the reasons for it. The tribes here are not known to be lactose tolerant. Many don’t drink milk or cannot afford milk and the alternatives to milk for the calcium needs of the body are not easily available either. Growing up we were told that colocasia or taro (ka shriew) provided bone health but that is fast going out of our palate and is being replaced by new foods that are perhaps not quite so nutritious.

The other day I met with a young mother of a four year old girl and now pregnant with twins. Her pallor was pale yellow indicating, even to the untrained eye, a case of severe anemia. She said she was having green vegetables and beetroot and was also having iron tablets. But perhaps it is the body that is unable to manufacture the much needed haemoglobin in the blood.  We are told that haemoglobin is necessary for transporting oxygen from the lungs to other tissues and organs of the body. We are also told that anaemia usually results from a nutritional deficiency of iron, folate, vitamin B12, etc. This type of anaemia is commonly referred to as iron-deficiency anaemia. Iron deficiency is the most widespread form of malnutrition in the world, affecting more than two billion people (Stolzfus and Dreyfuss, 1998). In India, anaemia affects 50 percent of the population (Seshadri, 1998). Anaemia may have detrimental effects on the health of women and children and may become an underlying cause of maternal mortality and peri-natal mortality. Anaemia also results in an increased risk of premature delivery and low birth weight (Seshadri, 1997). Early detection of anaemia can help to prevent complications related to pregnancy and delivery, as well as child development problems.

Even as young girls we would hear our mothers speak of anaemia (duna snam) and that doctors would prescribe along with iron tablets, boiled karela and its water (many find this too bitter) but again as the Khasis would say, “all nutritious food is not necessarily tasty. So take it or suffer the consequences.”

My involvement with the research team of MLCU helped me understand how unaware the average woman in the village is about maternal health. NFHS-2 had revealed that Meghalaya has the lowest knowledge about and lowest use of contraception. Hence multiple pregnancies with no spacing is the rule and not the exception. The low use of contraception is influenced by religion (every child is a gift of God. He knows how many children I need to have and I have to accept as many as God is willing to give). Blaming God is perhaps the easiest way to hide the religious underpinnings of a matrilineal society where women don’t enjoy reproductive rights. Woman after woman when asked why she is not using contraceptive has this to say. “If I ask the man to wear a condom, he disagrees (obviously there is not even a discussion of safe sex in the household and sex is just a form of entertainment. There is no need to think too much about the consequences – pregnancy). Some women said, if they make a song and dance about sex when a man wants to have sex, he might desert here and go to another woman. As it is there is a high rate of abandonment/divorce in Khasi society. We have not even begun to study the adverse consequences of having too many partners and a child or children from each partner.

The Khasi society is fairly liberal when it comes to marriage and co-habitation. There is no stigma attached to teenage pregnancies or out of wedlock pregnancies. One wonders if this is good or bad. But with the highest fertility rate in the country women in Meghalaya are dipping below the poverty line faster than they used to when the clan system and other community support systems could cushion the pangs of being abandoned with two to three children and the man not held accountable for maintenance of the abandoned wife and children.

The socio-economic caste census, 2011 found that 76% of rural Meghalaya is landless. In a society where land is supposedly held by the community or where land and property devolve through the youngest daughter, the above statistics reveal the irony of a matrilineal society. Today research shows that women do not own economic assets. It is not even left to the imagination to understand the plight of the average Khasi woman who is seen setting up makeshift stalls along the highways and each one is either a sole contributor to the family income or is an additional income earner.

Insofar as child health and mortality are concerned much has to do with the mother’s health and her ability to breastfeed the child or provide alternative nutritious food. Time was when infants a week or two old would be given mashed banana. Some mothers would give mashed rice with a little milk. Now how much nutrition there is in this kind of food given to infants is anybody’s guess. No wonder there is malnutrition and as a result stunting and non-development or slow development of the cognitive faculties. The cognitive domain includes mental processes of perception, memory, judgment, and reasoning. Is it any wonder then why a good number of us find mathematics and science so challenging? I would like to be proven wrong here.

It is a fact that we have to mend our socio-cultural practices to improve both maternal and infant mortality figures in Meghalaya. Schools really need to invest in sex education than just teach the three R’s. Pregnancy must be a conscious choice between husband and wife and not an accidental act. Before a child is born the parents have to be ready to take on the responsibilities. This of course requires a radical behavioural change. And that is where the role of peer educators and NGOs involved in training adolescent boys and girls comes in. Governments need to invest more in education outside the classroom and give that the importance it deserves.

And while MMR and IMR are seemingly health related matters they require interventions at several levels and by different stakeholders/departments coming together. So let’s not make this a ‘health only’ issue and therefore miss the woods for the trees. The society itself has to take responsibility to redefine women’s empowerment which should include in the main – Sexual and Reproductive Rights and Health.